Band-Aid for a Broken Leg

by Damien Brown

  ‘Darfur?’ cried Mum on the other line. ‘My God, child! Do you know what all this worrying does to the two of us? We—’

  ‘No, not Darfur!’ I cut them off. ‘Darfur is entirely different. It’s another part of Sudan altogether. I’m going to the south, Ma—the south! The south is at peace now. It’s safe,’ I said, making arguably the most optimistic assessment of the situation there in decades. That it had been the scene of Africa’s longest-running civil war they didn’t need to know, nor that skirmishes were still occurring over oil. The point to stress was that a peace agreement had been signed in 2005, now three years ago. So I reiterated this. And promised, as has been the obligation since I left school and no matter where in the world I am, to call every Sunday night.

  As for why I’d take this position barely three months after the Somalia tragedy, I’ll admit that frustration played a part. This was the only position available to me, and returning home wasn’t an option; I’d set aside the year at least for volunteering, and so far had spent three months mostly in cars, briefings or guesthouses. The prospect of seeing this region for myself was no deterrent, either. The projects here are considered by many the quintessential MSF experience: isolated, with difficult conditions and high workloads—much of which I’d coped with in Mavinga. The downside is that clan fighting does still occur, although I was assured that expats aren’t being targeted, and that my posting is well away from the volatile north–south border. So I took the job—barely a week ago. Since then I’ve left Africa, been debriefed in Geneva, re-briefed in Amsterdam, and flown back to the continent, transiting through Kenya once again.

  Something’s buzzing in the cockpit. The pilot removes his headset and retrieves a satellite phone handset from the dashboard. He listens for a moment and shouts into it, then makes a radio call.

  ‘WE’RE GOING TO DIVERT,’ he yells, turning back to face us.

  ‘OH?’

  ‘THERE’S A PATIENT,’ he shouts, pointing to nothing in particular out the window. ‘IN ANOTHER TOWN. THEY WANT US TO PICK HIM UP.’

  I give him the thumbs up: a detour is just fine with me. This view is incomparable, and between my fellow passenger’s commentary and the briefing documents on my lap, there’s more than enough to keep me occupied.

  It’s now almost two hours since we left. We continue to fly north, no clouds and the visibility must be hundreds of kilometres. I scan the map in my package, and from what I can tell, Ethiopia is not far to our east, beyond which lies Somalia. To our west is the Sudanese province of Darfur, where a small, under-funded African Union deployment is currently trying to monitor the conflict that exploded three years ago, patrolling a region the size of Spain. And further west of Darfur lie Chad and the Central African Republic, also regions of conflict, as too is the Democratic Republic of Congo, to our south-west. By any measure, this is a troubled part of the world.

  As for Sudan’s two civil wars (and the conflict in Darfur, to a degree), the origins lie in the divide between the Muslim Arabs of the north and the animist and Christian ‘Africans’ of the south.

  For thousands of years, African southerners were captured and sold by Arab slave traders, with clashes also occurring over access to the more fertile cattle-grazing lands of the south. For the most part, though, the two groups remained separate; even during the colonial period, the joint British–Egyptian administration managed the regions distinctly, promoting Christianity in the south but not the north, and requiring permits for travel between the two halves.

  In 1956, following Sudan’s independence, the country became united under a government dominated by northerners. Arabic was declared the official language, and Sharia, or Muslim law—a code that in its strictest interpretations allows for severe penalties such as amputations, stonings and lashings for violations of religious precepts—was imposed on all, causing extreme resentment in the south. A resistance movement was formed by southerners, and what followed was the first of two civil wars.

  After seventeen years of fighting, a decade-long truce was called during the 1970s, but the north gradually re-exerted their control. Increasing clashes occurred over the vast oil and water reserves of the south, and by 1983 a second civil war was underway—this one lasting twenty-two years. What resulted was the largest number of deaths from any conflict since World War II—two million people—and the displacement of four million others.

  In 2005, after what had been thirty-nine years of fighting over the past five decades, a peace agreement ostensibly ended the conflict. The south was granted autonomy, and a referendum has been scheduled to determine whether it will become an independent nation.* In the interim, a UN peacekeeping mission is monitoring the region. But the peace is a precarious one. Large oil reserves are positioned along the disputed north–south border, and, with oil accounting for more than half of Sudan’s income, create a compelling reason for neither side to concede any territory.

