RAAF Rwanderers 2

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RAAF Rwanderers 2
RAAF Rwanderers 3

April/May 95

bulletHalf Way Mark
bulletOver the Wire
bulletMissy
bulletKibeho Diary
bullet"I am not an Animal, I am EVAC"
bulletNerve Centre News
bulletPathological Patter
bulletA Day in the Psychosis of a Rwandan MO

Half Way Mark

Well here we are, still in beautiful downtown Kigali and still in a (reasonably) sane state of mind. Much of this can be attributed to the fact that our long leave is looming but also most of us are having an interesting, if busy and challenging time doing our respective jobs. We are still treating a large number of local patients on a humanitarian basis and in fact they account for well over fifty percent of our business. This is not a bad thing as it means we are exposed to true third world medicine and itís a great learning experience. It also brings out the maternal instinct in many of us (although not this cold-hearted old doctor) as many of our patients are kiddies and many of these are orphans from the Mother Theresa Orphanage up the road. Back in April we discharged our long term mascot, Missy who is an eleven year old mine victim. She was clomping up and down the corridors on her new wooden leg during her last two weeks and was an inspiration to all with her cheery grin. Just as well she left I suppose as she was thrashing our FLGOFFs at pat-a-cake and learning some "strine".

We had a major shake up of staff at the six week mark with rotations occurring between the ward, ICU, CHK wards, RAP and CCP. This has generally been a positive experience as most people appreciated the chance to try something different.

The big news of course and the thing thatís put us on the map again has been the carnage at Kibeho. Several RAAFies served down there and some of these intense experiences are shared in this issue. That fateful day of 22 APR was really a turning point for this contingent and helped us all to remember why weíre here. We all thank everyone whoís written since then - itís so nice to know youíre all thinking of us.

I hope you all read and enjoyed our first issue. This one is a double issue as, due to work commitments, itís been difficult to get this thing together. Many of the other sections have contributed this time with a little of whatís happening in their sections - EVAC, CHK, and pathology as well as many feature articles.

Until next time, think of us as we climb our stairs, haul our buckets, wipe away the HIV positive blood and float in a sea of pus.

Your Editor

SQNLDR Tracy Smart.

Over the Wire

by The First CHK Mob

We arrived in downtown Kigali with eyes and mouth wide open! With jetlag as our backpack and humour as our weapon we marched in to take over from the first contingent of Centeral Hopital Kigali (CHK) Pioneers. We didnít realise the meaning of "Culture Shock" until we had handover, which was brief due to our late arrival. (Thanks Tower Airlines!) The smile on their faces said it all, it almost outshone our look of awe. Major Todd and her crew could only be commended for their arduous efforts. After a week of acclimatisation (and we donít mean the weather) we realised there was no looking back and proceeded to "take up where the others left off".

With FLTLT Robyn Green at the helm as OIC and CPL Margaret (Magrat) Koimans as 2IC, the rest of us were dispatched to wards 1,2 and 7. Among our tasks there was also manning of the specialist clinics. In Ward 1 we had our sole Army rep LCPL "Bubbles" Brandon who set about learning the local lingo to the amusement of locals and provided us with some comic relief. In Ward 2 we had both Magrat and LAC Hayden ("H") Cohen. As Magrat continually had patients wanting to pass their babies off onto her, as they ran in the other direction, we thought it wise to keep H close at hand in case her maternal instincts overcame her. With H occupied instigating post-op care and trying diligently to teach them the basics of English, he barely had a hand free. Magrat meanwhile busily ran around taking African temperatures (hand on forehead) and feverishly tried to "milk" the social workers to provide for her patients, sometimes using radical sign language. In Ward 7, LAC Ross (Iím the boss) Macdonald met his match in both stature and temperament in "Fiery" Felician, head nurse. From medic to plumber, Ross, Mr. Flexibility himself, soon got things happening (as in a water supply) and was forever more thought of as a miracle worker. Also in Ward 7 was LACW Tricia White whoís maternal instincts never left her. She may have left her offspring at home but she soon became a mother figure to many, most notably an 11 year old orphan called Donacien.

