Band-Aid for a Broken Leg E-Book

Damien Brown

• Herausgeber: Allen & Unwin
• Kategorie: Sachliteratur, Reportagen, Biografien
• Sprache: Englisch

Seitenzahl: 534

Veröffentlichungsjahr: 2017

Beschreibung

Damien Brown thinks he's ready when he arrives for his first posting with Medecins Sans Frontieres in Africa. But the town he's sent to is an isolated outpost of mud huts, surrounded by landmines; the hospital, for which he's to be the only doctor, is filled with malnourished children and conditions he's never seen; and the health workers - Angolan war veterans twice his age who speak no English - walk out on him following an altercation on his first shift. In the months that follow, Damien confronts these challenges all the while dealing with the social absurdities of living with only three other volunteers for company. The medical calamities pile up - leopard attacks, landmine explosions, performing surgery using tools cleaned on the fire - but as Damien's friendships with the local people evolve, his passion for the work grows. Written with great warmth and empathy, Band-Aid for a Broken Leg is a compassionate, deeply honest and often humorous account of life on the medical frontline in Angola, Mozambique and South Sudan. It is also a moving testimony to the work done by medical humanitarian groups and the remarkable, often eccentric people who work for them.

Leseprobe

DAMIEN BROWN

First published in Great Britain in 2013

Copyright © Damien Brown 2012

Text design by Lisa White All photographs by Damien Brown Maps by Brittany Britten

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher.

The moral right of Damien Brown to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act of 1988.

Allen & Unwin

c/o Atlantic Books

Ormond House

26-27 Boswell Street

London WC1N 3JZ

Phone: [phone]

Email: [email protected]

Web: www.allenandunwin.com/uk

A CIP catalogue record for this book is available from the British Library.

Paperback ISBN 978 1 74331 665 8

E-book ISBN 978 1 92557 532 3

Typeset in 11.5/16.5pt Minion by Midland Typesetters, Australia Printed and bound in Australia by Griffin Press

10 9 8 7 6 5 4 3 2 1

Dedicated to all thosewhose stories fill these pages.

‘Here, it is like this . . .’ —Dominga, our Angolan cook

CONTENTS

Author’s note

Maps

Africa

Mavinga compounds

Mavinga township

Nasir

1 The Edge of the World

2 The First Dance

3 O Novo Doctor

4 Confusão

5 Testimonials

6 Mavinga is Different

7 Bargaining for Body Parts

8 Fighting Cubans

9 What Appendix?

10 Sleeping Easy

11 Memorable Lines

12 Watching Storms

13 Guidelines for Abduction

14 Net Fishing on the Zambezi

15 Shooting Down the Runway

16 Evacuation

17 Week from Hell

18 Airborne Reminders

19 An Angry Clan

20 The Assassin

21 Catfish and Cow Dung

22 How You Gettin’ Home?

Selected Reading

Acknowledgements

AUTHOR’S NOTE

All incidents described in this book are true. The names of patients have been changed to protect their confidentiality, but many of the names of staff have been left unaltered. Like Toyota, for example. I couldn’t have come up with a name like that—not for a person.

This book was written in the months after the events took place, and as such all dialogue has been recreated to the best of my memory. Any errors or misquotations that could be attributed to characters in this book are purely mine, and mine alone. I bear full responsibility for any and all inaccuracies. While editorial constraints have meant that some minor scenes have been compressed, or combined, this was never done to alter the integrity of the account as a whole.

At the time of writing, I had no association with Médecins Sans Frontières, and it had no editorial input. My respect for the organisation remains high, but I hope this book will be seen neither as a specific endorsement of any one organisation, nor as a rebuke, but rather as what it was intended to be—a story about people, and of the difficult conditions they happen to live in.

1. 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 ishow 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.

‘You sure? Can you be sure?’

‘Yes.’

‘You saw the body?’

He nodded again. We’d have hoisted this man—this real-life Rambo!—into the air in celebration had he been in any state for it, but for the moment he needed treatment. Someone was going to have to debride and explore the wounds, trim away the dead, infected tissue at the edges of the lacerations, clean them, and make sure there were no deeper collections of pus. In the meantime we gave him antibiotics and the nurse wiped his wounds with antiseptic. Sofia drew up a dose of morphine to give in anticipation of further treatment, but the patient shook his head.

‘It’s only for the pain,’ she explained. ‘You’ll feel better for it, then we can clean those wounds properly.’

‘Thank you,’ he said, ‘but no. It has been two days already. Two days since I was attacked. I have been travelling since then . . . walking, lying in the bush, and now the pain is gone. I do not need that medicine.’

