Well
here we are, still in beautiful downtown Kigali and still in a (reasonably) sane
state of mind. Much of this can be attributed to the fact that our long leave is
looming but also most of us are having an interesting, if busy and challenging
time doing our respective jobs. We are still treating a large number of local
patients on a humanitarian basis and in fact they account for well over fifty
percent of our business. This is not a bad thing as it means we are exposed to
true third world medicine and it’s a great learning experience. It also brings
out the maternal instinct in many of us (although not this cold-hearted old
doctor) as many of our patients are kiddies and many of these are orphans from
the Mother Theresa Orphanage up the road. Back in April we discharged our long
term mascot, Missy who is an eleven year old mine victim. She was clomping up
and down the corridors on her new wooden leg during her last two weeks and was
an inspiration to all with her cheery grin. Just as well she left I suppose as
she was thrashing our FLGOFFs at pat-a-cake and learning some
"strine".
We had a major shake up of staff at the six week mark with
rotations occurring between the ward, ICU, CHK wards, RAP and CCP. This has
generally been a positive experience as most people appreciated the chance to
try something different.
The big news of course and the thing that’s put us on the
map again has been the carnage at Kibeho. Several RAAFies served down there and
some of these intense experiences are shared in this issue. That fateful day of
22 APR was really a turning point for this contingent and helped us all to
remember why we’re here. We all thank everyone who’s written since then - it’s
so nice to know you’re all thinking of us.
I hope you all read and enjoyed our first issue. This one is a double issue as,
due to work commitments, it’s been difficult to get this thing together. Many
of the other sections have contributed this time with a little of what’s
happening in their sections - EVAC, CHK, and pathology as well as many feature
articles.
Until next time, think of us as we climb our stairs, haul our
buckets, wipe away the HIV positive blood and float in a sea of pus.
Your Editor
SQNLDR Tracy Smart.
by The First CHK Mob
We arrived in downtown Kigali with eyes and mouth wide open!
With jetlag as our backpack and humour as our weapon we marched in to take over
from the first contingent of Centeral Hopital Kigali (CHK) Pioneers. We didn’t
realise the meaning of "Culture Shock" until we had handover, which
was brief due to our late arrival. (Thanks Tower Airlines!) The smile on their
faces said it all, it almost outshone our look of awe. Major Todd and her crew
could only be commended for their arduous efforts. After a week of
acclimatisation (and we don’t mean the weather) we realised there was no
looking back and proceeded to "take up where the others left off".
With FLTLT Robyn Green at the helm as OIC and CPL Margaret (Magrat)
Koimans as 2IC, the rest of us were dispatched to wards 1,2 and 7. Among our
tasks there was also manning of the specialist clinics. In Ward 1 we had our
sole Army rep LCPL "Bubbles" Brandon who set about learning the local
lingo to the amusement of locals and provided us with some comic relief. In Ward
2 we had both Magrat and LAC Hayden ("H") Cohen. As Magrat continually
had patients wanting to pass their babies off onto her, as they ran in the other
direction, we thought it wise to keep H close at hand in case her maternal
instincts overcame her. With H occupied instigating post-op care and trying
diligently to teach them the basics of English, he barely had a hand free.
Magrat meanwhile busily ran around taking African temperatures (hand on
forehead) and feverishly tried to "milk" the social workers to provide
for her patients, sometimes using radical sign language. In Ward 7, LAC Ross (I’m
the boss) Macdonald met his match in both 
stature
and temperament in "Fiery" Felician, head nurse. From medic to
plumber, Ross, Mr. Flexibility himself, soon got things happening (as in a water
supply) and was forever more thought of as a miracle worker. Also in Ward 7 was
LACW Tricia White who’s maternal instincts never left her. She may have left
her offspring at home but she soon became a mother figure to many, most notably
an 11 year old orphan called Donacien.
Ah! Let us not forget our fearless leader, Robyn, with her
biological time clock ticking away, who has become surrogate mother to our
mascot Billabong (his mother is dying in CHK).