Ah! Let us not forget our fearless leader, Robyn, with her biological time clock ticking away, who has become surrogate mother to our mascot Billabong (his mother is dying in CHK).

We are now in the midst of handing over to our new team, including FLTLT Connie Scott, CPL John Harvey and LACW Anne Croft. This is not an easy task for any of us as we are beginning to see the positive effects of our influence at CHK. All the best to the new team - we hope you enjoy the experience as much as we did.

Missy 

by CPL John Harvey

I first saw Missy in her hospital bed
Covered with skin flakes and patches of red;
Her right leg a stump, swinging in the breeze,
Her left leg was putrid and reeked of disease.

Her one good eye watched me, followed me around,
I talked and I talked but she didnít make a sound,
Just looked at the ceiling, and then at the ground.

Days became weeks of painful attention;
Skin grafts and rolls, and games to break tension
Exercises for strength, too numerous to mention.

Missy now smiles, plays, does her homework,
To get her this far has been nothing but hard work.
But what of the future for little Musengimano,
In a country torn apart by war and plunder.

The mine that maimed her took her mother to God.
Her gran is the martyr who now sits by her bed,
Holding her closely, stroking her head.

Missy will leave us, her prosthesis in place.
She will go with her own kind to where I donít know.
We will remember her laughter, the smile on her face,
The thought of sweet Missy will fill us with grace.

She will go with our blessings,
Her future unsure,
Our poor little Missy
A casualty of war

Kibeho Diary

 

by FLTLT Kathleen Pyne

Below are excerpts from the diary of FLTLT Kathleen Pyne describing some of her feelings about the tragedy that was Kibeho. Kathleen served with FLTLT George Dohnalek, MO at Kibeho IDP camp from the day after the massacre, 23 APR to 01 MAY, enduring both emotional and physical hardships. This is her perspective.

22 APR 95. We are with Bravo Company, ZAMBATT at Rwamiko, we being FLTLT George Dohnalek, MO and four Army members. We flew in by helo in anticipation of relieving our other CCP. They have been at Kibeho for four days amid many a casualty as people are being shot or macheted all through the IDP camp..... We were on standby at the AUSMED Hospital to receive 11 casualties and were also on AME call to evacuate casualties however the helos couldnít land because of the gunfire. Next, we heard that we had 35 minutes to pack to join the first team..... 5 to 7 days worth of nickers, socks and Wetones..... We flew over the camp on the way in - lots of light blue tent structures in a dirt pit. As we landed, crowds of filthy dirty and very poor looking locals accumulated. How do they survive out here?? This is poverty at itís worst....I am sitting here with flak jacket, helmet and webbing on, weapon loaded at the ready. This is quite daunting but exciting. May we emerge safely with memories of an awesome experience.

23 APR 95. Where do I start? I have witnessed hell on earth today. We had reveille at 0400 hours and deployed to Kibeho to set up the CCP. It smelt strongly of death and filth - a scent we will never forget. As we entered the ZAMBATT compound, wounded were already waiting. We assessed six who we could do little for. If I write that they had gunshot or machete wounds it would basically cover all of the injuries we saw today - about 80 or so. A few visions are etched in my mind - a man face down in a puddle of water; a body with a bullet in the head and a machete in hand; a mother and child looked up at me from inside the toilet pit. Walking through the hospital there was nauseating - the smell was strong and the injuries were horrendous. To look a severely injured person in the eye and have to turn away without treating him is not an easy thing to do...... We cannulated, dripped and dressed wounds all day. Many children were wounded and many tiny babies were left as orphans. The shooting could be heard intermittently and we would soon receive the casualty to patch up and dispatch on cattle trucks to already overcrowded hospitals.

24 APR 95. It was an eerie feeling this morning as we approached the refugee camp. Hardly any people could be seen, the bodies were covered up and the NGO vehicles were evacuating the hospitals under the watchful eye of the RPA. Others left on foot, some passing us, some seeking assistance - we helped where we could. Two boys were asked if they had parents and their reply was that their mother was the last of their family members and she was shot last Thursday. My heart went out to them.

