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Another world

One Sunday morning many, many years ago I sat in bible class at the church that we attended as kids. It was the middle of summer in Townsville, North Queensland. It was before air conditioning. The roof of the church hall was corrugated iron. It wasn't even 10 o'clock but you could have fried an egg on it.

Not the most conducive learning atmosphere for a teenage boy, but I was enthralled. This particular morning, we weren't engaged in a dissection of the New Testament. We had a visitor. A missionary surgeon – Dr Barry Hicks. He'd been in Ethiopia and he was regaling us with dissection tales of his own. The highlight for me came when he described draining an abscess in some poor fellow’s armpit that extended up around his ribcage and under his shoulder blade. This, by far, was the coolest story I’d ever heard in my life. An incision over the offending bubo (an actual medical term for a swelling over lymph nodes – again, cool as) let forth a stream of pus. Litres and litres of it – it all had to be drained. A hand was placed into the incision in order for the flow to be assisted. He described in some detail how you could feel this poor guys ribs through the gaping hole in his side. I hasten to repeat again that I still thought this was a very cool story. I’m sure that my eyes were the size of dinner plates as I hung on every word that came out of his mouth.

Then, a flash of movement. It was a slow flash to be sure. In fact it was as if time itself had slowed and I’m sure, in that heat, in that moment – THAT Sunday was destined to be a few seconds longer than the usual 24 hours. Out of the corner of my right eye I could see the minister’s son who had moments before been leaning back nonchalantly in his chair, falling at a rate of knots towards the wooden floorboards. His lights were on but NOONE was at home. The regaling of this tale of volumes of pus in the heat of a North Queensland summer had been enough for his brain to say “ENOUGH!!!! No more of this today – Thank you very much” and Elvis then promptly left the building. He hit the floorboards hard and there was blood. The pallor of his face contrasted superbly with the stark redness of the claret on the back of his head. Unfortunately, the story had to be delayed for a period of time until he was back with us on planet Earth. Nevertheless, in a short while we were back into the thick of it with Barry describing the many and varied cases that he had been involved in.

Many years later as a 4th year medical student my sister suggested that maybe I might be able to do an attachment with Barry as he’d come back to Townsville and was working as a general surgeon in private and public practice. I jumped at the chance and had the opportunity to follow him around much like a lap dog for a week. At the end of the week he mentioned that he was going back to Ethiopia and I glibly remarked that going to Ethiopia for my medical elective at the end of 5th year would be pretty cool. His reply – “Send me a letter once I get there.”

To cut a long story short - in December 1993 I found myself flying to Ethiopia via Zimbabwe for a 4 week elective that would blow my tiny brain. Fortunately, I was well and truly fitted with rose-coloured glasses on my first trip to Ethiopia. Through these glasses I was confronted with a fascinating spectacle of rare diseases, dramatic rescues, life-saving surgeries and the amazing power of the human body to heal. I worked with (or more accurately for) a man who was almost unstoppable – he had unparalleled physical stamina and a love for his fellow man (no matter what his colour or religion) that oozed from his pores. When I went back to rural Soddo, Ethiopia a few years later Barry hadn’t changed (except for the fact that he was a little tireder) but my experience was far more sobering. I had been working in a large public hospital in Australia for almost two years. I knew how things should be done. I had a good idea of who should live or die. I understood how important good nursing care was to patient outcomes. I worked with staff who actually cared about their patients. The situation on the wards of Soddo Hospital was a far cry from the “normal” of Mackay Base Hospital in Queensland. Don’t get me wrong – I still really enjoyed my time and it was one of the most rewarding experiences of my entire medical career but there was more than one time that I went home from the hospital and shed tears for those that were lost that day.

One weekend in Soddo, Barry and I went to the hospital on a Saturday to do a ward round. This was usually a fairly lengthy process as there were many patients to see and we were on occasion interrupted by the “emergency” department to go and check a patient down there. By the end of this particular round it was late morning and before we headed back home we were asked to see one last patient. This unfortunate fellow was on a trolley in the corridor and had been there since the night before when he’d been admitted to the hospital. He was lying quite still, looking a bit pasty with a blanket over the top of him. The story that we were presented with was that sometime in the recent past he’d been shot in the arm and the local “healer” had “treated” him. His family brought him to the hospital thinking that perhaps we could help as he didn’t seem to be improving. At this point the blanket was peeled back. An almost palpable wave of stench assaulted my olfactory organs to the point where I had to walk away. I barely have a sense of smell so you can imagine how bad it was for everyone else crowded around the bed.

Have you ever smelt something so vile that you thought you could actually taste it? My stomach was threatening to turn itself inside out. I took a breath or two and rejoined the team. Meanwhile, Barry had not batted an eyelid. He had continued to take a history and get to the bottom of this poor man’s troubles. It transpired that the bullet had shattered his humerus (the bone between the elbow and the shoulder) and had also managed to take out his brachial artery (the main blood vessel supplying the arm). As you can imagine this caused a great deal of blood to be splashed around and the treatment imposed by the healer was to tie a tourniquet around his arm. This no doubt saved the guys life (in the short term) but in no way was it ever going to save his arm (or his life in the long term). The limb that was revealed when the blanket was pulled away was a kaleidoscope of colours – green, purple, even black – but none of it was the light coffee coloured skin like the rest of his body. It was unclear as to when the injury had taken place but we were talking days, not hours. He’d been brought to the hospital quite unwell from blood loss and now infection was starting to set in. Despite this, no one the night before had bothered to put a drip in and give him antibiotics or fluids.

