Tuesday, June 10, 2014

As I watch the Arabs flying by on the racehorses at the outdoor hippodrome near Abeche in Eastern Chad my mind quickly drifts back to the strange events that led up to my being here in this moment in time...

In November, when I was on a trip to evaluate the Adventist Hospital in Batouri, Cameroon, I received word that Olen's Uncle Scott wouldn't be going to the Koza Adventist Hospital in Northern Cameroon after all.  It appears that the extremist group, Boko Haram, from Nigeria crossed the border, kidnapped a French priest in Koza and took him back to Nigeria as a hostage.  Scott and his wife Bekki no longer felt it was safe to go to Koza.  Many emails and adjustments later, Scott and Bekki found themselves in Moundou near the beginning of January and Sarah and I found ourselves preparing to leave Moundou and move permanently to Abeche, near the Sudanese border.

After working for a month with Scott in Moundou, I got up one morning to drive to Abeche to start the preparations for moving out there.  That morning, I suddenly decided to drive the ambulance out there instead of our Vanagon. I drove to N'Djamena on Tuesday and participated in an AHI board meeting that evening.  At the meeting, when I told one of the board members that I was thinking of passing through Ati on my way to Abeche, he said I'd never find the route on my own, but I should wait and caravan up with the ADRA truck which would be leaving late in the morning Wednesday. 

The road to Ati and then on to Oum Hadjar on Thursday left me exhausted and the ambulance a little beat up.  I was accompanied by a friend named Abraham.  We lost a hubcap, the speaker for the siren and horn, and some pieces of old antennas on the roof that got ripped out trying to park the ambulance at night in a closed compound with a gate just one inch too low.

Friday, after meeting with the mayor and local health authorities, Abraham and I went to meet a British woman named Jill who has been working with a literacy program for the local nomads for years.  Sarah put me in contact with her.  Friday afternoon, as we sat around chatting on the mats, a friend of Jill's, Abunaga, came to visit with his son.  He had some property for sale and heard I was interested.  He was on his way to Mangalme but told me he'd be back Monday or Tuesday if I was still around.  I assured him I would be and we parted ways.

Saturday Abraham and I went to Abougoudam to visit the village where the dome hospital is in the long process of being built.  We slept next to the quad dome which will eventually be the OR and woke up Sunday morning to a group of people waiting around to see me.  They heard that a doctor was there and so I spent the morning seeing over 50 patients in the back of the ambulance, doing ultrasounds, referring for surgery and passing out meds. Meanwhile, Abraham discussed with the locals all that would be needed to plaster the domes using a local plaster mad of clay, sand and animal dung.

Saturday and Sunday, Abunaga called several times with us eventually setting up a meeting with him in Abeche around 3pm.  When the time came, we called him and he told us he would be on a horse by the side of the road.  We found Abunaga on top of a beautiful Sudanese Arabian stallion.  He thought we were also immediately interested in a horse and offered to sell us this one for $2000.

"Sorry," I told him in Arabic. "We're not currently interested in a horse, just land."

"No problem, " Abunaga replied. "I'll meet you tomorrow at 7am here.  I can't show you any property now because I'm taking this horse over to the races."

"When are the races and where?" asked Abraham.

"Four in the afternoon," Abunage informed us and then went on to explain where they were.

Abraham and I returned to our friends' house in Abeche where two youths agreed to take us to where the racetrack was.  We filled up with a little diesel and then wound our way through the brick-making yard on the outskirts of town just past the university.  The road twisted and turned through a wadi filled with piles of bricks in various stages of development: from piles of manure to men mixing the clay and manure to pits covered with tarps and filled with water from workers slapping the mix into molds to young guys lining them up to dry to others carrying piles between two of them on a litter up to the ones stacking them in square pyramids for firing with round palm nuggets used for fuel.  I felt I was back in Egypt during the period of the Israelite captivity and slavery.

Finally, we got to the outskirts of the brickyard and found the traces of a 1200m track with a wall on one side and a sort of bleachers with brick and cement benches covered with a tarp haphazardly attached over some twisted sticks. I parked the ambulance under the shade of a large tree in the middle of the track and we march back to the bleachers.

So I find myself watching the first race of 8 horses and jockeys fly by the stands and round the corner out of sight.  One horse takes the initial lead and never gives it up, winning easily by 5 lengths.  As the second batch of horses lines up for the next and final race, one of the announcers calls Abraham over where he consults with some of the organizers of the event.  The next thing I know, the MC is thanking me over the load speaker for bringing the ambulance to help them in case of injuries.  I wave to the crowd as they clap and Abraham tells me that they'd like to have a permanent relationship with me and the ambulance and that maybe I can drive it behind the racehorses so that if a jockey takes a tumble and is injured i can dress his wounds and/or take him to the hospital.

