BY DR BEN GUPT
I’d been invited to attend a traditional feast called a mumu and, walking along the path towards the meeting area, I was struck once again by how beautiful this area is.
Everywhere I looked, lush green hills were framed against a clear, blue sky. The sun was shining and the noise of exotic-sounding birds echoed around the valley. I’d been working as an anaesthetist for Médecins Sans Frontières here in the Southern Highlands for five months, but the scenery still had the power to leave me breathless.
Think of the word ‘paradise’ and you’d probably picture a landscape something like this.
The mumu only added to this sense of well-being. Villagers from miles around Tari had turned out to celebrate, and we watched in amazement as 107 huge pigs were slaughtered and then cooked in a giant, narrow pit that stretched as long as a football pitch.
There was dancing and celebration and, as we laughed and chatted, I felt it was a privilege to share in this experience with the local community.
Unfortunately, this wouldn’t turn out to be the most memorable aspect of the day. As I got back to the hospital around midday, Max, the surgeon, came out to meet me with a grim look on his face.
“Sorry mate, we’ve got to go to theatre now,” he said. “A woman’s just been brought in. She’s been chopped.”
My heart sank. ‘chopped’ means attacked with a machete. I rushed inside and got changed.
Back in the UK, these sorts of injuries would be encountered only a few times throughout a career, if at all. But here in png, they’re a daily occurrence.
What’s just as shocking as the injuries is the banality of the incidents that lead to them. Minor disputes about money, petty arguments and disagreements all too often lead to extreme violence. Between September 2009 and September 2010, 5,500 of the medical consultations MSF conducted in Tari were related to violence.
Hand in hand with this is the high incidence of sexual violence, particularly against women. According to the Law Reform Commission, 70% of women have been physically abused by their husbands; in some parts of the country the number reaches 100%.
Even after five months, dealing with the repercussions of this violence on a daily basis never felt normal. It had, however, become depressingly familiar. As I scrubbed up, I wondered how such extreme and endemic violence could exist in such an idyllic landscape, populated by such friendly, open people.
Lucy, one of the local theatre nurses, was attending to the woman as she lay quietly on one of the beds outside theatre. She had already applied pressure dressings to the woman’s arms and head and was talking to her gently.
Despite all the bandages, I felt positive when I saw her. She was alert and answering questions from Lucy, a sign that she probably hadn’t lost too much blood. She also didn’t have any facial injuries that would leave her with permanent disfigurement.
We took her through to the operating theatre and I put a local anaesthetic block in to numb her arm. While we waited for her arm to go numb, Lucy cleaned her head-wound and chatted to her in Huli, the local tribal language. She told us her story.
It turns out she had been arguing with her brother about money when, without warning, he had taken a machete to her head and arms. Here was another example of people using extraordinarily violent means to resolve conflict. It was sudden. It was disproportionate. It was completely and utterly inexplicable.
The surgeon, Max, began removing the bandages from her numb arm while Lucy continued to translate. Suddenly he stopped what he was doing. I looked over and saw that, underneath the bandage, the woman’s hand was almost completely amputated, barely hanging on by a tiny strip of skin.
There was a split second of silence before Max gently explained to the woman that her hand could not be saved. We then got on with the job of repairing what was left of her forearm. It took us a few hours, but we managed to repair much of the damage and tidy up some of the mess the machete had made. After the woman had been wheeled away to the ward, we cleaned up and left the theatre in silence. None of us felt like talking.
Over the next few days, however, we did begin to talk; not only about some of the patients we’d seen and the violence that seems to bubble away beneath the surface of everything here, but why it was happening.
Theories were bandied about, explanations presented, but none of us could work out a reason for it. Months later, I’m still no nearer an explanation. But what I do know is that if MSF wasn’t in Tari providing emergency surgical care, then a lot of people who had been attacked, wounded and maimed in this area over the last few years would almost certainly have died.
People like the 16-year-old girl who collapsed outside the hospital with a ruptured spleen as a result of a beating from a member of her family. A half-hour longer and she would have died. But we rushed her to theatre for an emergency splenectomy and she made a full recovery.
People like the woman who had been ‘chopped’ in the face, leaving a hole in a major artery. After multiple trips to theatre and many blood transfusions, she also survived. As did the girl whose brother tried to chop her head off and the boy who was shot in the abdomen during a tribal fight and the baby that had been mauled by a wild pig.
All these patients, and many more whose lives and limbs were saved, are still here because of the work that MSF is doing in png. Their faces will stay with me for the rest of my life. Christmas and New Year came and went and, as the weeks went by, I saw more and more of the woman who had been attacked.
Despite the horrific nature of her injuries, it was gratifying to see her slowly but surely making a full recovery. With the help of the professional psychological support provided by MSF, she also began to interact more with staff and even occasionally to smile.
Of course the real challenge for her will be when she leaves our hospital and has to learn to live not only with her disability, but also with the psychological impact of the attack.
There are no quick solutions or easy fixes for trauma like that, just as there aren’t any for a society where violence has become such an accepted part of daily life. But I hope that by being there, by providing much needed medical care and by setting an example, we are helping to make a real difference here. Such a beautiful country and such beautiful people deserve the best we can give.
Photo: Patients in the triage area at Tari Hospital [Fiona Morris]
Source: Médecins Sans Frontières Dispatches Newsletter