Archive for August 19th, 2008


an accident

This post describes a road accident that I witnessed. I have tried to keep this post as neutral as possible but its details are graphic. Please consider that before continuing on. 

I think I needed to write this post more than I need it to be read. I do hope you will read it though. I don’t mention my role in these events because I did a lot (I didn’t), but because I just happened to be there. Other people did so much more: Leanne, who was completely composed and decisive throughout; Joseph, who knew what to do, as always; the woman who applied the splint to the awful injury; the soldier who took an active role in organizing the accident scene.


August 12, 2008.

I have been wondering for a while about the trade-offs people make here, especially the one that exchanges safety for transportation. I think about this most often when I see young men side-saddling bikes, hanging onto slow-moving semis to ascend the mountain slopes.

Just after 2 p.m., about 10km south of the site at Bugarama (pictured in the ‘Enzo’ post), my friend, Leanne, her driver, Morisho, and I are driving down the mountain road, returning from a visit to the ‘Interior’. Leanne directs a U.S.-based contractor to help ex-combattants and she was kind enough to invite me to visit some of their vocational skills training facilities up-country.

Coming around one of the thousands of bends, we watch as a bicycle loaded up with two young men and a boy wedged between gets caught in the ditch next to the road. The bike is going almost as fast as the cars and probably has weak or no brakes. An old man is walking in the ditch. He never sees the bike coming. In an instant, bike, passengers and man collide. Bodies bounce down the slope, the bike flies off. A huge dust cloud rises up, trails after the limp forms rolling off with tremendous momentum, and swallows them up.

We’re about 20 meters back at that moment and by the time the dust starts to settle, we are at the bottom of the accident site. We stop the car and get out. Already a crowd has gathered around the young men and the boy.

I say, “I’m going to look at the other one.”

Leanne says, “The old man? He’s dead.” She doesn’t follow me. She had a wider view from the passenger seat; she saw more than I did – do I want to see what she saw?

“He’s dead.”

I stride up the hill toward the old man, who is flat on his stomach, motionless, his left leg draped over his right, like he had half-rolled over. I have a vague sensation that something doesn’t look right. As I get within a few meters of him, I see his right arm stir and slowly, it tries to push the rest of the body off the ground.

That is not what dead people do.

As I reach him, a woman in bright traditional dress and a head-scarf runs up and kneels down by his legs. She tries to uncross them, and then I see what seemed off before. His left foot is turned completely inward, pointing in the wrong direction. She slides a hand underneath and turns the foot back, too easily, I think, but there is no way we can untangle the legs. By now, the man is moaning weakly.

“woooh, oh-wooooh.”

Instead of moving his legs, we slowly turn his upper body over, but his legs stay crossed. I look at the man’s face. His eyes are clear – good, he looks alert. Blood is streaming down his head, bright red beads catching in his eyelashes. Turning over like he did, the man is now partially on the road. People seem content with leaving him as he is, but the Land Cruisers and semis shooting past are just feet away from running him over.

I motion that we have to get the man off the road. That’s the first thing. The second thing – the wound – I don’t even have a chance to think about yet. I don’t even know how bad it is. A soldier with a red undershirt peeking out from his uniform runs over to help – Superman.

The solider kneels down by the man’s head, resting his AK-47 against his own thigh. The rifle keeps sliding off, and he tries to reposition it each time. The gun barrel darts around, like it’s deciding between my head, my chest and my stomach. It’s scaring away other people, too, the people I need to help me move the injured man off the road. My eyes keep circling back to the barrel, which has been stuffed up with dirt, presumably to keep out other more menacing dirt. It’s amazingly clear; I notice the little cracks in the dry dirt, bits flecked over the muzzle. The soldier gets up and walks away for a moment, leaving his gun. I pick it up and move it to a clearing five meters away. We don’t need that right now. I don’t think about his reaction or the other soldiers’ reactions. It just sort of happens. As soon as I put the gun down, other people fly over to help the old man. The soldier is there, too, without his gun, using both arms to lift the man gently. I’m on one side supporting his waist, another man is holding up his thighs. The woman is trying to take hold of his feet, but when she touches his lower left leg, the man cries out, “Woooooh!” I look down and see a large part of the bone protruding from his shin.

We get him away from the side of the road.

With one hand supporting the man’s head and neck, the soldier reaches for a thin bamboo branch and hands it to the woman. In one motion, she grabs it and snaps it in half against the ground. She places one half against the inside of his leg. The man shrinks back in pain, tries to pull his legs toward his torso. When he does that, the left foot does not lift with rest of the leg. Now that I’m at his side, I can see the wound clearly: the bone is sheared off completely from the foot. The only things keeping the foot attached to the rest of his body are ligaments and skin. There is a lot of blood coming from both his leg and his foot, and it is not dripping out. I feel all my the muscles in my body pull toward my stomach. It tenses but holds.

