Saturday, September 27, 2008
I wrote this during our first month in Mabaruma. It was a time of great frustration and little sleep. Many things changed for the better since I wrote it.
Last night was not an example of Mabaruma Hospital at its finest.
We had just got back from dinner at the house of a very kind family from Canada who have upped sticks to live in Mabaruma and run a little yellow Cessna plane for emergency ‘med-evac’. On the way home we had dropped in on the boys at the little bar next to our house, where every evening from 6 to 11 (the hours of electricity supply) they play deafeningly loud soca and drink ‘high wine’- 70% distilled rum. We paid for some sugar we had borrowed a few days earlier and had a chat to the owner, Sion, who was a bit plastered, as were the others. They seemed gentle and kind, and in a boozey way, were sorrowful for the loss of past American occupants of our house. One of them, Fred, kept wanting to shake our hand and mumble something drunken and friendly.
Later in bed we heard a little scuffle outside and a knock on our door followed soon after. It was Fred’s sister. Could the Doctor come please? Fred had been in a fight. My first reaction - perhaps to my discredit - was anger. It had been a long working day, and we were just drifting off to sleep through the Soca beats. Whereas with a ‘genuine’ emergency I feel a sense of duty toward a patient, when it is the result of a fight it seems so stupidly avoidable that resentment is difficult to resist. Perhaps I should have expected some form of disturbance, it being pay-day; the whole town was on the razzle, and just like any town in the UK on a Friday night, trouble was fairly predictable.
As I walked with Fred’s sister she told me what had happened: Fred had got really drunk, and had left his phone on a seat outside the tiny shack that Sion serves from. He’d popped over the road for something, then staggered back only to find the boys had hid it as a prank. A fight ensued, and Sion, perhaps still feeling emotional about his long lost friends, had taken to him with a long iron bar.
In the hospital I asked where the on-duty Medex was. There are two, one living 5 minutes from the hospital, the other much closer, just opposite me. It turned out the closer Medex was actually Fred’s uncle, and that in a moment of familial synchrony he was “so drunk he doesn’t know himself, Doctor”. That left me with the improbably named Nurse Herod to patch up Fred’s head.
Fred was in the treatment room. It looked like a scene from Sweeney Todd: the whole of his upper body was covered in drying dark blood, with quick little streams of brighter fresh red running on to the floor from a big bump on his head. He had lost the use of his left arm which had a small gash just above the elbow. He was writhing around on the bed splattering blood on the floor, walls and everyone near him. His family stood around looking worried and there was a big-bicepped policeman present who had attended to the scene with a rifle slung on his shoulder. Strangely given the circumstances it was the rifle that unsettled me the most.
My mild irritation at the start of the episode progressed to disbelief and anger over the next 20 minutes. I was here as an unpaid volunteer, not to replace anyone, but to add capacity. With Medex drunk, I was in effect covering for his alcohol problem – “how ‘charitable’ of me”, I thought. Nurse Herod showed off her credentials as the worst Nurse I have ever worked with by doing nothing but yap to her friends on her cellphone instead of helping as any sensible person would do- to find a suture set, or get some anaesthetic. With (blunt) suture finally finding its way into Fred’s scalp, she commanded me to stop - it was two minutes to eleven and the electricity was about to be turned off. I was half way through the first of what needed to be about 15 stitches and having disturbed the clot on Fred’s head, blood was starting to pour out again.
“What about the hospital generator?”
“Porter not here, me can’t turn it on without he”
Pay day: the Hospital Porter was legless at home, too.
In an unusual moment of inspiration Nurse Herod called the men at the generator plant to ask for an extension. I was leaning over the patient for 2 minutes in suspense before she looked glumly at me and said: “They never answer, generator too noisy.”
The lights went out. I was still attached to Fred via the black suture when a boy turned up with a battery-operated strip light. We decided to continue with that until, just as we got Fred to cooperate by turning his head the right way, the battery ran out. Next up was the oil lamp, and in its Dickensian glow we tried to fumble around with the stitch. The lamp started to sizzle whoever’s hands were holding it, and the heat it emanated was adding to my discomfort. Fred was wriggling again. It was a lost cause.
We downed tools and Nurse Herod cursed at Fred for cursing. He started flicking excess blood off his face onto the floor. Most of his family huddled in the doorway.
I asked Nurse Herod to do a pressure bandage on his head to stem the flow until it was daylight and he was sober. She left the room and made a call without doing the dressing. Fred continued to bleed.
I took a mental step back to summarise the situation: no Medex, no Porter, no Nurse, no light; blunt needles, drunk patient, blood everywhere.
The lovely, and very rotund Nurse Phillips arrived with bed hair. She smiled and squeezed my nose. Straight away she dressed the wound, winding the elastic bandage round and round Fred’s head and chin with like she was waving an imaginary wand, and as if by magic it was all over.
But it wasn’t, because the Policeman had been doing a bit of thinking too, and now he suddenly grabbed Fred’s arm where the gash was, where his humerus had probably been fractured. He demanded Fred keep still, which seemed strange because every time he squeezed Fred’s arm, he fell around the bed in even greater agony, as if electrocuted. It struck me as very sinister that the Policeman had noticed so keenly the extent of Fred’s apparently minor arm injury. Fred screamed out. The Policeman’s arm sleeves were rolled high up his arms. “I’ll show you pain, boy”, he said, and squeezed harder.
“Beddy-byes”, giggled Nurse Phillips. I felt bewildered about what I was seeing and unclear what it meant. Perhaps the policeman was helping the nursing staff to ensure Fred would stay in his bed for the night. In his drunken state he clearly wouldn’t though. Fred’s mother said “Tie he to the bed, make sure he no move”. In retrospect that would have been far less harmful than what was happening. Feeling tired, powerless and confused in a strange country, I obediently wandered into the star-speckled darkness hearing Fred’s screams and kicks getting quieter. I lay in bed for a good hour afterwards reflecting on an evening, which had begun with an act of humanity and ended in torture.