...

So began my first full morning, just hours ago. But for the moment we’re still debating the net. Still discussing the pros and cons of cheap mesh, although the conversation—as with every other exchange I’ve had out here—is in truth clumsier, far more circuitous, because it requires another expat to interpret for me: I can’t speak Portuguese. It’s no small issue. None of the Angolans I’ve met here speak English, and there’s no translator for hire. So for now Tim interprets, I stare confusedly, and Toyota waits patiently. Tim insists that we need to find something special to bring, and Toyota laughs.

‘Aqui?’—Here?—he asks. ‘Eh! Look around!’

We do. It’s a valid point. Suggestions to bring chocolate—we have a modest supply in the expat compound beside this tent—are met with equal disapproval. ‘You cannot bring something that many people have never seen,’ Toyota says, ‘and expect that the couple can keep this for themselves.’

‘Why not give money?’ I ask.

‘Even worse!’ laughs Toyota. ‘This they will spend on little things. Things like soap and salt, or maybe batteries for a torch. They will not save this money. And what special thing, as you say you would like to give, can they buy with it? You have seen our market?’

I have. It’s another valid point. Donated clothes and the goods Toyota mentioned account for most wares, so we continue to go in circles. Tim asks Toyota what he’d think if we arrived at his next wedding with only this net to give on behalf of the team, which clearly catches him off guard.

‘This?’ asks Toyota. ‘For me?’ He pauses, dissolving suddenly into laughter. Big whoops convulse his body, and whether he’s laughing with us or at us I can’t tell, but it’s so utterly infectious that we both succumb anyway. His teeth are perfect; perfect white teeth in a chiselled face, and his skin, flawless, has the complexion of everyone here—a colour utterly dark, blacker than black coffee. His body seems designed for laughing, and when he does it’s so loud and all-consuming and high-pitched and totally unexpected from his muscled physique that I don’t even know why we started anymore but we carry on anyway, just swept up with him. And this, I suspect, is the difficulty with Toyota: his face, although handsome, is a thoroughly mischievous one. It seems impossible to take what he says seriously.

‘Now listen,’ says Toyota, regaining his composure. ‘We can talk all afternoon like this, but I am serious about the mosquito net. I do not joke about it. It is a good gift for many reasons. For one, it will last them many years—these things do not fall apart. And even more important, it will protect them from malaria. And tell me, Doctor, is this not what we are all about? Keeping people healthy?’

I can’t argue.

‘So this is a gift that could even save their lives, this net that you laugh at?’

‘Well—’

‘It is! But I will tell you another truth,’ he says, motioning us closer. He lowers his voice to near-whisper as his eyes sparkle, giggling excitedly in anticipation of his own point. We’re now three boys huddled together in a locker room. ‘Tell me this, you two,’ he begins. ‘Where do people make love?’

We stare blankly at him.

‘It is in their beds, yes?’ he prompts.

We agree.

‘Of course it is! And now tell me this: where does this mosquito net hang?’

We shrug, unsure of his point.

‘Over the bed!’ he answers.

I still can’t see what he’s getting at. Neither can Tim.

‘So imagine!’ enthuses Toyota. ‘Imagine that when they are making love—tonight, tomorrow, all the days after this—it will be under this net. Under our gift. And for years to come, all of us with MSF here in Mavinga—we will be in their hearts whenever this couple make love!’

And so, only hours later, sticking closely to the two roads we’re cleared to use, we make our way to the wedding. With mosquito net in hand. And yet again I’m forced to concede how thoroughly lost I am. How am I to relate to, let alone live with, people from such a different world? How am I to supervise this entire hospital—this only hospital—on my own? And what exactly did I imagine I was going to achieve coming here, anyway? All questions that seemed infinitely easier to answer two days ago. But for the moment we arrive at the wedding venue itself; and here, I’m at last afforded some respite from these bigger issues by a more pressing one: the entire congregation— bride, groom, minister and a hundred guests—are waiting patiently, the wedding ceremony having been delayed, because we’re late.

2. THE FIRST DANCE

Five kinds of people end up in places like Mavinga, the saying goes. The five Ms: Medics, Missionaries, Mercenaries, Misfits and Madmen— sometimes even a few categories in the same person. Me? I’ll take Medic, if only by exclusion. As for Mad, not yet, although we’ll see what six months on call in Angola will do. Ditto Misfit. And as for Missionary or Mercenary? Not in any sane applications of the words.