The soldier disappears and leaves the man on his back with his legs pulled up. His contracted position exposes a lot of bone. I have no idea what to do with this; I just want to straighten out his legs, let the woman finish splinting it and maybe get a tourniquet on him. I try to communicate this, but it takes a minute to get through. The soldier is back again and so is his gun. The woman clasps the other bamboo half to the leg and puts the parts together as best she can. It’s all we can do.

I walk back toward the Land Cruiser to see what Leanne is doing. As I get near, she calls out to me, “It’s good what you’re doing, but be careful. You shouldn’t get their blood on you. I know it’s insensitive, but….”

But she’s right. And I have it all over me. Even though Burundi has a relatively low HIV-infection rate – about 3-6% depending on the estimate – and even though I have no open wounds, I grab my water bottle and duck behind the vehicle. I pour water over the  splatters on my clothes and try to wash my hands off.

By the time I’m doused in water, Leanne has a plan. She tells Morisho to tell the soldier that we are going to drive back up the road to the nearby medical clinic to look for a doctor and a taxi, which we will send down to take the injured to the clinic.

We get back up to the clinic, about 5 kilometers away, and there is a large crowd of young men hanging out in front. They don’t do anything, they are just there. We pull up and ask for the doctor – is he in? There has been an accident and we need his help.

The men say, yes, but he is just a clinic doctor. He cannot help. We ask for a taxi. There are none. We drive further up the mountain to Bugarama, where I might be working in a few months time. There is only one taxi in town and it’s already been taken. We think of different ways to rework the definition of ‘taxi’. Maybe we can just hire out a private car or a van.

No luck. If there is a taxi or car around, it’s because someone hired it to get here, not because it’s just cruising around in the mountains looking for a fare. We drive back down.

When we get back to the accident site, there are more soldiers and more people tending to the wounded. The scene is astonishingly organized. The soldiers have blocked off the side of the road and are keeping the crowd back. The soldier with the red shirt is trying to flag down a truck. The man’s leg has been wrapped in a piece of cloth. We get out again to see how the injured are. The other two look bad, all bloodied, but nothing as obvious as the old man’s leg. Finally, the soldier stops a massive truck. We decide we have to drive the 30 km into Bujumbura with the injured if we are going to find a doctor so we ask the soldier to instruct the driver of the truck to follow us to a public hospital. The truck loads up the two wounded young men and we put the old man in our Land Cruiser. Instead of following, the truck just takes off. We assume he knows where the hospital is. 

On the way down, I’m sitting in a seat that’s been folded down, back to back with the old man. Not sure what to talk about. Leanne tries to call her doctor, but he isn’t there. I want to apprise the others of the old man’s condition so I say quite possibly the worst thing I could in that context: “He’ll probably lose his leg.”
Leanne replies quickly: “I don’t want to hear details.”

Get close, but not too close. Maybe that’s what makes it possible to help.

On the main road into town, only about one kilometer from the hospital, the truck stops. We pass it but have no idea what the driver is doing. We can only hope he will follow us down the road to the hospital. Strangely, the truck sits on the side of the road for ten minutes before driving up to the hospital. We feel uneasy about the driver.

We pull into the area marked ‘Services d’Urgences’.

There is no doctor. In fact, there isn’t even space at the hospital and they won’t take the three injured men. We’re totally baffled – can they even refuse? Leanne calls Joseph (cf. ‘ministry pt. 2’ post). He says he will arrive in 10 minutes. The hospital staff seem restless (maybe because they won’t do anything to help?). The truck driver gets out and says his boss called to tell him to leave.

The old man is whimpering softly, doing the only thing I can expect him to do: bleeding. A lot. An acquaintance of his that we asked to accompany the old man is cradling the the man’s head. I’m surprised he’s held together this long. I’m so grateful he’s not yelling out in pain.

As I walk back toward the truck, I see something that makes me break into a run: the driver is ordering his workers in the truck-bed to roll out the injured. One of the workers yanks off the bloody sheet that was covering one of the men. They’re not… I yell out in Kirundi, “Ngarara! Ngarara!” Stop! It’s  a tricky word for me sometimes but this time I pronounce it cleanly. This time, no one laughs when I speak Kirundi. The men stop pushing at the injured men and stare down at me. I grab Morisho, our driver, who is just standing there watching. I say to him, “Tell them to wait two more minutes. Tell them not to move the men in the truck.”