We are now in the midst of handing over to our new team,
including FLTLT Connie Scott, CPL John Harvey and LACW Anne Croft. This is not
an easy task for any of us as we are beginning to see the positive effects of
our influence at CHK. All the best to the new team - we hope you enjoy the
experience as much as we did.
by CPL John Harvey
I first saw Missy in her hospital bed
Covered with skin flakes and patches of red;
Her right leg a stump, swinging in the breeze,
Her left leg was putrid and reeked of disease.
Her one good eye watched me, followed me around,
I talked and I talked but she didn’t make a sound,
Just looked at the ceiling, and then at the ground.
Days became weeks of painful attention;
Skin grafts and rolls, and games to break tension
Exercises for strength, too numerous to mention.
Missy now smiles, plays, does her homework,
To get her this far has been nothing but hard work.
But what of the future for little Musengimano,
In a country torn apart by war and plunder.
The mine that maimed her took her mother to God.
Her gran is the martyr who now sits by her bed,
Holding her closely, stroking her head.
Missy will leave us, her prosthesis in place.
She will go with her own kind to where I don’t know.
We will remember her laughter, the smile on her face,
The thought of sweet Missy will fill us with grace.
She will go with our blessings,
Her future unsure,
Our poor little Missy
A casualty of war
by FLTLT Kathleen Pyne
Below are excerpts from the diary of FLTLT Kathleen Pyne
describing some of her feelings about the tragedy that was Kibeho. Kathleen
served with FLTLT George Dohnalek, MO at Kibeho IDP camp from the day after the
massacre, 23 APR to 01 MAY, enduring both emotional and physical hardships. This
is her perspective.
22 APR 95. We are with Bravo Company, ZAMBATT at
Rwamiko, we being FLTLT George Dohnalek, MO and four Army members. We flew in by
helo in anticipation of relieving our other CCP. They have been at Kibeho for
four days amid many a casualty as people are being shot or macheted all through
the IDP camp..... We were on standby at the AUSMED Hospital to receive 11
casualties and were also on AME call to evacuate casualties however the helos
couldn’t land because of the gunfire. Next, we heard that we had 35 minutes to
pack to join the first team..... 5 to 7 days worth of nickers, socks and Wetones.....
We flew over the camp on the way in - lots of light blue tent structures in a
dirt pit. As we landed, crowds of filthy dirty and very poor looking locals
accumulated. How do they survive out here?? This is poverty at it’s worst....I
am sitting here with flak jacket, helmet and webbing on, weapon loaded at the
ready. This is quite daunting but exciting. May we emerge safely with memories
of an awesome experience.
23 APR 95. Where do I start? I have witnessed hell on
earth today. We had reveille at 0400 hours and deployed to Kibeho to set up the
CCP. It smelt strongly of death and filth - a scent we will never forget. As we
entered the ZAMBATT compound, wounded were already waiting. We assessed six who
we could do little for. If I write that they had gunshot or machete wounds it
would basically cover all of the injuries we saw today - about 80 or so. A few
visions are etched in my mind - a man face down in a puddle of water; a body
with a bullet in the head and a machete in hand; a mother and child looked up at
me from inside the toilet pit. Walking through the hospital there was nauseating
- the smell was strong and the injuries were horrendous. To look a severely
injured person in the eye and have to turn away without treating him is not an
easy thing to do...... We cannulated, dripped and dressed wounds all day. Many
children were wounded and many tiny babies were left as orphans. The shooting
could be heard intermittently and we would soon receive the casualty to patch up
and dispatch on cattle trucks to already overcrowded hospitals.
24 APR 95. It was an eerie feeling this morning as we
approached the refugee camp. Hardly any people could be seen, the bodies were
covered up and the NGO vehicles were evacuating the hospitals under the watchful
eye of the RPA. Others left on foot, some passing us, some seeking assistance -
we helped where we could. Two boys were asked if they had parents and their
reply was that their mother was the last of their family members and she was
shot last Thursday. My heart went out to them.
25 APR 95. We had an ANZAC parade under a glorious
sunrise. I was most proud to be chosen to read a prayer during our remembrance.
We prayed for peace - it seems bizarre in the situation we are in - and hope and
strength. We set up the CCP as usual this morning despite the objections of the
RPA. Occasional gunfire can still be heard but today has mainly been waiting in
anticipation of the worst.....We cannot and will not ever be able to accept what
we have seen, nor imagine how dreadful it must be to see your loved ones
slaughtered.
