The Second War – Vita Crux
I am serving on a volunteer medical team for an NGO (Non Governmental Agency) in the jungles of Liberia, several miles away from the capital of Monrovia.
Over the past several decades the country has been embroiled in civil and territorial wars, much like many of their neighbors. As warring tribes rise up or cross into the country, the conflicts erupt into savage wars that last months to years. Groups of young men traversing the country, unleashing rape, murder, arson and genocide all in the name of their tribal rights; in the name of some perceived egregious assault on their “respect” or based on some family feud. They rise up, and are knocked down. A few months pass by and the cycle repeats with yet another self proclaimed militia. This has become the “norm”, the way of life, in many African countries.
When we arrived in Liberia, I had the occasion to rest for a moment while we waited for our ride to the compound where we would be staying. While reading through the local paper, such as it was, I noticed an add for a hotel. There was nothing special about the add, it had the usual accommodations you might expect, the usual lures of meals, and amenities. However, one particular sentence struck me, “We are with in 5 minutes running distance to the U.S. Embassy”. Where had I landed this time?
Back to the jungle. I had been in country a few weeks by this point. We had made several journeys into the jungle, seeking out the camps that had developed over the past several months. Camps full of people that had fled their homes during the last uprising, full of people that were too tired or scared to return to their decimated villages. This particular trip was one of the deepest trips into the jungle we had made. At the last camp, we had been informed that there was a camp even further out, with several people that were too ill to travel. So we made arrangements to travel back out the following day, and sent word ahead, so those who were staying near by could come into the camp for help.
The trips through the jungle were always surreal, we traveled together, packed into one of several land rovers owned by the mission hospital we were assisting, loaded with equipment and supplies. As we traveled over washed out, rarely driven roads, more so trails, bouncing along, you couldn’t help but wonder at the beauty of the jungle around you. So quiet, serene, with a lush green canopy of exotic trees overhead. The occasional voice of some unseen bird breaking into song as we passed through. Incredible, colorful butterflies floating just off the trail, the odd, rare little lizard scampering up a tree trunk. Some curious monkey in the distance. All blending into a tropical wonderland.
Whoosh, Bump, Bang, whirr! Jolted back to reality, as the truck bounces over a rut and lands in a mud hole, tires spinning as the truck centers on the tracks of the last, long forgotten vehicle to traverse through here. Out we get, rocking, pushing, heaving, until the tires catch and the truck lurches forward, back on the trail. We pile in, and are underway again. 20 miles out in the jungle, on these “roads”, is at least a 2 hour trip. 2 hours out, means 2 hours back. That’s important, as we can’t be caught in the jungle after dark. Though the last particular war is over, there are still bands of men that rove the jungles, looking for easy targets, as they play a cat-n-mouse game with the United Nations forces that now patrol to the keep peace.
As we arrive at the camp, we are directed to a small shelter toward the center of the camp, a left over vestige from the missionaries that helped settle many of the villages in the area. It was modest, but solid and had a roof, something that was often rare in these camps. There was already a line of people waiting outside the little impromptu clinic, some who had traveled most of the night to meet us, having heard of our pending arrival.
For these clinics we generally work directly out of the kits that we carried with us, so there isn’t much set up, other than finding space to work and chairs or benches to sit on. We divide up and see several people each. There are the usual respiratory infections, lacerations, skin infections, parasites, and some chronic diseases that we can provide medications for. Over all it is a routine clinic. There is the general satisfaction of being able to truly help people that have no other means for care. As I send my last patient over to our little pharmacy to retrieve their antibiotics, I notice the next patient quietly waiting by the door way. She appears to be about 12 years old, shyly staring at the ground, with a woman standing patiently behind her.
They approach the little area that I have set up and introduce themselves, the woman doing all the talking, as the little girl stands, shifting a little, still staring at the ground. Her aunt explains that she had been injured, and was now having trouble moving her arm. The aunt, rather bluntly, asks “can you get it out”. Obviously, something had escaped me. “Get what out?”, I asked. The aunt turned the little girl sideways, pulled down the collar of her shirt exposing her shoulder. She pointed to a red, scarred lump protruding about a half an inch out of her shoulder, “The bullet”.
In amazement, I investigated further. Apparently, this little girl had been shot during one of the many raids, the rest of her family had been killed, and she had come to live with her aunt. The bullet had lodged into her shoulder, and remained there as they had moved from camp to camp over the past several months. They had not come across any medical care at these camps, so they allowed the wound to heal over. Until the last few weeks, it didn’t seem to be a problem, however, recently it had started to ache and “catch” when she moved her arm. Hearing of our pending arrival, they traveled through the night to meet us at this camp to have the bullet removed. It was too dangerous for them to travel all the way into the city, and they were unable to stray too far from the rest of their family as they were continuing to move toward the border to escape the country. If they ended up too far away they might be left behind if they couldn’t catch up. “When exactly did this happen?”, wanting to know how long the bullet had been there. “It was at the end of her second war.” That phrase struck me, they were actually keeping time based on wars. Her third war, had just ended prior to my arrival in country. By my rough calculation, this child had carried around a bullet in her arm for just shy of a year now. I called one of my fellow team members over and discussed the case. We were not really equipped for any type of surgical procedure. All we had were a few sterile instruments and limited suture for minor wound repairs. We certainly didn’t have all of the potential things we could need for this.
Standing together in the corner of the clinic we reviewed the options. They could not come back with us into the city, as they would be left behind. We had neither the proper equipment or personnel for the procedure, and I was the only one who had ever performed surgery. The decision was left to me. Digging through the kits, attempting to assemble enough equipment for this potential procedure, I made the decision to try. We were there for a purpose, and the purpose was to do what we could for these people, in a time when so many had turned their back on them.
I asked for one of the others to break free from their area, to assist, we were going to give it a try. Walking back to where the little girl and her aunt were waiting, I crouched down in front of her and lifted up the sleeve of my shirt. I was “on break” from one of my rotations in the Middle East, working as a contracted medical officer. On my last rotation, I had been involved in an “incident” and had been shot, one of the rounds grazing my shoulder. It wasn’t really anything to speak of, but it had left a nice little scar. I looked at her, catching her gaze, and rotated my shoulder into view, tapping on the scar with my finger, I simply said, “It hurts doesn’t it”. A little grin crept across her face, as she now knew that at least I understood. I told her that we would get the bullet out. Her spirits instantly lifted, just the relief that someone was going to help, that the constant reminder of the atrocities she had witnessed would soon be gone, was enough to bring a portion of joy back to her little face.
Though the procedure would have been simple enough at any hospital back home, stocked with equipment and personnel, it was a bit more challenging in a dimly lighted shack, on a rickety old table. However, all in all, it went well. There was certainly creative use of instruments, impromptu anesthetics, a little leeway on sterility, and generous use of antibiotics. In the end, the bullet was coaxed from her arm, the wound sewn up, bandages applied, and even some consolation candy distributed, just like so many clinics back home.
As we packed up for the day, having attended to nearly 150 patients between us, I watched the little girl and her aunt starting their trip home with a handful of others from their camp. She looked back over her shoulder, neatly packaged in a sling, and smiled.
It was the last time I would see her, it was the last I would hear about her. I would never know if the impromptu field surgery had healed with out complication. If she was once again able to use her arm without the constant ache and discomfort. If she could return to some semblance of being a little girl again. My only hope was that she could live a life counted by birthdays, not marked by the latest war she had survived.