  My colleague’s yelling again. ‘MAURICE—HE SAYS THAT THE NUER ARE STRONG FIGHTERS, THAT THEY HAVE ALWAYS FOUGHT OFF OUTSIDERS.’

  ‘YEAH?’

  ‘OUI. THEY ARE BEAUTIFUL PEOPLE. BUT FOR EXPATS WHO ARE NOT USED TO THEM, THEY CAN BE A LITTLE . . . DIFFICILE.’

  ‘GREAT,’ I yell. ‘DIFFICILE IS MY SPECIALTY’—and I think of trying to get the team into the car in Mozambique.

  ‘AND MAURICE, HE ALWAYS SAYS THAT IF YOU GET A LITTLE, YOU KNOW, FRUSTRÉ WITH THEM, THAT YOU MUST REMEMBER THAT THEY HAVE ONLY EVER MET WHITE PEOPLE IN ONE CAPACITÉ. AS PEOPLE THAT GIVE AID. AS PEOPLE THAT ARE RICH, AND THAT HAND OUT THINGS.’

  ‘YES?’

  ‘OUI—MAURICE SAYS ALWAYS REMEMBER THIS, OKAY? DO NOT GET TOO FRUSTRÉ WITH THEM. MANY PEOPLE DO, BUT THE SUDANESE ARE JUST LOOKING OUT FOR THEIR OWN. LIKE THEY HAD TO DO IN THE WAR. THEY ARE WONDERFUL PEOPLE, BUT TOUGH. VERY TOUGH.’

  I know a veiled warning when I hear one. I heed the advice.

  We’re beginning our descent. I turn my attention back out the window, where a thin cover of dry scrub and low trees has appeared below, skirting quickly closer. My colleague points out some features and tells me that Maurice had spent some time in this village.

  ‘THIS MAURICE GUY SOUNDS REALLY FASCINATING,’ I say. ‘IS HE STILL WITH MSF? WILL I MEET HIM OUT HERE?’ I ask, in reply to which two furrows embed themselves deeply on the forehead of my colleague, his face now one of mild incredulity. Because Maurice, as he explains—

  ‘C’est moi!’

  —Is he!

  Appears then that Maurice, the fountain of knowledge and experience that he is, is also a proponent of the third person as mode of self-reference. And I love this quirk. I love talking with him even more now, and I love the cultural and linguistic fruit salad that these projects invariably turn out to be. People from improbably different backgrounds just lumped together in these insane conditions, often with no common language, living on top of each other as they try to find that happy medium somewhere between sleeping together and arguing over the definition of glass. A more fascinating sociological experiment can’t possibly have been contrived.

  ‘BUCKLE UP!’ yells the pilot, turning to face us. ‘WE’LL TOUCH DOWN QUICKLY. WE’RE NOT GETTING OUT OF THE PLANE.’

  I give him the thumbs up. Maurice thinks this is a little unusual, though—we usually get out and meet the team, he says, say hi to our neighbours—but it’s soon apparent why because WHUMP! we hit the dirt runway and taxi to the end, fast, engine still revving and armed men blurring past my passenger window—heavily armed men with automatic rifles slung over their shoulders. We come to an abrupt halt at the end of the runway, and a woman in a white MSF T-shirt comes to the side door as the engine cries its decelerating whine. She opens it from the outside and doesn’t introduce herself.

  ‘GET THIS GUY ON QUICKLY,’ she yells, pointing to a man lying on a stretcher below a nearby tree. ‘THERE ARE OTHERS LOOKING TO GET HIM.’

  But there are armed guys all over this airstrip already.

  ‘THEY’RE POLICE, AND H
IS CLAN,’ she says. ‘THE OTHERS AREN’T. SO LET’S HURRY UP!’

  The pilot climbs over his chair and begins removing the half-dozen passenger seats anchored to the floor. He folds and stows them behind the mesh stays at the back of the small cabin. A group of black men in MSF T-shirts lift the patient onto the plane’s floor, and I quickly examine him. He’s young, late teens or early twenties, conscious and moaning, and a hundred flies are feeding on the blood-soaked bandages adhering to his chest and neck. The engine slows and I ask the team on the ground what happened.

  ‘Shot,’ replies the woman in the MSF T-shirt. ‘But come—let’s get going!’

  ‘Does he have a pneumothorax?’

  ‘What?’

  ‘His lung—is it punctured?’

