reality check

I’ve still got blood on my shorts and shirt. It’s not mine. It’s dried now, looking a little less shocking. Talk about gaining perspective…

We came across a car wreckage on the side of the road about 20km from Aweil in Northern Bahr el Ghazal. The 5 or 6 passers by and 2 police officers that had gathered around had dragged the passengers into the shade of the shrubs alongside the wreckage and the road, and strewn up cloth to shade them from the sun. No one had done anything else for them and the crash had happened an hour and a half before. The first passenger had some bad scrapes, especially on his head, but the bleeding was subsiding. The second was in a similar situation but also with a broken upper arm. They were brothers.

The third was lying on his back struggling for air – it sounded like he had fluid in his chest. The first thing I noticed was his eyes: half open, vacant, cloudy. His left eye had a minute mound of orange dirt piled over the pupil. His right pupil had no shape. His arms held tightly to his chest. It was over 35 degrees and he was shivering. He was vacant but whimpered in pain when I tried to examine him. His pulse was strong and fast. His head was misshapen and spongy to the touch. What could I do for him?

The fourth was lying on his side in a semi-foetal position. He had an open fracture of his lower leg with a good portion of the bone protruding and was spilling bright red into a small growing pool at his feet. Small globules of fat reflected the sun’s light. It covered my hands as I tried to bandage him with a rag someone fetched for me. He couldn’t move for the pain in his hip, but he could talk. His jaw looked broken and the skin had been shaved off his hand.

The fifth, the driver, was completely unscathed.

20 or 30 km to Aweil. A dirt and bumpy road. Two would be ok but had sufficient reason to complain about pain. The guy with the leg breaks I was worried for because the bleeding wasn’t stopping. I expected the guy with the head injury to die at any moment. I dithered, remembering that one of the most damaging things you can do for a person is move them…. but reasoned that that’s when you have alternatives of ambulances and paramedics. Here they would definitely die. Picking them up, moving them to my truck, piling them in, bumping them over 20 or so Km would do some damage, but we should reach the hospital fairly soon… I hope. A local guy’s impression of near or far is completely relative.

We waved down 2 other cars and put three passengers amongst them, laying the guy with the broken legs on the floor of a minibus. I put the guy with the head injury in the back of my car on the floor. The driver, a now-terrified looking Darfuri, held his head. The police officers looked on.

10 minutes into the journey he was foaming at the mouth. We were killing him but there was nothing we could do. I couldn’t put him into another position, hold his head back, or do anything that would help. We kept driving. When I looked back the police officer had covered his face with the sheet we’d carried him into the car on. It’s a cold equation of life, I suppose. A head injury like this will kill you and no matter the intention, strength, clarity or desire of those nearby, there is nothing they can do for you. I cried.

Our small convoy pulled up at the police station and the driver was plucked out. We continued to the hospital and after a 5 minute verbal battle with an administrator, found out where we should take them. All were still alive, even the guy with the head injury! Revival or presumptuous declaration of death? I had little time to reason as my hands were full and bloodied by the guy with the leg injuries I was carrying. Me moved into a dark room with 2 shuttered windows lit by a single incandescent bulb. The last patient’s blood was still on the metal exam table, his blood-stained dressings 1/3 on the table, 1/3 on the floor and 1/3 in the open, plastic waste paper basket. Had I really done these guys a favour by brining them here? The single medical assistant present looked terrified and to the yelps of the patient, moved his leg around which bent in inhuman ways.

The bones grated. The blood stank. A number of spectators piled into the room. Amongst those who came in was a mild mannered, handsome, well-dressed northern doctor who shouted only at the medical assistant. He was very interested in my involvement with his patient and offered to let me reset the bones. Civility returned to situation, they found the patient some morphine and I accepted the offer. He was stitched, bandaged and plastered quite quickly and quite professionally, but I still I thanked God it wasn’t me.

I found the guy with the head injury next door with a small group and a small American doctor attending to him. His heartbeat was still strong and fast, but they were breathing for him. They said he had no chance. They were about to stop ventilation when I left.

Whilst the lack of emotion certainly helped in getting them patched and to the hospital, it also meant that I felt such little compassion as almost not to stop for them. I struck the right balance by accident this time. I hope I have the sense, and the heart, to consciously do it again if ever I have to. I hope that’s not anytime soon though.