A plan was quickly made to amputate his arm. We departed the scene with Barry declaring that we were off to have some lunch and we’d be back in an hour or so to perform the surgery. I decided to forgo any substantial lunch as my small intestine was still stating quite strongly that it wished to exit my body via my mouth. However, I did take the opportunity to find some moth balls in a cupboard back in Barry’s house and I used these to rub on the inside of the surgical mask that I was going to wear in the afternoon. The smell of the moth balls was pungent to say the least but it was a darn sight more fragrant than the stench that I was about to experience.

On arriving in theatre in the afternoon we were confronted by a posse of relatives who remonstrated with Barry that something else should be done and were refusing to sign a consent.

“Give him some antibiotics” – No, it’s a waste of time.

“Wait a bit longer” – No, he will die.

Back and forth the discussion went until Barry stated quite bluntly – “Either I amputate his arm or you will need to take him back home with you.”

The reply was equally matter of fact – “Where do we sign?”

Once in theatre I was given one job – I was to be {trumpet fanfare} – the arm holder. Yes, my sole job was to hold the arm up by the hand as it was prepped with antiseptic and then removed. Now when tissue goes dead, bacteria start to grow in the tissues and under the skin and sometimes gas is released. This becomes trapped under the skin and you can feel it. Imagine if you will skin gaining the texture of bubble wrap. Mmmmmmmmm – that was what I felt as I stood on my tippy toes lifting this very heavy arm whilst the operation proceeded. The stench was quite unbelievable and I hope for all your sakes that you NEVER have to smell anything like it in your lifetime. The dead muscle was removed, the bone trimmed and the wound was closed. About a week later he went home with a massive grin on his face. I think I would have been happy to get rid of that stinking mess as well.

Another patient from Ethiopia remains vividly in my memory. He was in his mid 30's and he presented with a large cancerous growth on one of his legs. It was putrid. It had maggots wriggling about on the surface. He had lymph glands the size of golf balls in his groin. He was desperately emaciated. The skin on his face appeared as if it were applied directly to his cheekbones. We admitted him and the next day his leg was amputated. Postoperatively he was one of the happiest patients that I think I saw during my stay. He was so glad to be rid of the stinking mess that was once his leg. Over the next week he rapidly improved. The lymph glands in his groin disappeared. He put on weight - his face filled out. Then - about 8 days after the operation he became suddenly unwell. He was very short of breath and running a temperature. Within a few hours he was dead. I assume that he had a massive pulmonary embolus. I was just devastated. Could we have saved him in the first world? Did I do something wrong? I got hardly any sleep for nights. He was one of many who I met and treated and cared for and who affected me in a deep way.

One thing that struck me when working in Ethiopia was the proximity of death. It was just one of those things that was accepted as part of the day-to-day routine. We performed a caesarean section for one woman and the baby died shortly after delivery. I didn’t know what to do. I felt helpless, hopeless, lost. As I stood forlornly over the still lifeless form of this tiny baby one of the orderlies came in and placed it in a cardboard box. I was angry and I asked him why he would do this. “In Australia, most mothers still want to touch and hold their babies, even if they are dead,” I said. He replied very matter of factly “It will give her something to bury her baby in.” There was no arguing with that sort of logic and so I helped him wrap the baby in a sheet that had been used to wrap surgical instruments and he delivered it to the maternity ward. Very unlike here in the first world where death is not easily accepted. It's hidden. It's not discussed. People go to hospitals where someone else will deal with the reality of death.

Coming back from working in Ethiopia was the pits. After every trip to Africa that I’ve had I can honestly say that once safely ensconced in my tiny little flat I look around and think “I own a LOT of crap.” I would clear out and feel a bit better about myself for a while but slowly and surely I would find myself surrounded by STUFF – again!

Going back to work was worse. After seeing any number of unimaginably horrid injuries and cancers in Ethiopia I would at some point in time be confronted (usually in the emergency department) by some whinging, ungrateful, abusive time waster that I just wanted to punch in the nose. I wanted to scream at them. Tell them how good they had it, Show them photos. But I didn't.

So if there is a moral to this story it would be …….

Have gratitude.

Be thankful….

For having a sometimes slow-moving but nonetheless functional public health system that for the most part – gets the job done.

For having wonderful nurses who really do care for you and yours even though they may not necessarily do it with a smiling face when they’re run off their feet because of staffing shortages.

For having a life expectancy of 82 in Australia as opposed to 62 in Ethiopia (and 54 right next door in Somalia)

Stop moaning about how bad it is in Australia. We have it good and often forget that fact in our rush to be the best, the brightest, and the most beautiful. Our insatiable desire to be part of the “Me” generation has left most of the rest of the world destined to be a subplot in our drama filled, selfie documented lives. I was lucky enough to be transported to what seemed to be another world, an altered consciousness, a place where life was to be lived on the front line. Where what I did really (no REALLY) mattered.

So you might wonder why I’m not working in some far flung country in the grimy midst of a refugee camp. The niceties of practising medicine in private health seem so distant from what I had envisioned in my dim, distant past. A “career” in MSF or the Red Cross once seemed a distinct possibility. Life – got in the way. Love – made it all worthwhile and so, for now, sponsoring a World Vision child and giving financial support to Barry and his wife help assuage an irrational sense of guilt. I think I’m one of the fortunate ones. I’ve seen the other side. I KNOW how blessed we ALL are even though the majority will never truly recognise that fact.

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