26 APR 95. One of the infantry guys told me that some of
the torturing and massacring has been done by women. I don’t know how and I
don’t know who to feel sorry for or who are the innocent except for the very
young children. At present we’re just waiting to see if we’re going to go
back to the camp.
27 APR 95. We did go back yesterday and personnel were
appalled at what they saw. Barely living amongst the dead and dying, there were
approximately 300 people (actually closer to 2,000 - Ed) in faeces, urine and
every type of excrement. The stench was overpowering. This is all a mockery to
human existence. We treated and evacuated 8 people by ambulance. I was in the
back with four of them and it took us four hours to reach Butare Hospital. The
stench in the back was notorious - I was wearing a mask and suffering from
hypoxia. Everyone stunk that night, of death and filth. The infantry guys and
others dug a mass grave for the forty or so dead bodies they dragged out of the
compound, bodies bloated and bursting, covered with fleas, lice, and any other
filthy insect or mite you could name. Like a scene from a Jewish Concentration
Camp they were loaded on to the back of a truck and dumped in the grave.
Hopefully they died quick deaths, merciful deaths for those living in this
devastating pit of suffering, this valley without tears. For tears must all be
gone, helplessly, hopelessly. In life they probably had little dignity in the
end - in death they certainly had none......I have no desire whatsoever to go
back to the IDP camp at Kibeho. Unfortunately I don’t have a choice.
Kathleen and George were at Kibeho for ten days in all. They
were joined by CPL Col Jenner, EVAC, and followed by other RAAF members -, FLTLT
Robyn Yeo in CCP3 and SQNLDR Tracy Smart, LACW Tricia White and LAC Ross
Macdonald in CCP4. For all of us it was a powerful experience although different
for each rotation. CCP4 was lucky enough to have the extremely positive
experience of assisting in moving nearly a thousand people from the camp and
watching the last people leave, but for all of us came the satisfaction that
although so many lost their life in this disaster, AUSMED members were on hand
and saved all up hundreds if not thousands of lives.
Although we could not all go to Kibeho to be first hand
witnesses, all in Med Coy contributed as back at the hospital we had six
casualties to deal with on the day of the massacre. Staff members worked long
hours due to the excessive workload and staff shortages, without complaint and
all acquitted themselves extremely well. All RAAFies can be proud to have
contributed to this operation.
Read more about the events leading up to this massacre and
our response on the Kibeho page.
LOST
One Teddy, answers to the name of
"RAAFie".
If found please contact the China Doll in the Orderly Room. Please - a
desperate mother!
(nb. Passport also missing therefore may have embarked on long leave somewhat
prematurely.)
by CPL Col Jenner
Deep down in the fetid bowels of ASC 2 lives the beast -
EVAC. Manned by the creatures your mother warned you about, spending their days
roaming the streets of Kigali, spreading fear among other road users, making use
of the rule "the bigger you are, the more right of way you have.
Dividing their time between the RAP AUSMED, RAP UNAMIR HQ and
on standby in the EVAC dungeon are such people as Paul "The Tongue"
Jordan, OIC, John "You talking to me, sucker" Church, Dominic
"Stuff ‘em" Boyle, George "Trooper X" Taulelei, Shane
"Get off the road, ya peanut" White and me, Col "Senna"
Jenner.
Each member, hand picked for their individual skills,
collectively they form a formidable force with no known peers and are referred
to throughout the contingent in hushed tones - "EVAC". Relentlessly
this force stamps it’s mark on Rwanda with their own special brand of
compassionate care for the suffering, broken forms of the unfortunate indigenous
folk who are swept into their care. The teams have had cases of all priority
levels ranging from PRI 3 ("I’ve got a bit of a cough") through PRI
2 ("You told me to come back if it got any worse") to PRI 1 ("Ooh
it hurts a bit").
Despite a crushing workload that would rob a normal man of
grace and dignity (they had some to start with? - Ed) this often flatulent crew
can be heard laughing rambunctiously deep within their lair, plotting the
downfall of the country itself or arguing over whose turn it is to make the tea.
