dread the month of March. For reasons no one has ever properly explained to
me the department saw huge rises in the number of patients in this month.
All sorts of possible explanations were given as to why this was, all I knew
was that, at times the place resembled Dante's inferno, on a particularly
bad day.
Anyway, no one had warned me that the inevitable switch from sensible
February to mad March could plunge the project to levels of chaos and
disorder not seen since some of my GCSE coursework.
Things had started reasonably well. I returned from a nice break and hung
out in the TB program for a while, which was very chilled out indeed. Later
that week there had been a plan to do some outreach and see the guys in one
of the clinics for some much needed training and support.
There is a famous military saying that no plan survives first contact with
the enemy. This plan didn't even have time to put its boots on.
The dust swirled around the plane as the propeller whirred. As I stood on
the airstrip, having just disembarked I pulled my hat over my face and
crouched down to try and shield myself from the biting sand. The propeller
stopped, the sand and grit did not. We had landed into the middle of a
sandstorm. It lasted only a few moments but everything was covered in a fine
film of grit.
We had received a letter from the health worker that he had had a huge
increase in the cases of meningitis in the clinic. Another clinic had
reported that people had started pitching up from a village half way between
the two. Four people had died already, and sadly that number was to
quadruple before the end on the fortnight.
With me was not my usual outreach buddy (away doing a similar assessment
somewhere else) but a nurse from Denmark, Anne, with loads of experience in
this kind of misadventure and, being Scandinavian, impeccable English.
We landed at around lunchtime and, after throwing the tents down, we headed
into the clinic. We didn't leave until just past midnight. Enough critically
ill people to fill an average western intensive care unit, and all requiring
just that level of care, had it been available. It wasn't, the nearest they
had was me and another nurse and a group of utterly exhausted clinic staff.
We ran out of space in the huts and had to get one of the guards to drive
wooden posts into the rock hard ground outside so that we would have
something to hang the IV drips on. At sunset I looked out across the clinic.
A few small fires were burning as caretakers tried to sort an evening meal
for the patients. It was surreally peaceful.
I fell into the tent and slept with clothes shoes still in situ and
stethoscope round my neck. To be woken a few times during the night to sort
out various drips and, sadly, to confirm that another family had lost one of
its members.
The next day we organised a meeting of the chiefs. Well, if I'm being
strictly accurate, we gate crashed one that was already going on. As we sat
under the tree they told us their people were dying, we asked them to show
us where.
So the next morning I found myself walking out to an outlying village with
not only a chief but also a bulging medical bag and absolutely no idea what
we would find. The chief pointed, with a long stick he carried, to a hut.
'Two children are very sick in there' he said.
It was dark inside the hut. Shadows moved around in the dim light as my eyes
struggled to readjust to the sudden change from the glaring brightness of
outside. As I looked down there was the wizened face of an old woman (the
grandmother) kneeling over the lifeless bodies of two children. The younger
was three, the older eight. Without any further examination it was clear
what had happened.. meningitis. We carried the children outside and placed
them under a tree. Both were contorted with heads thrust back, rigid and
feverish, they were gurgling very ominously. We administered strong
antibiotics and organised for the chief to take them to the clinic.
My heart was now racing, how many more would there be in this village?
Thankfully the answer was none. After a few more hours of walking round the
village we returned to the clinic. The drama of the day wasn't over however.
It was about ten o'clock that evening, I had just managed a few spoonfuls of
pasta when one of the clinic staff appeared at the gate. There is a very
sick baby you have to see. I walked/trudged over to the clinic. The child
had a nasty case of pneumonia so I set about sorting out some antibiotics.
As I was sitting in the pharmacy a few shots rang out, reasonably close.
This is a fairly frequent occurrence here, mainly a result of a very heavily
armed population.
As I waked across from the pharmacy to where the child was sitting a few
more shots. All seemed to be aimed skywards. Very quickly after that a lot
more shooting, and this was not going into the air. Perhaps thirty seconds
later what can best be described as bursts of very loud, very close, machine
gun fire pierced the cool night air. At this point I abandoned my 'how to
give your child antibiotics' chat and opted instead to lie on the ground and
crawl, very slowly, to the relative safety of one of the huts. Five minutes
doesn't seem a very long time, I can assure any reader when there are very
hot bits of metal fizzing over your head it seems like an eternity.
After leaving a healthy fifteen minutes from the last shot I emerged from
the hut and looked for Anne. Thankfully she was fine and had much the same
experience as me, spending a good half an hour lying on the floor of the
kitchen. We opted to stay put and not try and walk to the other clinic or
back to base, often the worst things to do in these situations is to move
around drawing attention to yourself.
In the morning it was as if nothing had happened. Apparently the bullets had
been expended in the quest for the meat of a hyena. I'm yet to be convinced.
Not a single shot heard for the rest of the week. Maybe they had used up
that weeks ration.
The next evening I did what any sane mid twenties bloke would do, and rung
my mother. 'Keep your head down' was her sound advice. Obviously working in
an area of conflict these things are occasionally going to happen. However
not one of us, here or in the west, can wake up in the morning and say we
will see the evening with an absolute certainty. I could be in places much
more dangerous and the crucial difference here is that I'm not a target; I
can't say that of the place I call home, London.
And what of the two children with meningitis we had found in the village?
After a week of convulsions, antibiotics, and crossed fingers both children
walked home. In terms of a justification for being here, no more reason
needed. Next blog.....Vaccination.
Happy Easter all