25 APR 95. We had an ANZAC parade under a glorious sunrise. I was most proud to be chosen to read a prayer during our remembrance. We prayed for peace - it seems bizarre in the situation we are in - and hope and strength. We set up the CCP as usual this morning despite the objections of the RPA. Occasional gunfire can still be heard but today has mainly been waiting in anticipation of the worst.....We cannot and will not ever be able to accept what we have seen, nor imagine how dreadful it must be to see your loved ones slaughtered.

26 APR 95. One of the infantry guys told me that some of the torturing and massacring has been done by women. I donít know how and I donít know who to feel sorry for or who are the innocent except for the very young children. At present weíre just waiting to see if weíre going to go back to the camp.

27 APR 95. We did go back yesterday and personnel were appalled at what they saw. Barely living amongst the dead and dying, there were approximately 300 people (actually closer to 2,000 - Ed) in faeces, urine and every type of excrement. The stench was overpowering. This is all a mockery to human existence. We treated and evacuated 8 people by ambulance. I was in the back with four of them and it took us four hours to reach Butare Hospital. The stench in the back was notorious - I was wearing a mask and suffering from hypoxia. Everyone stunk that night, of death and filth. The infantry guys and others dug a mass grave for the forty or so dead bodies they dragged out of the compound, bodies bloated and bursting, covered with fleas, lice, and any other filthy insect or mite you could name. Like a scene from a Jewish Concentration Camp they were loaded on to the back of a truck and dumped in the grave. Hopefully they died quick deaths, merciful deaths for those living in this devastating pit of suffering, this valley without tears. For tears must all be gone, helplessly, hopelessly. In life they probably had little dignity in the end - in death they certainly had none......I have no desire whatsoever to go back to the IDP camp at Kibeho. Unfortunately I donít have a choice.

Kathleen and George were at Kibeho for ten days in all. They were joined by CPL Col Jenner, EVAC, and followed by other RAAF members -, FLTLT Robyn Yeo in CCP3 and SQNLDR Tracy Smart, LACW Tricia White and LAC Ross Macdonald in CCP4. For all of us it was a powerful experience although different for each rotation. CCP4 was lucky enough to have the extremely positive experience of assisting in moving nearly a thousand people from the camp and watching the last people leave, but for all of us came the satisfaction that although so many lost their life in this disaster, AUSMED members were on hand and saved all up hundreds if not thousands of lives.

Although we could not all go to Kibeho to be first hand witnesses, all in Med Coy contributed as back at the hospital we had six casualties to deal with on the day of the massacre. Staff members worked long hours due to the excessive workload and staff shortages, without complaint and all acquitted themselves extremely well. All RAAFies can be proud to have contributed to this operation.

Read more about the events leading up to this massacre and our response on the Kibeho page.

LOST

One Teddy, answers to the name of

"RAAFie".

If found please contact the China Doll in the Orderly Room. Please - a desperate mother!

(nb. Passport also missing therefore may have embarked on long leave somewhat prematurely.)

"I am not an Animal, I am EVAC"

 

by CPL Col Jenner

Deep down in the fetid bowels of ASC 2 lives the beast - EVAC. Manned by the creatures your mother warned you about, spending their days roaming the streets of Kigali, spreading fear among other road users, making use of the rule "the bigger you are, the more right of way you have.

Dividing their time between the RAP AUSMED, RAP UNAMIR HQ and on standby in the EVAC dungeon are such people as Paul "The Tongue" Jordan, OIC, John "You talking to me, sucker" Church, Dominic "Stuff Ďem" Boyle, George "Trooper X" Taulelei, Shane "Get off the road, ya peanut" White and me, Col "Senna" Jenner.

Each member, hand picked for their individual skills, collectively they form a formidable force with no known peers and are referred to throughout the contingent in hushed tones - "EVAC". Relentlessly this force stamps itís mark on Rwanda with their own special brand of compassionate care for the suffering, broken forms of the unfortunate indigenous folk who are swept into their care. The teams have had cases of all priority levels ranging from PRI 3 ("Iíve got a bit of a cough") through PRI 2 ("You told me to come back if it got any worse") to PRI 1 ("Ooh it hurts a bit").