It’s not quite clear to me how I’ve ended up volunteering, though. I can’t recall any precise moment of decision-making. But there is history. Born during the latter years of the apartheid era, I spent the first fourteen years of my life in Cape Town, South Africa; a privileged middle-class childhood, albeit one largely cocooned from the rest of my country by race laws and attendant Whites Only signs. The wider realities of the region did occasionally reveal themselves to me, however, such as when the sprawling shanty-towns—oceans of poverty in which millions of my fellow countrymen drowned, their homes cobbled together from scavenged materials—blurred past our car window. But these were only ever fleeting objects of curiosity as we travelled fast between two wealthy areas, which was largely my experience of Africa in those days: a series of glimpsed images, of momentary encounters and half-baked impressions that seemed deeply contradictory.

The real Africa was in my mind a pitiful place, a thing to be mourned. ‘Don’t you dare leave those vegetables on your plate,’ my grandmother would reprimand me, ‘because there are children starving all over this continent!’ Yet equally it seemed a place to be feared, avoided. Reports of violence filled the daily newspapers, while high-walled compounds and private security companies were the norm in many white areas. Nothing like life for those in the poorer black townships, though. Political unrest and police crackdowns resulted in numerous deaths there during those years, and gang-related crime was rampant; I’d heard it said that a girl growing up in these areas had a statistically greater chance of being raped than of learning to read.

But none of this directly affected my young life. For the most part such things happened there—outside the cities, in the townships, several of which could be seen from the sports fields of my school on a clear day but were as foreign to me as the favelas of Brazil. I never had black friends who could share their stories, and a state-controlled media and whites-only education system perpetuated my ignorance to a degree. Maybe I’m just making excuses; I did see street kids, ragged throngs of them begging in the city centre, or huddled from the cold of Cape winter mornings beneath sheets of newspaper, but I took this to be an inescapable fact of life on the continent. My overriding recollection of Africa is rather its profound appeal: stories of a childhood in rural Africa from my great-grandmother, whose two stuffed, mounted lions looked on from the corner of her lounge; hiking for weeks with my father along the rugged southern African coast, baboons climbing down the rock faces to rifle through our campsite for food; a family safari in Zululand, not far to the east of my grandfather’s farm, with leopards well-fed and at a safe distance; and the gentle nature and easy laugh of the few black Africans I did meet.

Amid increasing political tensions in the early 1990s, my family migrated to Australia, where I went on to study medicine. It was the obvious career decision for a seventeen-year-old who’d been fascinated by the surgical procedures of the nearby vet, and who harboured a vague notion of ‘helping’—maybe even of returning to Africa. But it wasn’t until my university years that I had my first close-up, if inadvertent, encounters with poverty.

Backpacking with borrowed money during lengthy semester breaks, I travelled widely. In Kathmandu streets, I came across leprosy sufferers who begged from pitifully makeshift wheelchairs—wooden trays fitted with furniture coasters—on my way to trek in the Himalayas. En route to tropical beaches, I met children and elderly people working the busy intersections of South American cities, selling rolls of toilet paper, individual boiled sweets, even just a lone apple; in a town in the Andes I chatted with a young woman selling string by the metre to support her unwell mother. Health care was too expensive for them to access, she told me: the medication they needed would cost thirty dollars a month. What pensions would be available for these people to claim? What access to health care? Another day, a group of street children approached me, selling finger puppets. ‘But mister,’ replied one little girl when I evasively showed her the two I’d previously purchased, ‘you have eight more fingers. You can buy eight more!’

And the only common denominators I could see in all this were opportunity and circumstance. That I was a medical student who spent time backpacking had more to do with the chance events of my birthplace and parents than any great effort or brilliance on my part: it could have been me staring into that car window from the edge of a shanty-town. So there was no religious compulsion, family pressure or career disillusionment behind my decision to volunteer. It wasn’t about escapism, though I’ll admit that the travel and cultural aspects of working in less-developed contexts were far from a deterrent. But I wanted to help. Or at least try, in some capacity.

Embarking on a whirlwind tour of duty in Australian hospitals after graduation, I gained as broad a range of medical experience as I could, rotating through various paediatric, obstetric, surgical, medical and emergency departments. After two years, I flew to Peru to study for a diploma in tropical medicine. A short stint volunteering in a clinic in Thailand followed—a brief but immensely rewarding experience. Mornings were filled by lengthy rounds in open-walled wards, treating Burmese refugees suffering from malaria, TB and HIV/AIDS, among other conditions. Many had crossed the border just to seek health care, fleeing ethnic persecution under a military regime that allocated only forty cents to each person in the annual health budget. In the afternoons I gave teaching sessions to the health workers, themselves Burmese refugees, who sat cross-legged for hours as I drew hearts and kidneys on the whiteboard, explaining the basics they’d never learned. And in the evenings I cycled past rice paddies to my teak guesthouse, where the neighbours were saffron-robed Buddhist monks, whose saffron-coloured laundry chequered the whitewashed monastery walls on sunny afternoons. Everything about the experience appealed to me, and I was sold. This work, I decided, was what I wanted to do with my life.

