Thoughts From a World Turned Upside Down

Sad me

Monday is always a busy day for me. I have prison visits for work in the morning and I usually try to go to the bank to get our finances in order for the start of a new week before that. This Monday was no different. It was already sunny when I left the house to head to the bank and shaping up to be a great day. I flagged down two tuk-tuks (kind of three wheel rickshaws that are used for public transport here) that were already full, before sliding in beside a pleasant Malagasy couple heading in my direction. Having dropped them off I, unusually, failed to slide into the middle of the bench, preferring to stay on the right hand side and feel the breeze on my face. As we approached the office belonging to the Regional Director for the Ministry of Population, where I work regularly, I let my mind wander. Then I heard a crack and suddenly my world was literally turned upside-down.

I wouldn’t learn this till later but what happened was that the axel broke and the front wheel of the tuk-tuk came off and went under the vehicle forcing us to loose balance and roll. All I knew was that in an instant I saw the form of the driver twist horizontal and I fell from the tuk-tuk to the right and my body hit the tarmac- a split second later so did the tuk-tuk, trapping my left foot beneath it. But the tuk-tuk didn’t stop, and I was pushed along by the cage of the machine as we slid further down the road, my foot being dragged along between road and metal. When we stopped I heard someone screaming, it was a good few seconds before I realised it was me. I was still trapped inside the body of the vehicle with my torso on the road staring at the sky, but when I looked down all I could see was my leg disappearing beneath the cabin of the cab. I continued to scream, I couldn’t control it and then into the field of blue sky in my eye line came the silhouette of a head.

In my shock and confusion my French abandoned me but with gestures and mimes I got him to understand. With great effort he lifted the tuktuk off the ground, for a second he faltered and I braced myself for the machine to come crashing back down onto me, but then several hands reached through the roof cage and pulled me, mercifully, away from the cart. In the only French I could muster I screamed out “Hopital, s’il te plait, hopital”.

The rest is a blur- within minutes I was carried into a passing taxi- I remember thinking about all the bank documents in my bag and screaming our “Mon sac! Mon sac!”. The face of the Regional Director of Population appeared at the window, worried and afraid and a man sat beside me, cradling my foot, which until this point I had been too scared to look at- but there it was, pink and black and bleeding and most definitely broken. I remember calling my friends and volunteers telling them to meet me at the hospital and then we were pulling through the gates.

The closest hospital, which is where we arrived, is a large local establishment of questionable reputation and my heart did not lighten at the sight of it. Just last month an article in a local paper had described a rather interesting state of affairs whereby a lack of staff during the night left corpses unattended in the morgue, where they were then being eaten by rats. I must say I was not disappointed when they took one look at me and sent us packing in the opposite direction to ‘the new hospital’- Hopital Manara Mipetra.

By the time I reached the new hospital my team was already there. My friend Laurence, who I begged to act as translator, my volunteer Roxanne, who is familiar with the running of the centre and therefore could act as go-between for me with work and Kristen, our new American volunteer who happens to also be an almost-doctor familiar with the Malagasy medical system.

I was hoisted onto a gurney, lifted by several men pulling my body and one gingerly holding my foot. I was shadowed by my team, asking questions to the doctors and generally looking out for my best interests, making me feel safe but definitely annoying the doctors. I was lying next to a man who did not look well- his family informed us he had been attacked by Foroche, the local name for the gangs round here. While I held someone’s hand my foot was cleaned and prodded. Things were said about police and the driver and x-rays and every time I needed some gauze or betadine someone had to write out a prescription to be taken to a pharmacy to be filled by one of the girls. The population director’s face swam in and out of view as did the social worker, a UNICEF rep and several other familiar faces. Seems like word spreads fast in a town like Diego.

My mind was spinning, between the pain and confusion of the accident and its implications the hours between my arrival and my transfer to the surgical ward are a daze. I was in agony and every time I needed to be moved a team of men were called to lift me from one bed to another, wracking me with pain. The injured foot was sutured when the IV increased the bleeding to a worrying degree and I started to feel nauseous. The only pain relief available was paracetamol and I received 1g every six hours, no more than you would for a simple headache. When I arrived at the surgical ward Laurence’s god-mother Yvette was there and I was so relieved to see her I wanted to cry. She is Malagasy and was onto the business of police records and prescriptions, doctors and pain killers so efficiently I thought I could never have loved anyone more than I did her in that moment. My doctor was in surgery, we were told, and would come and see me later.

I couldn’t look at the foot, it made me feel sick, but I knew it wasn’t pretty. To stop it moving they put the foot in a rigid basket, the sight of which made me more worried than ever. It was a simple metal wire cage, cased in plastic paint that was peeling off as the rust poked through and my foot was placed directly into it without so much as a towel to separate the ruined skin from the rusting metal. I was taken up to the surgical ward and left like this for 9 hours before the pain of the metal digging into my raw foot lead me to beg them to bandage it up. This in turn lead to another charade of prescriptions being written out for betadine and gauze, bandage and jersey and even cotton wool, none of which could be provided to me directly by the hospital and necessitated endless trips by my friends to various pharmacies until they had everything they needed.