The second group of 5 horses and jockeys trots off the the left to the starting line.  Four of the horses line up but the fifth jockey can't get his horse back on the track into the lineup.  Finally, the turbaned arab officiating just waves the white towel in front of us and the four horses blast off at full gallop soon passing right in front of us.  I'm filming them with my phone just until they all but disappear around the bend in a cloud of dust.  As I pull my eyes of the phone's screen I see the fifth horse has finally made it on the track and the jockey is whipping it mercilessly as he desperately tries to catch the pack.  Just past us he gets too close to the mound of earth marking the interior border of the track and his horse stumbles, taking him down and rolling over him.  The horse quickly gets up and trots off.  The jockey lies there motionless.  Everyone is stunned and immobilized for a split second then people start breaking off the stands and running towards the fallen hero.

I feel since they just announced that I'm a doctor and have the ambulance there for them that I should do something so I jog over as best I can in a long, flowing Arab robe.  By the time I get there, the man is squeezed in a mass of humanity.  I manage to push my way through in time to see someone has grabbed him  by the neck and his pulling and jerking his head upwards with one hand under the chin.  His arms are flailing and he has a crazed, dazed look in his eyes.  I try to get them to put him down and give him some air but the place has gone crazy with 10 different people saying 10 different things and doing 10 different maneuvers.  I finally give up as the dust is starting to choke me from the mob.

Finally a morbidly obese man pushes through on one side and grabs the injured man's legs while a skinny guy pushes through from the other side threatening to stab anyone who gets in his way and with the help of a few other hands they grapple the man into the air and run off with him across the track.  I'm just standing there stunned when a man comes up and tells me to go get our ambulance.  I half run over and as I open the door to the ambulance, a Toyota Hilux pick up whips up and they drag the man out of the back seat and toss him in the back of the ambulance.

I flip on the lights and sirens and take off across the field, cross the track, try to avoid the straggling crowd and whip around the stacks of bricks following a car and several motorcycles that seem to be heading back to Abeche.  I whip off the dirt and across the paved road, trying as best I can to dodge the ubiquitous three wheeled motorized rickshaw taxis and motorcycles.  I fly through town, mercifully avoiding the other vehicles and several animals and then take a sharp left that plunges me into a market.  I feel like I'm in an Indiana Jones movies as people dive left and right to get out of the way.  I cross a speed bump and fly through the gate into the hospital.  The ER is just on the left and as I open the ambulance bay a group of nurses is already there with a gurney.

A crowd of Arabs is trying to push there way in the ER as the hospital staff tries valiantly to keep them out while letting me slip in.  I tell the staff what happened.  The man is complaining of left sided chest and flank pain but is in no immediate distress.  I ask if they have xray and ultrasound available.

"Not until tomorrow morning," says one large female nurse.

"Well, not ultrasound," contradicts a tall male nurse. "But we can call in x-ray."

"What about lab?" I ask.

"Sure, no problem."

"Ok, I'll go get the ultrasound I have in the ambulance if you can call in x-ray," I order even though I have no authority to do so.

I bring in the portable ultrasound.  I put it over his spleen and don't see any obvious intra-abdominal fluid, but there might be a little something?  It's so early, I can't say he doesn't have a splenic injury.

"Do the xray if you can," I turn to the nurses. "If he starts having serious respiratory distress, put an 18 gauge IV catheter right here over the second rip just in line with the nipple and you'll save his life.  Do a hemoglobin now and in the morning.  If his belly starts to swell or he has any other problems he'll probably need immediate surgery."

"Will you come and read the x-ray?" asks the tall nurse.

"No, that's not necessary," interrupts a second nurse. "The doctor on call will read it."

"No problem," I say. "But here's my name and number if you need it, don't hesitate to give me a call."

I scribble the info on a piece of paper and Abraham and I go back home.  We eat a good supper of grilled goat, bread, and salad and then watch a bad Jean Claude Van Damme film with the young guys we're sharing a room with. When the movie is mercifully over, I turn to Abraham.

"We should go see the patient, see how he's doing." I'm a little worried about him and don't trust the government hospital to watch him closely enough.

"Yes, that's a good idea, let's go," replies Abraham.

We arrive in the ambulance within five minutes and go into the ER.  I find the tall male nurse sitting at a desk consulting another patient.

"As salaam aleikum," I greet in Arabic and then continue in French. "We've just come back to see our patient."

"The family decided to take him home just after the house officer saw him and prescribed his treatment, sorry."

I'm disappointed and a little mad, but not surprised that the family has no faith in the government hospital.  "Ok, what can we do?  Everyone is free to do what they want.  Au revoir!"

"Merci, au revoir."

And Abraham and I walk out.