As for Angola? The position was the first to be proposed by MSF in the months following my application. It came at a good time; a new doctor had arrived at the Thai clinic, and the year I’d taken off for volunteer work was already halfway gone. Not knowing anything about Angola, though—such as where it was on a map—I called my parents.

‘The irony . . .’ Mum sobbed. ‘I mean, we migrate from southern Africa, end up in Australia . . . We have every opportunity here, everything! Landed with our bums in the butter, as your grandma used to say, and now you want to go back to the region? And to Angola of all places? Good heavens, child . . . Angola? Speak to your father about this . . .’ At which, a couple of octaves lower and with a thicker accent on a faulty cordless phone—

‘Ja, hello? What’s he . . . Angola? Shit! You know that I was there, don’t you? You know I got sent to the border there during their war, just on the Namibian side?’

This I only vaguely recalled. Dad’s stories of his conscription into the South African Defence Force seemed to revolve more around flipping truck tyres around compounds, dressed in full combat attire—punishment for having disrespected an officer, he’d joked— rather than any tales of battle per se, but by now there was again sobbing on the other phone because Mum had just remembered a high school friend.

‘Cliff! Oh my God . . . you know Cliffie was shot there? He was so young, such a nice guy . . . Shot dead near the border. Somewhere in the south, I think . . .’

—so I decided not to disclose that my posting was in fact near the border, and in the south, too. But, their initial shock aside, my parents were unfailingly supportive.

‘Just make sure you know exactly what you’re getting into,’ Dad cautioned.

Background reading revealed nothing reassuring: Angola had only recently emerged from a long, catastrophic, twenty-seven-year civil war. Images of Princess Diana touring minefields came up frequently during any internet search, outnumbered only by pictures of amputees and bombed-out buildings. Descriptions of the conflict and its aftermath were frightening. Far from any notions of a war with clear objectives and established fronts, a soldier recalled the confusion, as detailed in a book I came across, Ryszard Kapuscinski’s Another Dayof Life: ‘You can travel the whole country and come back alive,’ he’d said, ‘or you can die a metre from where you’re standing. There are no principles, no methods . . . Nobody knows where they really stand.’

The conflict began as an unfortunately common scenario of the era: a post-colonial scramble for the control of a newly autonomous country. Following Angola’s independence from Portugal in 1975, several armed liberation groups, previously united in their struggle against the colonial government, turned immediately on each other. Capitals were declared in different parts of the country, and fighting erupted; no one was going to relinquish control of this vast, diamond-and oil-rich nation. Two groups eventually emerged as the major protagonists: UNITA (The National Union for the Total Independence of Angola), and the Marxist MPLA (The People’s Movement for the Liberation of Angola), with other countries weighing in. The Soviet Union and Cuba supported the Marxist MPLA, the Cubans in particular sending tens of thousands of troops, while South Africa and the USA supported the opposing UNITA forces; these were, after all, Cold War years. And in the meantime, vast diamond and oil reserves helped fund the conflict’s perpetuation as foreign companies continued to trade with the belligerents.

Only in 2002 did the war end, following the assassination of the UNITA leader. By this time roughly a million people had died, four million had been displaced, and landmines littered thousands of square kilometres of roads and farms. Infrastructure and health care were almost nonexistent; an average parent of the day could have expected one in three of their children to die from malnutrition or disease.

This was the disaster into which MSF and other aid groups arrived to provide assistance, and Mavinga, the town I’d been offered a post in, was reputedly one of the worst affected areas. It had now been four years since the ceasefire although it sounded as if little progress had been made in town. Health care was still provided solely by MSF, and landmines remained problematic. There’d be no possibility of transferring patients, I was told, nor any prospect of moving outside our small security perimeter. Adding to the pitch, MSF were also dealing with a cholera outbreak along the coast, and an Ebola-like virus was killing more than ninety per cent of infected patients in the far north of the country. But, as I read on, with none of this particularly reassuring, it became clear anyway that there was no decision to make. I was in from the start. Because really, fuck it: one could talk about maybe trying to help, of doing something like this in the coming years—when the loans are paid off, when the Master’s degree is under the belt, or when a decent house deposit has been saved—and never actually make it happen. Now was the time. I was ready to roll up my sleeves.