Joseph does arrive in the next two minutes, and after some tense negotiating, we get the truck to follow our convoy to another public hospital. Joseph and I are in his car; Leanne and Morisho with the old man in the Land Cruiser. As we near the hospital, the truck pulls into a gas station. Again, total disbelief. We split up – Joseph and I turn around to find the truck, the others continue to the hospital.

When we find him, the truck driver refuses to go on. Not until he gets gas at this specific station. We press and press but it’s no use – his boss said so. Joseph gets the boss on the phone only to get yelled at. We convince the driver to promise to come to to the hospital after he gets gas.

At the hospital, the Land Cruiser is idle and no one is around it to help the old man. Leanne is waiting to talk to a doctor who is chatting with a couple. It’s hard to tell if they’re just bantering or if he really is dispensing medical advice. The doctor (I assume) is in a pristine white coat, a stethoscope wrapped around the back of his neck like a towel after a workout. 

Leanne tries to explain the situation, asks him to see the old man’s injury.
The doctor, says, “We cannot help. We have no places. The hospital is full. There is a line and we have to help the other people first.”

This goes on for a bit. Leanne gives one more try.
“But there has to be a triage system. How do you prioritize the patients?”
Same response.
She turns to me and says, “What are we supposed to do? Just put him on the ground and leave him to die?”

This far into my stay in Burundi, I have not seen the need to get angry. Things are already so ridiculous and difficult, it hardly seems worth it to be genuinely mad about something. Frustrated – for sure, but not angry. Until today.

After Leanne stalks away, angrier than I have ever seen her, I approach the doctor and invite him just to see the man, telling him I wasn’t asking for anything more than that. Instead of responding to my words, the doctor spins toward me and asks hotly “Why did she get angry?”

I think there must be some misunderstanding so I try again: “This is not about her. You and I, we are having a conversation. There is a man that needs your help.”

The doctor replies, “No, why did she get angry like that? That is not right.”

I don’t believe it. All that matters to him is a personal dispute that he really has no right to be upset about – he’s the one not doing his job. I wanted to punch him right on his shiny nose and then whip the stethoscope he has pretentiously draped over his shoulders around his neck to drag him over to see the old man. It takes a lot to suppress my rage. I turn away without another word and leave. We still need to find a hospital. As I walk away, I hear the doctor say, “You can leave him on the ground there and we will look at him later. There is a system to these things…”

The Land Cruiser goes ahead. As Joseph and I are pulling out of the lot, the truck arrives. Keep going, we tell the driver. To a third hospital.

When Joseph and I arrive at the next hospital, the Land Cruiser’s back door is open. Leanne and Morisho are standing nearby and a large crowd is watching. Two ex-pat doctors, a bald man with blue eyes and a mustached fellow, are giving directions. Leanne smiles as we walk up: “They will take them. They have no places either, but after seeing the injury, they said they would take them. We’ll see what happens.”

We mill around for a while. It’s already past 5 p.m. and even at a hospital, people expect to leave work. The doctor says, if we operate on him now, we can save the leg. If tomorrow, we amputate.

There is some hesitation amongst the hospital staff about treating peasants who probably cannot pay. Leanne takes out what money she has on her, and the bald doctor (Théo, from Germany) lectures the administrative staff on the expectation that anyone in Burundi would casually carry on their person 300,000 Burundian francs, the amount for the deposit. Finally, the doctor gets to work. 

I’m glad to learn everyone will recover to an extent. The other two looked worse than they were; I don’t know what happened to the boy. I do wonder about the old man though. An injury like that, even if he can walk normally again, would take at least nine months to heal. Food prices are rising, jobs are scarce. If you’re an old peasant man with no income and no mobility, what do you do? What do the people around you do? 

And this kind of accident happens all the time. What happens to the next old man? Who actually gets to use the “public” hospitals? Which organizations’ vehicles will drive past again without stopping? Doctors Without Borders? The Red Cross? (To their credit, the Red Cross funds this last hospital because it actually treats people. It’s the only one they support.)

The next day, Leanne visits the hospital and finds out the old man has to stay for five to six weeks. She has to negotiate with the hospital how to pay for his fees, which she will do out of her pocket. I plan on contributing. We have a conversation that ends like this:

“If this happens again, in a week or two, would you still stop?”
“Yes. You have to. Don’t you?”
“Sure. But nobody else did.”


A few other things I want to mention:

Leanne and I would make pathetic doctors. Our diagnoses were way off. That’s why we do aid work instead.

When someone at the hospital asks one of the young men who was steering the bike what happened, he replies that he veered off into the ditch to avoid an oncoming car that was passing another car. That couldn’t be possible because if there was such a car, we would have hit it.

Later on the night of the accident, one of Leanne’s security guards asks, “What happened to the bike?”

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August 2008