At some point during the next few hours several people came to visit, including the driver of the tuk-tuk, who was devastated by the state of me and got a bit emotional. I knew the accident wasn’t his fault and was touched by the guilt he was feeling. He said he had driven these three-wheeled taxis for 5 years and never had an accident. He said it was a day he would never forget.

Eventually my surgeon came in. I was surprised to see a neat little Malagasy woman at the foot of the bed. She was kind, efficient and explained the situation clearly- there were three separate broken bones in the let and it needed surgery to pin them back together. They did not have the necessary materials and even if they sent for them we would have to wait an unimaginable amount of time and even then there was only so much she could do. Her suggestion: I be shipped to La Reunion and seen to by doctors there.

This news started the chain of phone calls between my insurance, my Malagasy surgeon, a hospital in La Reunion and my unwavering step-father, a doctor himself and a formidable man, which lead to me being accepted for a medical evacuation, which would take place the following day. I slept fitfully that night, exhausted but in agony with Laurence in the bed beside me. At the orphanage the volunteers worked their magic and packed my bag for the trip. The next day some of the staff came to wish me well and promised to look after my babies while I was away. Laurence selflessly elected to postpone her own work and come with me as companion to Reunion to act as translator and comforter so I wouldn’t have to be alone. By the time we got into the ambulance to the airport I was feeling hopeful that my recovery would be quick in Reunion and see me back at work by the following week. Little did I know then, that this would be the beginning of a long road to recovery.

The journey to Reunion was horrible. It started with the ambulance ride to the airport where the young man driving was obviously delighted that his siren allowed him to drive like a lunatic, despite the fact we were in no hurry. We asked him to slow down, and were ignored, until a truck pulled out in front of us forcing the ambulance to swerve wildly to avoid collision. As the vehicle fishtailed my gurney bounced around the cabin and I started to cry. At this point Laurence made herself extremely clear, telling the driver in no uncertain terms that he was an idiot and we had no plans to have yet another accident on the 15-minute drive to the plane!

When we arrived at the airport the ambulance went off-road to gain access to the runway and the jolting and bumping made me wince. We waited an hour and a half on the tarmac before finally being allowed on the tiny private aircraft that would fly me to salvation. The men once again heaved me out of the ambulance and placed me on a plastic sheet on the ground. In the wind and dust of Northern Madagascar I was wrapped up in the plastic and tied down and several men hauled me into the plane- the experience was not smooth or coordinated and necessitated my being laid down on the steps and the ground and repositioned several times before I was actually lying comfortably on the bed. We were then informed that was would usually have been an hour long flight would be stretched to three by the capacity of the aircraft and we took off on the most turbulent ascent I have ever had the misfortune of experiencing. I was stressed, tired, afraid and in pain, and although I owe each person who played a part in this transition a debt of gratitude I am ashamed to say that I was not feeling particularly grateful at the time.

At some point during the flight I drifted off to sleep. I was flying away from the Indian Ocean island that had been my home and comfort for the last 9 months and leaving behind the children and staff who had come to mean more to me then I ever could have imagined. I would wake up on the descent to Reunion feeling emotional and frail and not at all my usual ballsy self. But that story will have to wait till next time because all this remembering is making my head hurt and I need to have a rest…

Part 2- thoughts from the colonies...

Reunion Island takes your breath away- there is no other way to put it. It rises up out of the water like an animal. Lush green mountains, appearing as from nowhere out of the deep, blue sea. The roads that snake along the base of the cliffs with their parade of tiny ant cars only reaffirm the immenseness of the body of the island. Saint Denis is the capital of Reunion and on the descent I saw the city tumbling down the valley like a river, little white buildings like cresting waves snaking their way to the sea in an ever widening path to freedom.

I was exhausted by this point, awed and amazed by the sharp mountains on one side of the runway and the tempestuous sea on the other. We landed at sunset and by the time I was manoeuvred out of the plane and into the waiting ambulance I was in a strange sort of daze. I watched as the plane doctor administered my one and only taste of morphine.

The hospital was well into the night shift by the time we arrived and we were ushered through check-in, x-rays, ward transfer and so on in record timing. Everyone expected us and was aware of our imminent arrival and I had only been in my room 2 minutes before the phone rang. It was my mother and Pierre, full of concern and eager to let me know that the surgery was scheduled for the next morning. I fell asleep that night with the strange peace of knowing that this is where I would be fixed up to be sent home. I already missed the babies and my doggy and was longing for the next morning’s surgery.

The Belle Pierre hospital is nestled up against the side of a huge mountain, vibrant and green it reaches up into the clouds as birds circle constantly around its base. I am lucky enough to be in orthopaedic ward, room 721, from which I can see this beautiful piece of scenery laid out before me like a peace offering from the universe.

It has been over a week since I arrived and wrote this introduction and it is too much to give a blow-by-blow account of my time here. I will make do with a summary and beef it up with my musings.