Then I told my girlfriend.

And so, eight flights, two briefings, three continents and several teary goodbyes after leaving Australia, I sat, a single man, immersed in the intoxicating fumes of aviation gas and denial, bumping around in a charter plane. With no idea that the next day I’d be discussing the virtues of mosquito nets. And as we headed due east, leaving the Atlantic coast of West Africa behind us, I tried to correlate what I’d read with what I could see. It wasn’t so easy—the absence of landmarks mandated a little imagination. So I gazed to the right, due south across dry plains, and tried to picture my father standing sentry at a military compound on the nearby Namibian border almost twenty years ago. I looked to the left, due north, and tried to imagine the Congo River snaking past (the setting for Joseph Conrad’s famous novella, Heart Of Darkness, in which Kurtz speaks of ‘The horror! The horror!’) where it forms part of Angola’s border with the Democratic Republic of Congo. There was little chance of seeing the river, though—it was well over a thousand kilometres away. Ahead? Only scrub. Flatness. Nothing. Zambia lay somewhere beyond all that, but below us it was just more of the same: an endless khaki plain, with gnarled trees and knotty vegetation forming a balding covering that thinned as we headed towards the south-east corner of the country. An occasional sandy road was visible, but I could see no other evidence of settlement. Difficult then to comprehend that a war took place for three decades down there, because from above it looked so serene.

We began descending.

‘Already?’ I asked the pilot.

He nodded.

‘Where to?’

He gestured towards the horizon.

‘But where’s the town?’

He laughed. ‘There—’

Jesus, it’s nothing! Just mud huts! We descended quickly and soon made a low pass to check the dirt runway, a crowd of black faces gathering to watch all this, and as we came around and lined up to land I was forced to concede that despite my previous bluster regarding certainties, just getting on with it, I was actually quite nervous all of a sudden. I could see ‘grids’ cut into the bush around town—paths for the de-mining teams, the pilot explained—and there was the hospital, just beside the runway, and it was far bigger than what I expected, this town far smaller, and My God I was actually getting scared and maybe I wasn’t ready for this after all. And of all the things I could think of at that moment—the violence in South Africa, for example, and whether or not as a white man I was going to be safe in the middle of this war-torn piece of Africa—what was bizarrely worrying me most was the note I had seen in the aviation office at the hangar where we boarded the plane; the note that was written in bold red on the Important Information whiteboard of the pilot’s office. The words had caught my attention as the pilot stood metres away on a stepladder, fuelling the plane himself, the other end of the rubber hose dangling into a drum of avgas; it was a note that made my palms sweat and heart pound and head realise more than any of the documents I’d read that this was going to be another world, because really, where else would such words constitute the most vital piece of information for the pilot?

Mavinga—airstrip dry. Watch for stray dog.

...

If the wedding gift seemed unusual, the venue is no less so: a large metal shed, one of three, built to temporarily house refugees returning after the war. It’s one of only a dozen buildings in town not made from mud. A dozen intact buildings, that is. The foundations of a few brick structures still peer from the bush in places, but they’re bombed out, shelled, damaged beyond repair. A loose sprawl of huts accounts for most of what I see, their stick frames protruding like ribs through an emaciated mud-and-dung skin. The landscape—flat, dry, brown but for pockets of yellow grass and a defiantly green tree here and there—is broken only by a shallow river meandering past the southern end of town, along which women collect water and lethargic cattle graze. Gone, any resemblance to the Africa I’d known as a child.

We arrive at the shed door. All six of us volunteers—Andrea, a Swiss-German midwife; Pascal, an Italian logistician; Isabella, an Italian nurse; Sofia, a German doctor; Tim, the Swiss-French coordinator; and me. Tim’s the one carrying the mosquito net. He gets nudged in first, but he darts straight back out.

‘We’re late,’ he says, looking back confusedly.

‘What?’

‘Everyone’s already in there, standing quietly. Like they’re waiting for something.’

‘For us?’ asks Sofia.

This shouldn’t be. We’d arrived earlier at the scheduled time— five—only to be confronted by an almost empty shed. Only one person was inside, a man atop a wooden ladder, fixing a length of wiring to the roof. ‘Oh yes,’ he’d laughed. ‘The wedding is here. It is just late!’ He’d suggested that we try again later, although exactly when later was he couldn’t specify. We’d suggested eight. ‘Sure,’ he’d replied. ‘Eight is very good. It should definitely be starting then!’