Despite a crushing workload that would rob a normal man of grace and dignity (they had some to start with? - Ed) this often flatulent crew can be heard laughing rambunctiously deep within their lair, plotting the downfall of the country itself or arguing over whose turn it is to make the tea.

Ever conscious of the "hearts and minds" attitude, these highly disciplined crews fervently endeavour to avoid running through puddles thus splashing innocent civilians, or over-revving engines to create a toxic diesel smog. NOT!!!!!

Well thatís all for now from the EVAC cave but always remember that famous EVAC saying: "Never try to teach a pig to sing - you waste your time and annoy the pig." Until next time,

Semper fi Rwanda 

Nerve Centre News

 

by FSGT Pete Matthey

Direct to you from the very hub of AUSMED Hospital here in Kigali, in other words the actual area from where everything is generated, anything from kicking butt, to praise and criticism, passing on gossip and rumour, comes this months Wardmasterís status report. Life is never dull and boring here - all of a sudden we may get an urgent PRI 1 request for an AME to Butare, and after weíve told the OC, the team is off and racing, hastily jumping into flying suits in the back of the ambo (or 110 - very interesting - Ed). FLTLT (aka FSGT) George Dohnalek and the male medics donít mind but we have noticed it takes our resident NURSO from Edinburgh a long time to change into her gear! They reach the Presidential Hangar and jump aboard the Canadian Bell 412 and head off for the 30 minute trip to pick up our "PRI 1" who has a fever and a sore leg and walks onto the chopper. But the scenery is nice on the way down.

Back to the action area, CPL Lucy "China Doll" Wong handles (literally speaking that is) all our admissions and discharges with great zest, even to the point that Iíve noticed a few grey hairs popping up here and there. Lucy is off to Amsterdam for her long leave on the 25th of May for two weeks and is hanging out for that.

The Kibeho incident has seen us fairly busy with medical teams deployed and the hospital receiving patients from the scene. The experience of Rwanda will leave a lasting impression on everyoneís mind for a long time.

We are all looking forward to long leave - Iíll be back home on 16 Jun and believe me I think weíll all enjoy the rest, not just from the workload but because thereís been quite a lot of gastro among the Aussies, some requiring drips to supplement.

From the Wardmasterís desk, things have been hectic, especially with a few AMEs and Resuses thrown in, plus just recently a bit of theatre time. Lucyís also been out and about, learning how to give injections, trying her hand as a dental assistant and being a motherly type to the heaps of kids we have on the ward.

Anyway, regards to all at home and see you soon.

Pathological Patter

by CPL Frank Alcantara

The alarm goes off at six,
Itís another day in Rwanda,
Time to get up
And go for a wander.

PT, coffee,
Doxy and breakfast,
What will the day bring?
Iíll try and make the best of it.

Bacteria and Malaria
Fixed on slides on demand,
Fixed in an instant
From blood, faeces and glands

The siren sounds
And itís time for a RESUS
The stretcher teams arrive
What do they have for us?

MVA, gunshot
Amputation or illness
Itís time to get down
And start our business

Haemoglobins, crossmatches,
Electrolytes, blood gases
Itís gone past the stage
Where adrenaline rushes

The RAP sends medics
With yet more requests
The boss yells "Fill out the paperwork
Or we wonít do the test"

The evening arrives
And the day staff goes home
The on-call technician
Will do it alone

The days continue
With more of the same
And I remind myself
"This is why I came!"

Translation of Ancient Swahili Proverb

" Intense desire removes intelligence"

A Day in the Psychosis of a Rwandan MO

by FLTLT George Dohnalek 

Well it may feel like eons, but weíve only just reached the reflection stage of our tour, however a definite routine has developed. My adherence to some form of daily routine is part of my coping mechanism; it serves as an attempt to create a sense of normality and a chance to recharge the batteries that seem to drain as fast as the depleting supply of hairs on my head. Therefore I will attempt to convey to you a day in the life of a warped Rwandan medical officer.