 On the morning after I arrived I was taken to surgery- at first I was advised to do the surgery awake with an epidural but I think one look at my face told them this might not be the best plan and that having me asleep was probably the wise choice. I didn’t wake up until the following morning; Thursday. I was still exhausted when I finally surfaced a full 24 hours after my surgery. I had expected a day of not much happening, but my physiotherapist turned up to get me out of bed on an walker to get myself to the toilet, to sit on an armchair and generally start moving around. The doctors turned up next with news; the surgery had gone well, the break had in fact been ‘open’, contrary to the information they had received from Madagascar, making the whole thing a little more complicated. The plate with its seven little screws had gone into the thin outer bone above the ankle and the heavy duty pin and screw had been placed through the thick inside bone with no problem but they had come across something they hadn’t expected: necrosis.

my new hardware

At some point during the 48 hours before the surgeons in reunion unwrapped my leg the inside portion of the foot and ankle on the left side (which had been dragged worst along the road beneath the rickshaw) had begun to die. I had three spots of necrosis and because they hadn’t been told about it in advance and had no idea at what point it had set in they also didn’t know how bad it was. They tenderly tried to explain that they would change the dressings, clean it and generally keep an eye, all the while pumping me full of antibiotics and good thoughts, but that it would be at least a week before they would know whether further surgery to remove the necrosis and skin grafts to replace them would be necessary. And so the wait began.

On Friday I had my first shower since the accident and Laurence and I spent a full 2 hours trying to brush out the matt that had developed in my hair from being dragged along the road. On this day the surgeon also turned up with a scary looking power saw and made big windows in the cast so as to expose the damaged skin and allow for dressing changes and better access to the necrosis. I tried out crutches for the first time and barely made it down the corridor- and even that was with my huge physiotherapist taking most of my weight on the left side. My least favourite part of this day that I remember was the beginning of the anticoagulant injections in my stomach that ward off blood clots. Eventually I will have to learn how to give these to myself as they are planned to continue the duration of the cast and well into my time back in Madagascar.

At some point on Saturday they came and looked at the necrosis and informed me it looked superficial and that, although they would not be able to say anything for definite until the middle of the following week, it was looking promising. Then I had my first dressing change; it is not a pleasant experience what with the hydrogen peroxide which burns like a mother <?!/*%$^ and the dressings getting stuck to icky bits and the dead skin having to be removed slowly but that first dressing change will be burned into memory for one other reason- they had to pull the drains which had been leading into the surgery site out by tugging them out of the sutures in the foot and up through the cast till they came out the top. If I NEVER have to have that done again it will be too soon. They are seriously lucky I didn’t vomit on their nice sterile dressings.

The days passed fluidly into one another, I was still having the dressings changed every other day, a painful and unpleasant experience which breaks up the monotony of the day and at some point over the weekend they removed my IV making it easier to move around. I walk around the ward on my walker three times per day to try and get used to the movement and build up muscles in my arms for the crutches. Laurence had been going to town to do work at the library during the days and coming back in the early evenings with treats and photos for me, after which we would eat dinner and watch a program before bed.

Throughout this time, with the exception of two very down days, my spirits have been up and my belief that I am one of the luckiest people on this planet has been reaffirmed tenfold. I do not know if it is the cosmos, or my family from beyond, or God, or karma, or what- but something, somewhere is watching me all the time and surrounding me with a giant golden bubble through which very little bad stuff ever penetrates. I am in a hospital filled with people much much worse off than me and the state of the new arrivals from Madagascar proves that I pretty much walked away from what could have been a disaster. The most recent Madagascar story is a young woman who was mugged in Nosy Be and arrived here a couple of days ago- the would-be thief slashed the strap of her bag with a machete when she was walking along with two friends in this tourist hub, but he misjudged the attack and instead of walking away with her bag he slashed her hand and cut off her fingers. I will not dwell on these horrible stories, but the superstitious Reunion Creole and all the Malagasy I spoke to before I left are convinced that the accident was set to do me much more damage than it did, but then something stepped in to protect me, and to be honest who am I to argue against this under the circumstances. For some reason I am charmed.

This has only been reconfirmed through the rapid spontaneous improvement of my necrosis, which is getting better on its own and will probably require no further surgery and just continued cleaning and antibiotics.

I am only human and I have shed many tears this week from both physical pain as well as a depression of spirit on my down days but I would like to make clear that my overwhelming feeling this whole time has been one of extreme good fortune. I am so so lucky that the accident was not worse, that I was alone in the journey and not with any children or staff, that I have such good friends who looked after me those first few days and one who even crossed borders to be at my side. I owe much to my colleagues and volunteers who have continued to run the centre while I have been away and to every single doctor, nurse, orderly or cleaner who had made this experience as positive as possible. I was touched by the concern and proactivity of my family members and the support that was given to them by our friends. For all this and so much more I can never thank everyone enough.

My last thought is a message to whatever is out there looking after me: I am sure you are doing it for a reason and I will work very very hard to make sure that whatever I am supposed to do in return gets done to the best of my ability.

It is now Friday the 16^th and I have been here for two weeks. Laurence left today to go back to Mada and I received my first picture of my leg post-op, screws and pins and all. I will write again soon, but for now progress is good and I have a lot to smile about.