It’s now seven-thirty. Ostensibly early, but a large group of Angolans are standing quietly beyond the entrance. They turn as we put our heads around the corner.

‘Hi,’ whispers Tim, in Portuguese. ‘Don’t bother moving—we’ll stay here.’

They move. Tim gestures frantically. ‘No, no,’ he says, ‘stay,’ but the crowd parts to create a corridor into the centre of the room. We can now see the bridal party, the emcee, the pastor. They see us.

‘Oh! Boa noite!’ exclaims the emcee—Good evening! ‘Ladies and gentlemen, it’s our expadriados! Please welcome them!’

A hundred-and-something faces turn to look.

‘Please, come to the front,’ calls the emcee. ‘We have been waiting for you. We would not want to begin without our friends from the hospital!’

Solemnly, deeply embarrassed, we follow Tim down this impromptu corridor. No one utters a word. Homemade paper-chains and a Fanta beachball dangle from the roof above, coloured fabric from the steel walls ahead. People press in and stare at us, although the fascination is mutual—for me at least. They’re remarkably handsome, the Angolans; lean, with strong bodies and equally strong faces, their coffee-complexions accentuated by chiselled jawlines, prominent cheekbones and dark, intense eyes. Definitely no office-type physiques in this room. Many of the younger women are utterly gorgeous, too; curvaceous with beautifully shaped hips, their long limbs slim and toned like an athlete’s, although this latter point is no surprise. Every woman I’ve seen during the day has been either carrying something—children, water, food or wood, often several of these simultaneously—or pounding grain.

We arrive at the centre of the room. A half-dozen plastic tables have been arranged around the bare concrete floor to create the ceremonial area, where the bride and groom are already standing. Waiting. Guests crowd closer, the women draped in ornately patterned traditional dresses in an explosion of colours—blues with pinks, reds against greens—their matching headscarves knotted elaborately to one side, although men wear a more eclectic range of Western garb: trousers with any combination of mismatching shirt, jacket and tie, two noteworthy items being a T-shirt advertising a Dublin plumbing company, and what looks suspiciously like a pair of pyjama pants. Clothes that were undoubtedly once donated.

‘Please, our expadriados,’ says the emcee, who’s making far too much of our arrival. ‘Come, take your seats!’ He leads us to a row of plastic chairs near the front—right next to the bridal party. The ceremony begins immediately.

The bride, who’s no older than sixteen, wears a traditional Western gown and is standing before the African pastor, staring ahead nervously. The groom is in his early twenties and wears a neat black suit, appearing equally anxious beside her. I can’t imagine where either of them got their outfits from out here. And I’d argue that this girl is far too young to be getting married, definitely too young to even contemplate motherhood and the risks of childbirth, but in a country where the median life expectancy is thirty-nine, and where a woman bears an average of six children, of which two will likely die before their fifth birthday, I imagine that people see little point in waiting.

The pastor speaks for an hour. Only the sound of a petrol generator drones in the background as it powers the bare bulbs above. No singing, no hymns, no laughter; it all seems remarkably austere. Not what I’d imagined of an African wedding. An arranged marriage, perhaps? The bride and groom stare solemnly at the floor and I see no stolen glances, no hand-holding, so maybe it is. But all of a sudden there’s applause: the couple are man and wife!

‘Senhoras e Senhores!’—Ladies and Gentlemen!—cries the emcee, bounding excitedly back to the centre. ‘Please, let us congratulate our new couple!’

Enthusiastic cheers follow an awkward kiss.

‘And now,’ declares the emcee, ‘our new couple will dance together. Please let us welcome them!’ He leads them to the centre of the shed as onlookers step back, then nods to the DJ in the corner. What follows is a marvel of improvisation: with the flick of a switch and jiggle of a connection, tape player, speakers and car battery unite instantly, unleashing a barrage of crackly sound. A high-pitched wail of a man’s voice fills the shed, the lyrics something about a man loving a wom . . .

Jesus, is this . . .?

It is! Mains electricity hasn’t made it out here, neither plumbed water, sanitation, telephones, nor a school with a roof—but this has? Michael Bolton? I’d laugh but the moment is so sincere, the two of them are enjoying their first dance, and maybe this wasn’t an arranged marriage after all because now the tension of the ceremony is over they’re embracing, they do look to be in love. And maybe Michael Bolton is the newest thing here because I suppose they missed his heyday during the war, missed everything—did they even have weddings at that time? Possibly—but loud music? There’s no way. This must surely be new, this celebrating and planning and doing what the rest of the world has been doing for the last three decades, without fear of another raid or conscription, or of starving to death like a thousand other Angolans on each of the worst days, or of being forced into the sexual servitude of a soldier three times your age as many girls were—

‘Okay, Senhoras e Senhores,’ chimes in the emcee over the second verse. ‘I would like to ask our special guests to come up here, to join for the first dance!’