Ever conscious of the "hearts and minds" attitude,
these highly disciplined crews fervently endeavour to avoid running through
puddles thus splashing innocent civilians, or over-revving engines to create a
toxic diesel smog. NOT!!!!!
Well
that’s all for now from the EVAC cave but always remember that famous EVAC
saying: "Never try to teach a pig to sing - you waste your time and annoy
the pig." Until next time,
Semper fi Rwanda
by FSGT Pete Matthey
Direct to you from the very hub of AUSMED Hospital here in
Kigali, in other words the actual area from where everything is generated,
anything from kicking butt, to praise and criticism, passing on gossip and
rumour, comes this months Wardmaster’s status report. Life is never dull and
boring here - all of a sudden we may get an urgent PRI 1 request for an AME to
Butare, and after we’ve told the OC, the team is off and racing, hastily
jumping into flying suits in the back of the ambo (or 110 - very interesting -
Ed). FLTLT (aka FSGT) George Dohnalek and the male medics don’t mind but we
have noticed it takes our resident NURSO from Edinburgh a long time to change
into her gear! They reach the Presidential Hangar and jump aboard the Canadian
Bell 412 and head off for the 30 minute trip to pick up our "PRI 1"
who has a fever and a sore leg and walks onto the chopper. But the scenery is
nice on the way down.
Back to the action area, CPL Lucy "China Doll" Wong
handles (literally speaking that is) all our admissions and discharges with
great zest, even to the point that I’ve noticed a few grey hairs popping up
here and there. Lucy is off to Amsterdam for her long leave on the 25th of May
for two weeks and is hanging out for that.
The Kibeho incident has seen us fairly busy with medical
teams deployed and the hospital receiving patients from the scene. The
experience of Rwanda will leave a lasting impression on everyone’s mind for a
long time.
We are all looking forward to long leave - I’ll be back
home on 16 Jun and believe me I think we’ll all enjoy the rest, not just from
the workload but because there’s been quite a lot of gastro among the Aussies,
some requiring drips to supplement.
From the Wardmaster’s desk, things have been hectic,
especially with a few AMEs and Resuses thrown in, plus just recently a bit of
theatre time. Lucy’s also been out and about, learning how to give injections,
trying her hand as a dental assistant and being a motherly type to the heaps of
kids we have on the ward.
Anyway, regards to all at home and see you soon.
by CPL Frank Alcantara
The alarm goes off at six,
It’s another day in Rwanda,
Time to get up
And go for a wander.
PT, coffee,
Doxy and breakfast,
What will the day bring?
I’ll try and make the best of it.
Bacteria and Malaria
Fixed on slides on demand,
Fixed in an instant
From blood, faeces and glands
The siren sounds
And it’s time for a RESUS
The stretcher teams arrive
What do they have for us?
MVA, gunshot
Amputation or illness
It’s time to get down
And start our business
Haemoglobins, crossmatches,
Electrolytes, blood gases
It’s gone past the stage
Where adrenaline rushes
The RAP sends medics
With yet more requests
The boss yells "Fill out the paperwork
Or we won’t do the test"
The evening arrives
And the day staff goes home
The on-call technician
Will do it alone
The days continue
With more of the same
And I remind myself
"This is why I came!"
Translation of Ancient Swahili Proverb
" Intense desire removes intelligence"
by FLTLT George Dohnalek
Well it may feel like eons, but we’ve only just reached
the reflection stage of our tour, however a definite routine has developed. My
adherence to some form of daily routine is part of my coping mechanism; it
serves as an attempt to create a sense of normality and a chance to recharge the
batteries that seem to drain as fast as the depleting supply of hairs on my
head. Therefore I will attempt to convey to you a day in the life of a warped
Rwandan medical officer.
My daily routine usually starts at about 0430 when I am
awoken by the sounds of the religious cleansing of hoards of Indian orifices.