My daily routine usually starts at about 0430 when I am awoken by the sounds of the religious cleansing of hoards of Indian orifices. The Indians who share the compound with us, ritually vomit, spit, or cough up whatever evils they think they possess, at no less than 100 decibels of noise intensity. In case you then are actually contemplating returning back to the realms of unconsciousness, this is promptly aborted by the continuous Indian Ďrapí music that pumps out through loudspeakers, consisting of sounds that could only be made by a junkie with the worst case of haemorrhoids known to man. It is so irritating, that Iím sure it is soon to be classified by the World Health Organisation as a form of environmental warfare. If that doesnít get to you thanks to the advent of sedatives, then parade practice at 0500 will. Like mating calls of desperate gorillas, our much loved UN counterparts try to outdo each others bellowing of commands at ferocious repricosity. Okay so now youíre awake - how selfish of me to not thank them for ensuring I wouldnít be late for work.

The morning next comes with the excitement of determining whether the water is on, or whether showering will require juggling the everfaithful bucket. Oh, and the morning just wouldnít be complete without the ĎCeremony of the Cisterní; a salute to manual flushing of the toilet. Whilst other people are running around in a desperate attempt to find that elusive creature known as physical fitness, I gently amble to the frontier post known as the front security gate, and begin the task of looking ĎHardí. Prior to leaving Townsville, we were issued with explicit instructions to remain ĎHardí at all times, to make ourselves a less likely target. With a Godfather like expression, I load my rifle, check my Army issued condom for serviceability, and launch into the street. Occasionally, I am so hard it hurts.

The walk to the hospital, albeit short, reminds you vividly that your not in Kigali attending summer camp; thereís no singsongs or holding hands. From the road, a view across Kigali greets you, often clouded over by fog or more commonly smoke from the not so modern Rwandan stoves. Itís usually quite cool and crisp in the mornings, often wet from the previous evenings rain which comes with remarkable frequency. This concept of rain more than once a year took quite some convincing with me as each afternoon we receive Waggaís annual rainfall. To complicate my view of the world, I was shocked to discover grass of the green variety, obviously a distant relative of the brown species notably fighting for survival in my front yard back home.

The walk takes you past the Rwandan Patriotic Armyís (RPA) training academy, heavily guarded by soldiers clad in the latest designs of prosthetic footwear - Targetís rubber gumboot collection. The bright red or yellow gumboots look particularly suave when worn with the green camouflage safari suit number, obviously reserved for soldiers with a meticulous attention to detail. In the early hours of the morning when the RPA head off on their tribal jog through the streets of Kigali chanting such famous tunes as ĎBring out your deadí and ĎThe funeral marchí, these gumboots provide excellent visibility for oncoming cars, reflecting a country steeped in high standards of occupational health and safety.

Often we are greeted by a friendly "Aussie go home", or the acknowledgment of our presence by the traditional Rwandan reverse nod. Initially we thought this action was a nervous twitch but realised it must be obviously an anti-mosquito bite defensive mechanism, a remnant from the days prior to the existence of mossie repellent. Once inside the AUSMED gate, we swiftly unload our rifles, defying the temptation to kill and mame a sandbag and be the winner of a US$1000 fine. A few have been overcome with the desire to be winners and yet another bag bites the dust. Theyíre not that difficult to miss.

After putting to bed our rifles into the lockable cupboards (sometimes without our magazines even - Ed), itís off to the ward where the warm greetings flow thick and fast. "How about getting rid of some patients today", I would be asked, with a friendly set of hands clasped around my throat, rapidly depleting the supply of oxygen to my hair. That would complete the doctor/nurse handover, and whilst I regain consciousness, a marathon session of nursing handover would take place. Here the realm of medicine is redefined. Like a stockmarket report in the news, critical patient details are conveyed to the next round of nursing gladiators. The performance of each patientís orifices is tabulated, and gold stars awarded to those patients exceeding excremental expectations.