There’s no way, I think, there’s absolutely no way I’m getting upthere to—but the emcee walks to our table and ushers me up, actually guides me by my elbow to the middle of the floor where he brings over one of the young flower girls to dance with me. And now he fetches my colleagues while a hundred pairs of eyes stare from around the room, fascinated by us foreigners—the only six in the entire region— as we begin to dance.

Michael Bolton finishes, which is fortunate: I’m not sure how to slow-dance with a six-year-old. But for this second song we’re blaming it on the boogie with the Jackson Five, so I hold her hands somewhere above her head, below mine, and we step side to side but embarrassingly she does it with more rhythm than I do. Tim nudges me as he bounces past with his partner—a big, voluptuous African aunt of a woman, the first overweight person I’ve seen in here—and Andrea sashays across the concrete, swept around by our sixty-year-old head of Outpatients, who’s really cutting up the floor—straight back, good rhythm, leading well despite his bookish appearance—but the rest of the shed stand transfixed. Children peer from between adults’ legs; adults gape; there’s nothing left to lose, so I go for broke—I pirouette my partner. The room laughs! She loves it, she giggles delightedly in her white frock and wants to go the other way, so we do. A round of applause this time!

‘Okay,’ calls the emcee. ‘Everyone, on the dance floor!’ And now people relax and this wedding is what it should be, and I’ve forgotten all about the hospital, all about those malnourished children and that leopard-attack survivor this morning, and I’m thrilled and excited to be here, and I imagine that this is what my life as an aid worker will be like from now on: gatherings on the weekends, events with the locals, beers, dinners—

‘Fat chance,’ laughs Tim, as we take seats at our undecorated plastic table. Fried pork knuckles and a handful of beers have been placed out for us. ‘You will be at work most of the time,’ he says, ‘and at home you will want to kill your colleagues within two months, because it’ll soon be just four of us. Sofia’s off on Monday and Isabella in a week, and the conversation will quickly run out.’

Pascal and I are unlikely to run out of conversation anytime soon, however. Unlikely to start one either. He speaks Portuguese but no English, I the opposite, so we just clink beers and exchange a few words and laugh. He at least looks to be an amicable guy, bearing no small resemblance to a young Che Guevara. As for Andrea, the new midwife, we seem to get on well, and I suspect she’s going to be very popular out here: attractive, easy laugh, and three male colleagues— all of us locked together in a small compound for six months.

Tim’s whisked back onto the dance floor. Sofia pulls up a chair beside me, grabs a pork knuckle and tells me I’ll settle in quickly— presuming I speak the language. ‘How on earth did they send you if you can’t speak Portuguese?’ she asks, and I tell her that I speak a little Spanish and squeezed in five hurried Portuguese lessons before I left. ‘But that’s not good enough,’ she replies. ‘You need to be conversational. What will you do on the wards? Who will translate?’

Questions not lost on me.

‘Tell me, Damien,’ she asks next. ‘Do you have a girlfriend?’

‘Until a week ago I did. Now, well . . .’

‘Because of this?’ she asks. ‘Because of this posting?’

‘This was the final straw, I guess, but there had been—’

‘You will absolutely get back with her!’ says Sofia. ‘You simply have to. Because out here there is little else to think about. You need someone to care about, Damien, a person to email in the evenings, because . . .’ and now her eyes mist up, ‘because the work out here can be . . .’ God, and now she’s flat out crying! ‘It can be difficult,’ she says. ‘The people, the . . . I’m sorry. Wait—I shouldn’t be saying this. I’m just tired . . . A patient of mine died two days ago, from eclampsia. I knew her well, and I’ve been up a few nights lately . . .’

I look for a tissue but see none. I instead see Tim waving on the dance floor, trying to get our attention as he gestures to the front, pointing to where the bride and groom are opening their small pile of gifts. I’d rather not watch. They’re standing together, going through each package, counting out cash when they find it, slowly, meticulously, and soon enough they get to ours. Too late to change it now. We even put our names on it! Gently, they peel open the pages of the Italian gossip magazine we used for wrapping, and see the net. They open the plastic and unfurl it, then check the paper. They look again at the net. Check the paper once more, look around at us, and we’re all thinking the same thing: bloody Toyota! Hopefully the couple will feel differently when they climb under it tonight, though—they fold it neatly enough, salvage the paper, and move on to their last gift.

