South Sudan’s recent appearance in the news prompted me to post this series recounting my experience operating on the Nile riverbank in 2007.
The operating room is better known as the operating theatre in most of the English-speaking world. Cool, huh? Room is pretty boring. Wouldn't we all prefer to perform in a theatre, perhaps in a ruffled shirt and cape a la Shakespeare?
Lo, suffering patient, have bullets rent thine flesh? Tell me, then, where thou most hurtest?
War surgery and orthopedics were both out of my usual scope of practice. So, I was improvising - because that's what you do when you're the only doc in hundreds of miles.
You reach in the exit wound and push the muscle around, far from the shattered proximal humerus (different patient).
Between cases, I sit drinking water, trying to dry the sweat out of my scrubs. A nurse comes into the OR tent. She’s never been in here before. She looks serious.
Have you heard of the problem in the maternity ward? she asks.
I came to inform you.
The C-section from last night. Her husband just came onto the ward. He is very angry. He says he did not give permission for her surgery.
Consent? The patient gave consent. We saved her baby.
I know that, and you know that. But I wanted to inform you…Anyway, it has been difficult to explain to the husband.
I’ll come explain it, after the next case.
Perhaps you had better not, she says.
The husband is drunk and carrying a large stick. There are two other men with him. They were threatening people in the maternity ward and asking for the doctor who cut his wife.
The scrub assistant, John, then appears. He tells me not to worry, that the man’s anger will pass. His manner is truly comforting, as he understands the situation – the context – better than I. He also knows that Akot, the nurse in charge of the operating theater, is taking care of business in a culturally-appropriate way.
Akot and John have been at my side working long hours at local wages in the operating theater. They never complain, though we operate at the pace of a visiting surgeon trying to finish as much work as possible in a sea of surgical candidates. They are proud of their work.
Akot is almost fifty. I don’t know how he became such a phenomenal nurse since nearly all his adult life was spent as a soldier in a civil war. But I am glad that this nurse is acting as a warrior on my behalf. I learn later that Akot, catching wind of the drunk, stick-wielding, doctor-hunting trio, marched alone to the maternity ward, disarmed the men, called them stupid and ungrateful in front of all the new mothers and babies, and shoved them out the hospital gate. He returned, wordless, to finish the day’s operating schedule.
After a couple of local gunfire incidents (see upcoming missives) Bor Town was put under curfew. No activity in the streets sundown till sunrise. Hospital employees were being beaten on their way to work. A soldier who didn’t speak the local language would stop a nurse in dawn light, they would exchange useless words, and a rifle butt would break the language barrier.
This put some pressure on the operating schedule toward the end of the day. I’d squeeze in a quick case in the afternoon, we’d run into some snag (no sterile gauze, blood donor has wandered off, etc.) and now I’m sewing like Betsy Ross on the Third of July. Getting home, for me, was a matter of darting across one dirt road. But that road was seeing more and more boots every day, and the OR staff had much farther to walk.
I had grown accustomed to late planes. Nearly every one leaving Bor was delayed – cows on the landing strip, mud on the departure strip, plane needed elsewhere to transport a patient, etc. So I made rounds again, then cracked a beer. Our chief logistician, a jolly Congolese man of limited English, found me drinking at lunchtime and asked about my plane. I explained the situation at our headquarters.
The instability is, is, is…It is coming, said the man from the Congo.