The Indians who share the compound with us, ritually vomit, spit, or cough up
whatever evils they think they possess, at no less than 100 decibels of noise
intensity. In case you then are actually contemplating returning back to the
realms of unconsciousness, this is promptly aborted by the continuous Indian ‘rap’
music that pumps out through loudspeakers, consisting of sounds that could only
be made by a junkie with the worst case of haemorrhoids known to man. It is so
irritating, that I’m sure it is soon to be classified by the World Health
Organisation as a form of environmental warfare. If that doesn’t get to you
thanks to the advent of sedatives, then parade practice at 0500 will. Like
mating calls of desperate gorillas, our much loved UN counterparts try to outdo
each others bellowing of commands at ferocious repricosity. Okay so now you’re
awake - how selfish of me to not thank them for ensuring I wouldn’t be late
for work.
The morning next comes with the excitement of determining
whether the water is on, or whether showering will require juggling the
everfaithful bucket. Oh, and the morning just wouldn’t be complete without the
‘Ceremony of the Cistern’; a salute to manual flushing of the toilet. Whilst
other people are running around in a desperate attempt to find that elusive
creature known as physical fitness, I gently amble to the frontier post known as
the front security gate, and begin the task of looking ‘Hard’. Prior to
leaving Townsville, we were issued with explicit instructions to remain ‘Hard’
at all times, to make ourselves a less likely target. With a Godfather like
expression, I load my rifle, check my Army issued condom for serviceability, and
launch into the street. Occasionally, I am so hard it hurts.
The walk to the hospital, albeit short, reminds you vividly
that your not in Kigali attending summer camp; there’s no singsongs or holding
hands. From the road, a view across Kigali greets you, often clouded over by fog
or more commonly smoke from the not so modern Rwandan stoves. It’s usually
quite cool and crisp in the mornings, often wet from the previous evenings rain
which comes with remarkable frequency. This concept of rain more than once a
year took quite some convincing with me as each afternoon we receive Wagga’s
annual rainfall. To complicate my view of the world, I was shocked to discover
grass of the green variety, obviously a distant relative of the brown species
notably fighting for survival in my front yard back home.
The walk takes you past the Rwandan Patriotic Army’s (RPA)
training academy, heavily guarded by soldiers clad in the latest designs of
prosthetic footwear - Target’s rubber gumboot collection. The bright red or
yellow gumboots look particularly suave when worn with the green camouflage
safari suit number, obviously reserved for soldiers with a meticulous attention
to detail. In the early hours of the morning when the RPA head off on their
tribal jog through the streets of Kigali chanting such famous tunes as ‘Bring
out your dead’ and ‘The funeral march’, these gumboots provide excellent
visibility for oncoming cars, reflecting a country steeped in high standards of
occupational health and safety.
Often we are greeted by a friendly "Aussie go
home", or the acknowledgment of our presence by the traditional Rwandan
reverse nod. Initially we thought this action was a nervous twitch but realised
it must be obviously an anti-mosquito bite defensive mechanism, a remnant from
the days prior to the existence of mossie repellent. Once inside the AUSMED
gate, we swiftly unload our rifles, defying the temptation to kill and mame a
sandbag and be the winner of a US$1000 fine. A few have been overcome with the
desire to be winners and yet another bag bites the dust. They’re not that
difficult to miss.
After putting to bed our rifles into the lockable cupboards
(sometimes without our magazines even - Ed), it’s off to the ward where the
warm greetings flow thick and fast. "How about getting rid of some patients
today", I would be asked, with a friendly set of hands clasped around my
throat, rapidly depleting the supply of oxygen to my hair. That would complete
the doctor/nurse handover, and whilst I regain consciousness, a marathon session
of nursing handover would take place. Here the realm of medicine is redefined.
Like a stockmarket report in the news, critical patient details are conveyed to
the next round of nursing gladiators. The performance of each patient’s
orifices is tabulated, and gold stars awarded to those patients exceeding
excremental expectations.
My ward round is then ready to commence. With the aid of our
multilinguistic local interpreters, capable of translating such difficult
tongues as KinyaRwandan, French, American and British into English, we begin.
The toughest task is to distinguish the patients from their live-in carers, who
often look worse than the patients. Each day a different member of the family
assumes the carer role, and usually it is someone who wants free medical care
from us, or who needs a good feed, with food that doesn’t need to be to be
stapled to the plate to prevent it from running away. To aid with our
identification process we have concluded that those in the ward beds must be the
carers and those bunked out under the beds are the patients, but they have
obviously found a loop hole in our hypothesis and now everyone sleeps in the bed
together. Talk about a superior survival instinct!