My ward round is then ready to commence. With the aid of our multilinguistic local interpreters, capable of translating such difficult tongues as KinyaRwandan, French, American and British into English, we begin. The toughest task is to distinguish the patients from their live-in carers, who often look worse than the patients. Each day a different member of the family assumes the carer role, and usually it is someone who wants free medical care from us, or who needs a good feed, with food that doesnít need to be to be stapled to the plate to prevent it from running away. To aid with our identification process we have concluded that those in the ward beds must be the carers and those bunked out under the beds are the patients, but they have obviously found a loop hole in our hypothesis and now everyone sleeps in the bed together. Talk about a superior survival instinct!

As a UN hospital whose purpose is to treat UN patients primarily, we have very little work on the wards. As an arm of the local hospital, Centre Hospitaliare Kigali (CHK or CHUCK as we so fondly refer), we are constantly inundated with the most amazing plethora of patients. The other common source of patients, other than directly from the ĎNothing Really is an Emergency Departmentí or ĎRwandan Trial of Life Centreí, are the various orphanages that are routinely visited by clucky individuals.

ĎShoppingí for the patients as itís so fondly come to be known, must go down as one of the all-time best blood sports available in Kigali. This process usually is initiated with the ritual ringing of the bat phone, which is linked internally to CHK. Through a combination of hand signals given over the phone, an indication of need for help is assumed, and we usually head off with our shopping trolley (four stretcher bearers) and a doctor, to see what specials are being offered.

The thing that is initially apparent when you first arrive in the CHK Emergency Department, is the lack of urgency displayed by their staff. Often there would be patients lying in pools of blood, exsanguinating before our eyes, and our first impression is we have found our next transfer. Not so, because behind door no. 1 is our awaiting prize; usually a little low on life. But wait, itís two for one day at CHK, and thereís more.........you also get.......The sale is on and our trolley is now overflowing. We have now learnt from grotesque experience, that sight-seeing shopping tours over the wire in casualty, donít come without an expensive fee; more resuscitations; more surgery; more admissions; more horrific photographs.

Our other common excuse for admission is the wonderful world of tropical disease. Everything that flies, bites, burrows and crawls, carries delicious bugs just waiting for a chance to feed on the human breeding grounds. What a perfect culture medium the human species can make.

Malaria wins the contest for frequency. Basically, if you have a fever, you have malaria. If you think itís malaria, it is. If you donít think itís malaria, it is. If you think you canít think or are all thinked out, then you yourself probably have malaria.

Occasionally, other organisms rear their ugly heads, sometimes directly out of mouths of people. Several times patients have opened their mouths to say Miraho (hello), and a friendly worm pokes its head out to answer the question for them. One lucky Rwandan recipient was even made a proud father after delivering not one, but several thousand bouncing baby worms by caesarean section after several days in labour with stomach cramps.

In addition to worms, other animals have also been found on patient safaris. Itís not unusual whilst examining someoneís ear, to find ticks staring back at you, annoyed by the rude interruption to their voracious feeding. Occasionally, you can be surprised by a small nest of ants in somebodyís wound, forced to scatter as the hydrogen peroxide or betadine rain is administered. But most often the animals are so small we need a microscope to see them, and this is where we call in the great white path hunters from the laboratory jungle. These yet unclassified or typed mutations of the human species can usually be found knee deep in faecal, blood, or pus specimens, tracking such elusive creatures as amoebas, malarial parasites, tetanic spores, schistosomes, or any one of a variety of bacterial herds which they round up and culture in little jar farms.

One of the most complicated processes to be handled on the ward, would have to be communication to the vast varieties of peoples and tongues and almost all dialects and languages inherent to Africa are covered by the range of nations working under the UN umbrella. Subsequently, itís common place to strike a patient who speaks a language not covered by our interpreters. In this case we use a chain of people, each capable of understanding two different languages, and arrange them like a set of dominoes to create a flow of information. What is actually said is anyoneís guess, but even simple instructions can be misconstrued as we found out when we asked one fellow if he had passed flatus to which he presently rolled over dropped his pants and let us be witness to his answer. As the noxious truth hit our nostrils, we quickly decided to leave questioning until the ill wind had passed.

After my daily working ward round, breakfast is usually in full swing. The highlight has to be the ritual swallow of the doxycycline tablet; our contraceptive from malarial parasite babies.