  ‘I’m not a doctor.’

  ‘Has a doctor seen him?’

  ‘No. She’s out. Sick. They flew her to Kenya for a few days.’

  We can’t take off with him if he’s got an air leak around his lung. He could decompensate during the flight for reasons of both time and the reduced air pressure up there, although pottering around to stabilise him on the airstrip while armed clansmen mill about doesn’t seem ideal.

  I climb to the back of the plane and quickly rummage through my bag to retrieve my stethoscope, then peel off his bandages. The entry wound is clearly on his back near his left shoulder blade, the exit wound on the left side of his neck. Small bubbles of blood gurgle at both sites with each breath. His lung’s certainly punctured. He’s likely also lost a lot of blood, and he isn’t breathing well. Trying to resuscitate him mid-flight would be almost impossible.

  ‘I just need a couple of things,’ I say.

  ‘Let’s go,’ says the pilot, climbing back to his seat. He immediately begins resetting for take-off. ‘Come, let’s go.’

  Debbie, an Australian midwife in this project, offers to quickly fetch what I need. She runs off and returns with a large needle and several syringes and climbs into the back of the plane with me. I ask the pilot to hang on another minute. The procedure is quick, and we can finish it during the flight.

  One of the Sudanese men in an MSF T-shirt explains to the patient what’s about to happen. The patient grimaces. I wipe his skin clean and inject a small amount of local anaesthetic, then insert a large-bore IV catheter between two ribs at the front upper portion of his left chest wall—a simple, relatively safe procedure that allows the leaking blood and air to drain rather than build up dangerously around his lungs. I aspirate repeated syringes of blood and air via the cannula.

  The pilot revs the engine. Debbie climbs out. We’ll meet one day for beers in Sydney, we agree. Maurice reboards and sits beside the pilot, and the patient’s mother looks decidedly uncertain about getting in although finally does. She refuses a seat and kneels beside her son, and we promptly turn and accelerate quickly down the bumpy runway as blurred images of men with guns alternate with beautiful images of huts and African scrub through the windows.

  In no time we’re up, climbing—Jesus, these flights are bumpy in these warm air currents!—and I continue to aspirate on the syringe every few minutes and keep an eye on the patient’s breathing, and I think, What a welcome to South Sudan, this flight: me, a man shot in the back, his elderly mum, and more flies than a bad Australian summer, all bundled into the back of a bumpy plane, barrelling towards God Knows What through these beautiful skies where kites and hawks ride the thermals to almost the same altitude as our plane.

  And I’ve been in this country just three hours.

  • • •

  We land in the town of Nasir barely half an hour later. The team are waiting for us on the runway. The patient is loaded into the back of a LandCruiser and immediately whisked to the hospital, the surgeon at his side. Maurice, myself and the pilot meanwhile wait for the car to return, standing in the shade of a wing, the three of us saying little as we look around. The scene is telling enough.

  Not far from us, at the end of the dirt airstrip, the wreckage of a crashed plane rests on its belly, partially embedded into the nearer bank of the broad, muddy river that cuts past the runway’s edge. A cautionary landing beacon, I’d imagine, and now an apparent play centre: a group of kids call to us as they bounce the intact wing.

  Closer to our right side, a dozen people have gathered in the shade beneath a small clutch of trees. It’s sorry respite from a sun that’s bearing down with malicious intensity—a sun that will burn this region to fifty-degree-afternoons and beyond in coming months, Maurice tells me, and that prompted the Nuer to name the month of February simply ‘Fire’—but it’s some respite, nonetheless.

  Three of those under the tree are Sudanese soldiers, looking bored as they recline with shirts unbuttoned, their hands behind heads. Rifles rest beside them. There’s much excited chatter among the other handful of adults nearby, though; all are missing a limb, or part thereof, and they’re pointing at the small collection of prostheses that the pilot is unloading and stacking gently beside my backpack. Forget where you are and you’d almost think he was an intrepid mannequin salesman doing the rounds with his samples—samples here including a replacement foot, a lower leg, a lower leg and thigh, and a leg with a red running shoe—but I imagine that prostheses are not uncommon here. These ones were custom built by Red Cross technicians in Juba, the South Sudanese capital, and are now ready to be fitted to these patients at the MSF hospital.