As a UN hospital whose purpose is to treat UN patients
primarily, we have very little work on the wards. As an arm of the local
hospital, Centre Hospitaliare Kigali (CHK or CHUCK as we so fondly refer), we
are constantly inundated with the most amazing plethora of patients. The other
common source of patients, other than directly from the ‘Nothing Really is an
Emergency Department’ or ‘Rwandan Trial of Life Centre’, are the various
orphanages that are routinely visited by clucky individuals.
‘Shopping’ for the patients as it’s so fondly come to
be known, must go down as one of the all-time best blood sports available in
Kigali. This process usually is initiated with the ritual ringing of the bat
phone, which is linked internally to CHK. Through a combination of hand signals
given over the phone, an indication of need for help is assumed, and we usually
head off with our shopping trolley (four stretcher bearers) and a doctor, to see
what specials are being offered.
The thing that is initially apparent when you first arrive in
the CHK Emergency Department, is the lack of urgency displayed by their staff.
Often there would be patients lying in pools of blood, exsanguinating before our
eyes, and our first impression is we have found our next transfer. Not so,
because behind door no. 1 is our awaiting prize; usually a little low on life.
But wait, it’s two for one day at CHK, and there’s more.........you also
get.......The sale is on and our trolley is now overflowing. We have now learnt
from grotesque experience, that sight-seeing shopping tours over the wire in
casualty, don’t come without an expensive fee; more resuscitations; more
surgery; more admissions; more horrific photographs.
Our other common excuse for admission is the wonderful world
of tropical disease. Everything that flies, bites, burrows and crawls, carries
delicious bugs just waiting for a chance to feed on the human breeding grounds.
What a perfect culture medium the human species can make.
Malaria wins the contest for frequency. Basically, if you
have a fever, you have malaria. If you think it’s malaria, it is. If you don’t
think it’s malaria, it is. If you think you can’t think or are all thinked
out, then you yourself probably have malaria.
Occasionally, other organisms rear their ugly heads,
sometimes directly out of mouths of people. Several times patients have opened
their mouths to say Miraho (hello), and a friendly worm pokes its head out to
answer the question for them. One lucky Rwandan recipient was even made a proud
father after delivering not one, but several thousand bouncing baby worms by
caesarean section after several days in labour with stomach cramps.
In addition to worms, other animals have also been found on
patient safaris. It’s not unusual whilst examining someone’s ear, to find
ticks staring back at you, annoyed by the rude interruption to their voracious
feeding. Occasionally, you can be surprised by a small nest of ants in somebody’s
wound, forced to scatter as the hydrogen peroxide or betadine rain is
administered. But most often the animals are so small we need a microscope to
see them, and this is where we call in the great white path hunters from the
laboratory jungle. These yet unclassified or typed mutations of the human
species can usually be found knee deep in faecal, blood, or pus specimens,
tracking such elusive creatures as amoebas, malarial parasites, tetanic spores,
schistosomes, or any one of a variety of bacterial herds which they round up and
culture in little jar farms.
One of the most complicated processes to be handled on the
ward, would have to be communication to the vast varieties of peoples and
tongues and almost all dialects and languages inherent to Africa are covered by
the range of nations working under the UN umbrella. Subsequently, it’s common
place to strike a patient who speaks a language not covered by our interpreters.
In this case we use a chain of people, each capable of understanding two
different languages, and arrange them like a set of dominoes to create a flow of
information. What is actually said is anyone’s guess, but even simple
instructions can be misconstrued as we found out when we asked one fellow if he
had passed flatus to which he presently rolled over dropped his pants and let us
be witness to his answer. As the noxious truth hit our nostrils, we quickly
decided to leave questioning until the ill wind had passed.
After my daily working ward round, breakfast is usually in
full swing. The highlight has to be the ritual swallow of the doxycycline
tablet; our contraceptive from malarial parasite babies.