Immediately following breakfast, still trying to swallow the tablet, itís time to launch into the consultant ward round, to answer questions that have plagued us since the previous one. Questions such as "why did I leave a prosperous job and my Mercedes for this" and "how many Frequent Flyer points will I earn on my way home", feature heavily in the minds of our great consultants whilst reviewing the plight of our ward patients. Despite these seemingly devastating ponderances, they nevertheless still have the energy to save the lives of just so many patients here, their obvious dedication to the maintenance of humanity featuring highly in their minds. Everyday, this grand ritual of doctors and nurses moving from patient to patient, offers each one at least some hope in the preservation of life, and ultimately the returning of dignity to a devastated population. It is a spectacle to be admired and instils a sense of self pride in me that will be etched in my mind forever.

In contrast to the UN patients who are medevaced out of the country if we cannot give them optimal treatment, what we provide for the Rwandans is the best that they are going to receive; there is no next level. After us they are left in the hands of God.

For most of our UN patients, our entourage is almost like a morning parade as each patient due to their military discipline comes to some form of attention, often not without itís impracticalities. As a salute is given, a drip pulls out; as a stand to attention is made, a patient falls over forgetting about his recently amputated limb. These are the realities of a military service hospital. Fortunately for the UN, the inpatient toll has been minimal since our arrival, with tropical disease being the main cause of hospitalisation.

Following grand rounds, routine procedural and investigative duties become the order of the day, unless theatre lists are scheduled; which recently has become a virtual daily occurrence. This presents me with an opportunity to break the umbilical cord with the ward and traverse into the serene world of the operating theatre, to assist with either the anaesthetic or cutting end. The operating theatre, has been restored to a remarkable level of function with theatre equipment imported from Australia. Alongside the AUSMED operating theatre, a second theatre is available, which is used by the ophthalmologist from CHK. You cannot help but be amazed by the extreme differences in technical operation and standards of function. Imagine the surgeon operating without gloves, but still sterile gowned. Its like having sex with a full body condom only thereís a hole in it. Such is medicine in a third world country.

The theatre lists consist of a large variety of cases, ranging from those relating to war medicine (amputations, wound debridements, etc), to those seen in most hospitals, and those specific only to third world countries, due either to gross disease often presenting too late, or corrections of the consequences of the genocide. Sometimes the injuries have been just so horrific and devastating that they defy survival. Many of the patients have managed to survive in the bush hiding with these wounds, often self treating with local remedies such as laying dirt over wounds to stop them bleeding, and voodoo type witchdoctor treatments involving the laying of tiny scars strategically across their abdomens; likened to a form acupuncture.

On average, alternate days we receive a patient which needs immediate resuscitation. These resuscitations are somewhat different to the patient with a splinter or a twisted ankle which defines a resus at a Health Services Flight; these patients are BND (bloody near death). The commonest condition we see in these circumstances would be car vs human; currently the cars are winning by an alarming margin. And no wonder when you realise that there are virtually no road rules here. If you make it to your destination without crashing you obviously got the rules right. There are no traffic lights in operation; you must give way whilst actually on the roundabout; and when approaching what you think is a speed hump, check it doesnít have arms and legs first. At night the last rule is hard to apply as everything is black, and you often can only tell as the teeth pass over the bonnet, or the wheels tend to spin for a moment.

After work, entertainment presents itself in the form of writing letters, sleeping, jogging around our cell block, sleeping, drinking at the mess, sleeping, or working at the hospital as the on-call sleeping slave. Recently Iíve learnt to do multiple things at once in order to maximise my spare time. I can now eat in my sleep whilst catheterised, and write letters on the exercise trail whilst reading a book. Occasionally I forget to breathe but always remember prior to entering a coma.

Then itís off to bed where we sleep uninterrupted, that is until the whole process begins yet again with the Indian belch, and dry reach of a new day.

And so completes an outline of typical daily happenings in the life of a medical officer, imprisoned in a small area of the world that time and seemingly morality has forgotten. Thank god the Australian sense of humour flows freely. Laughter is the best medicine for without it we all get sick.

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