Another dance, and we soon leave. We thank and congratulate a long line of relatives we’ve never met, and wave to those swaying to the Afro-Latin beats of Kisamba the DJ’s found on the radio, hips grinding ever closer under the tangerine orb of that Fanta beachball.

We stroll across the grassless soccer pitch, and as we do I’m forced to contemplate the effectiveness of finding and clearing landmines using trowels. Three thousand have been recovered from town this way—two hundred in just this central square—and walking on it now I wonder how certain they are that they got them all out.

But we survive the crossing. Along the moonlit, sandy main road we wander, talking and laughing, breathing in the smell of wood smoke from the hundreds of cooking fires burning earlier this evening; a camping trip, maybe. Yes! That’s what this is!—an adventurous weekend away with friends. One where you swap stories as you walk, and can see the night sky through the mortar holes in the town’s school building there; where you greet the guard who sits sentry outside your living compound, hunched alone over his fire for the long, cold night, then bury yourself under a pile of musty blankets and fall asleep to candlelight, a teach-yourself-Portuguese book on your lap; and where you get to wake up in a day’s time to make sense of, and somehow supervise, the most daunting, heartbreaking place you’ve ever walked into . . .

3. O NOVO DOCTOR

. . . because even this first patient after Sofia’s departure, just this morning, worries me greatly.

He lies feverish, a halo of sweat darkening the sheets around his young body. His family watch closely; mother and two brothers from where they share his single metal bed, father from the floor where he’s spent the night. They watch his chest rising slowly under a sheen of sweat, and they sponge him often with an old cloth. And they do it with such hopeful attention that they don’t react to the dozen of us crowding around.

‘How was he during the night?’ I ask, as the father shifts their belongings for us—pot, enamel bowls, a box of matches.

‘The same,’ replies one of the health workers. Isabella, the blue-eyed Italian nurse, translates for me. ‘He had some diarrhoea this morning, otherwise nothing. His parents say no change. He is not any better.’

‘And his fever?’

The health worker flicks through the chart. ‘It was down a little during the night,’ he says. ‘But now it is back up.’

The boy remains deeply comatose, unresponsive to any stimuli. His risk of dying from cerebral malaria, the condition we think he has, is significant. If that’s what he’s suffering from. It’s a presumptive diagnosis—a likely one given the incidence of malaria out here—but without further tests we can’t be one hundred per cent sure. The blood test that we have here for falciparum malaria, a plastic strip that looks and works not unlike a home pregnancy test, was positive in his case, although that in itself doesn’t confirm the cause of his coma. Either way, we’re treating him for severe malaria; the quinine infusion was started as soon as he arrived last night. I now pull out my tropical medicine handbook to re-check our dosages, making sure we’ve not forgotten anything. We haven’t. We’re doing everything—everything that we can do out here, that is, because consider the context: this boy is in Intensivo, our ‘intensive care ward’, which isn’t too different from any ordinary brick room. Four single metal beds crowd along one wall, a hazy fibreglass window opposite. His quinine infusion hangs from a nail on an improvised wooden stand, and there will be electricity for lighting for just four hours this evening when Pascal runs the generators. There’s little else. No machines, no oxygen, no electronic equipment—just a small cupboard with essential medicines. A little misleading then to call this Intensivo, I’d have thought, but the set-up means that patients can be watched more closely; two health workers will be able to concentrate on a maximum of four patients here, as opposed to the eight or more cases in each of the other rooms. Sofia assured me that’s a big advantage. And what then of referral to a bigger hospital—like one with oxygen? No chance. The only hospital larger than ours in this province is in the regional capital, Menongue—a run-down, former ivory trading centre that’s a two-day journey by road, and where the wards are even more poorly equipped. Flights too are out of the question. The little Cessna that MSF charters to fly us out here is a five- to ten-thousand-dollar round trip, even without medical equipment or nurses on board. There’s no guarantee, either, that the family will be able to afford the cost of treatment elsewhere.

So for now we continue with the quinine. And cross our fingers, because we’re this boy’s only option for medical care. A thought that frightens me.

‘His IV bag looks new,’ I note. ‘Has it just been changed?’

The health worker nods.

‘Great. So how much quinine are we giving him through it this morning then?’

He rustles through the patient’s papers. Along with eight other health workers, all men, he’s one of the clinicos—the seniors that work at a level somewhere between a doctor and the enfermeiras, the locally trained nurses. He says nothing.