Immediately following breakfast, still trying to swallow the
tablet, it’s time to launch into the consultant ward round, to answer
questions that have plagued us since the previous one. Questions such as
"why did I leave a prosperous job and my Mercedes for this" and
"how many Frequent Flyer points will I earn on my way home", feature
heavily in the minds of our great consultants whilst reviewing the plight of our
ward patients. Despite these seemingly devastating ponderances, they
nevertheless still have the energy to save the lives of just so many patients
here, their obvious dedication to the maintenance of humanity featuring highly
in their minds. Everyday, this grand ritual of doctors and nurses moving from
patient to patient, offers each one at least some hope in the preservation of
life, and ultimately the returning of dignity to a devastated population. It is
a spectacle to be admired and instils a sense of self pride in me that will be
etched in my mind forever.
In contrast to the UN patients who are medevaced out of the
country if we cannot give them optimal treatment, what we provide for the
Rwandans is the best that they are going to receive; there is no next level.
After us they are left in the hands of God.
For most of our UN patients, our entourage is almost like a
morning parade as each patient due to their military discipline comes to some
form of attention, often not without it’s impracticalities. As a salute is
given, a drip pulls out; as a stand to attention is made, a patient falls over
forgetting about his recently amputated limb. These are the realities of a
military service hospital. Fortunately for the UN, the inpatient toll has been
minimal since our arrival, with tropical disease being the main cause of
hospitalisation.
Following grand rounds, routine procedural and investigative
duties become the order of the day, unless theatre lists are scheduled; which
recently has become a virtual daily occurrence. This presents me with an
opportunity to break the umbilical cord with the ward and traverse into the
serene world of the operating theatre, to assist with either the anaesthetic or
cutting end. The operating theatre, has been restored to a remarkable level of
function with theatre equipment imported from Australia. Alongside the AUSMED
operating theatre, a second theatre is available, which is used by the
ophthalmologist from CHK. You cannot help but be amazed by the extreme
differences in technical operation and standards of function. Imagine the
surgeon operating without gloves, but still sterile gowned. Its like having sex
with a full body condom only there’s a hole in it. Such is medicine in a third
world country.
The theatre lists consist of a large variety of cases,
ranging from those relating to war medicine (amputations, wound debridements,
etc), to those seen in most hospitals, and those specific only to third world
countries, due either to gross disease often presenting too late, or corrections
of the consequences of the genocide. Sometimes the injuries have been just so
horrific and devastating that they defy survival. Many of the patients have
managed to survive in the bush hiding with these wounds, often self treating
with local remedies such as laying dirt over wounds to stop them bleeding, and
voodoo type witchdoctor treatments involving the laying of tiny scars
strategically across their abdomens; likened to a form acupuncture.
On average, alternate days we receive a patient which needs
immediate resuscitation. These resuscitations are somewhat different to the
patient with a splinter or a twisted ankle which defines a resus at a Health
Services Flight; these patients are BND (bloody near death). The commonest
condition we see in these circumstances would be car vs human; currently the
cars are winning by an alarming margin. And no wonder when you realise that
there are virtually no road rules here. If you make it to your destination
without crashing you obviously got the rules right. There are no traffic lights
in operation; you must give way whilst actually on the roundabout; and when
approaching what you think is a speed hump, check it doesn’t have arms and
legs first. At night the last rule is hard to apply as everything is black, and
you often can only tell as the teeth pass over the bonnet, or the wheels tend to
spin for a moment.
After work, entertainment presents itself in the form of
writing letters, sleeping, jogging around our cell block, sleeping, drinking at
the mess, sleeping, or working at the hospital as the on-call sleeping slave.
Recently I’ve learnt to do multiple things at once in order to maximise my
spare time. I can now eat in my sleep whilst catheterised, and write letters on
the exercise trail whilst reading a book. Occasionally I forget to breathe but
always remember prior to entering a coma.
Then it’s off to bed where we sleep uninterrupted, that is
until the whole process begins yet again with the Indian belch, and dry reach of
a new day.
And so completes an outline of typical daily happenings in
the life of a medical officer, imprisoned in a small area of the world that time
and seemingly morality has forgotten. Thank god the Australian sense of humour
flows freely. Laughter is the best medicine for without it we all get sick.
[ Back to Top] [ Home ] [ Up ]