  As for the landscape, it’s as stark as the flight in had suggested. An unrelentingly flat plain of cracked, grey-brown clay, unbroken by even the smallest of rises, merging with the sky somewhere in an indistinct, hazy horizon. The river punches a twenty-metre wide channel through it as it courses west, though I see few other natural features. Looking south across the water: four trees, some cattle, a handful of huts. To the north, the town itself arcs back from the river for a few hundred metres, then thins, dissolving into the heat haze; it’s along this nearer bank that things are concentrated. At the eastern end is the market, and beyond that the high fence of the UN Peacekeepers’ compound. To the west is the MSF hospital and far beyond that a military compound, though I can see neither clearly from here. For the most part there’s just a loose cluster of straw homes; everything in browns, almost no green; no cars nearby but several bicycles; and plenty of cattle—big, lyre-horned white and brown beasts, being watched over by young men, several of whom have guns slung conspicuously over their shoulders.

  The LandCruiser returns. I farewell Maurice and clamber in with our gear and the amputees. We head west, no need to stick to any tracks as we drive because the ground here is smoother than any African road I’ve seen anyway, and the huts are clustered in small kraals that are spaced well apart from each other.

  After a couple of minutes we arrive at two steel gates set into a high straw fence, above which the organisation’s flag flies. Two guards wave us in. Through a flourish of colourful dresses and scantily clad children we nudge slowly ahead, passing between the collection of old brick hospital buildings, stopping finally at a second straw fence in the back corner. A small gate leads through it, and into the expat compound—what’s to be my new home for eight months.

  • • •

  For much of the afternoon I’m given a tour by Zoe, the Belgian coordinator of the project. She shows me my bedroom (a scorching mud hut, haunted by a smell I can’t quite place), and takes me through the hospital (busy, and crowded). She points out the two fleshy black light bulbs in our brick house (bats, sleeping for the day) and casually mentions the Safe Room (where I’m to run to if I hear gunshots). And as we cross the dusty compound to the next building, all I keep thinking is that Tim was right: Mavinga was a paradise. But it’s always too much to take in at once, these first sights, so for the moment I don’t even try. I just shake hands, ponder new faces and this utterly foreign language, and revel in the state of joyous confusion that arriving in the field is: a sensory overload of the highest order, almost as if standing on a new planet.

  Nasir />
  In the evening the expats gather at the long wooden table beside our house. It’s a large group—ten of us altogether—with a forty-year age range, and representing five continents and seven first languages. Half of the group sleep in the brick house behind us, the rest in the mud huts scattered around the yard.

  The sun sets although it’s no cooler for it. As soon as the generator kicks in, Amos, a garrulous Kenyan water engineer, bolts for the common room to watch a DVD, while Carol, a Colombian midwife in her late fifties, heads to the kitchen to make a batch of porridge. She’s done with the spaghetti and chickpeas we’ve been served, she says. The rest of us stay at the table: Zoe, the coordinator; Heidi, a German nurse on her first assignment, and in whom I recognise that same excited but slightly bewildered look I’d worn on arrival in Mavinga; Anwar, the gently-spoken Indonesian log; Paul, a sixty-year-old logistician from New Zealand, also on his first mission; Maya, an immaculately dressed administrator from Uganda; Steffi, the somewhat brusque Austrian doctor I’m replacing; Ben, a quiet Kenyan laboratory technician; and Marina, a talkative Italian surgeon, who requests that the next time I arrive in a project I please bring cheese and wine, rather than a man shot in the neck.

  After dinner I take a cold shower, then retreat to my little hut. Not that there’s much point in freshening up, though; on getting into bed I adhere immediately to the sheets in a lather of sweat, and contemplate once again the ungodly smell in here. By any standards this is a simple compound—an ugly, dusty, insect-riddled space—but here’s the conclusion I’ve come to: none of this detracts from the experience. It is half of the experience. Few volunteers lament it. Nor the missed weddings at home, the lost income, or the fact that one’s worldly possessions are squashed into a dozen boxes stashed in a storage unit, the stale smell of which evokes an assurance of being single for the foreseeable future. Not that I’m suggesting there aren’t trade-offs to volunteering. There are. Plenty. It’s just that they pale into insignificance at times like this; like when lying in bed with the river gurgling on one side, kids fooling in the hospital yard on the other and streaks of moonlight dappling the floor of the hut, and then falling asleep with the knowledge that tomorrow you’ll get to work in one of the most fascinating, challenging, inaccessible environments on the planet.