Tragedy

Friday, September 20

Today was by far the worst day in Malawi.  I am dreading journaling tonight, and yet I have a desire to process the day so my mind can start to move on.  This day may be one that many of you want to skip and certainly it is not one to read with children. It has been a day of trauma and death.  The harsh realities of a third world country and a broken world.  

The morning started in the typical fashion.  Morning report was spent discussing scabies and the challenge they create for the HIV patient and for a hospital such as ours. Things like medicines that are hard to find and expensive to procure. Simple tasks like washing bed linens, that instead of using machines on the hot cycle and the dryer, here you need to boil the blankets to rid them of mites.  Things are already so much harder and then you need to do more.

Pediatric rounds went well.  Sam asked for the day off after rounds as he rounded last weekend and must do so again in the morning.  I thought that to be reasonable. We did have one patient that was admitted for a meningitis and convulsion concern last night, that in asking more questions today discovered a history of over 11 episodes of seizures over the last 2 ½ years.  The students and nurses were able to see in real time the value of rounding as a team and how their involvement led to a completely different diagnosis and treatment plan. Team rounding really does help.

Little Stella was working hard to breathe again this morning but with some diuretics was able to be comfortable and even colored for a while. The little one with TB was finally able to go home and I was able to arrange payment for the one with meningitis to go home with the bill paid on Sunday.  Dr. Alyson now has a tab with the business office. I just hand them a slip with a name written and pay on Monday. Good efficient system I think. (Love you Wayne!)

Lunch came and I enjoyed a grilled cheese while listening to one of the students tell me her story.  She had leukemia at 15 and her chemotherapy cause her to have a necrotic hip and then a hip replacement at 18.  She has been having pain on the surgery rotation just standing still for so long. However, she is cancer free and healthy.  We talked at length about her processing the reality that is she had grown up here she would long since have been dead. How much we take for granted.

The students headed back a little early but I still had time and read a little.  That is when everything changed. I got a text saying that my resident had heard there was a big accident near by and was heading in.  I went and put on my coat and gathered my things as I got another text from Melissa saying she heard there was an accident and was praying for all of us.  I called out to another student and told them to come along to help.

I hit the hospital and it was immediate chaos.  I was told to head to the casualty area. There were people everywhere.  And screaming. And blood. Everywhere. There are two long buildings with central halls and rooms off both sides.  Patients laid in the halls. Some were being stitched as they lay there. I was told there were children and directed into a small room off the side of one ER room.  Three children laid inside. The first a small girl on the floor in a pool of blood, already dead. Then a bed with two children in a bed. I went first to the furthest away with a fixed gaze. He was already gone.  The one closest to me was crying. He spoke English and was able to tell me that his leg hurt but nothing else did. He was stable and had a good heart rate and lungs were clear. He had an open fracture of his lower right leg that was wrapped loosely.  An IV was started.

I headed back out into the hall. They were stabilizing a man and women in the ED room and were moving to load the man into an ambulance. We were calling to move the boy into the ambulance as well but then someone came with a car that was family of the boy and we decided he was stable enough to go with them as it would be faster.  

Injured people continued to flood in.  It was chaos with women crying and falling in the floor.  Lots of adults were around with red shirts emblazoned with Ebanezer written on them. This is the local school.  The minibus in the accident was carrying the local kids home from school. So now parents were swarming desparate to find their children.  I moved to the room across the hall and found a man with an IV in laying in the floor. I assessed that he was alive and conscious but his abdomen was tender and rigid.  I called out for the adult physicians and then ran to get the radiologist and the ultrasound. They struggled to get that going as I went to look for surgery staff. The surgeons had all left-each in an ambulance with unstable patients headed to KCH the main hospital.  Therefore, we no longer had any surgery options, it was just to stabilize and move to ambulance. I ran back and delivered that news.

There was one room with three men.  All were bleeding from superficial wounds.  Two were conscious. On lay on the ground shivering with an IV in.  At first I worried about him having a seizure but it was just shivering.  He was talking to the nurse but confused. He then had purposeful movements and just seemed to be having some emotional shock.  I moved back down the hall.

One patient from the next hall was loaded in a waiting ambulance and the patient on the floor with the tense abdomen was loaded in quickly and sent them away.  He was probably needing blood but there was no more in the lab. We then moved to the next room that had the three. The man shivering was gone. The remaining two were an older man with a hip fracture but closed and one with a tender abdomen who we moved into the ER room.  His oxygen level was low so I ran with the student to pull a compressor from the wards. We got that hooked up and they worked on IV lines. They placed a jugular line while I talked to him. All during this, the screaming and wailing continued. I do not know if it was families discovering the dead or those relieved. The patient was able to tell us he had a sister.  We got her. The police came in and started collecting information.  

I had run out to inform that we would need another ambulance.  We were at first told it would be close to an hour with but with a few calls there was one in ten minutes.  Papers were just taped to patients chests with simply name if known and vitals and condition. We walked down the halls and our was clear.  We walked room by room and ensured patients had been addressed or sent. I am sure those with little injuries just were bandaged and stitched and sent out.  I believe we sent 10-12 in ambulances but many had gone before most of us even arrived. There were still two in the casualty room. One was sent and the other was moved to the medical ward.  I saw so many but do not know where they went.  

Writing this it seems linear and focused.  It was not. I did so much running, and spinning, and looking.  So much just being helpless and feeling helpless. Everyone was working and doing all they could.  The student nurses and nurses were amazing but it was devastating. And this was our village, our kids, our people.  So everyone also had those emotions and had people suffering that they knew.  

After the last ambulance left, I helped to pick up the needles and sharps that were scattered everywhere.  There was blood and medical equipment everywhere. Then we went to move the bodies to the morgue. We brought the gourney to the room with the children.  The girl was placed, bloody bandages on her face. My most profound image is her little crossed feet, bloody sock on one and the other with the sock crumpled into a little black maryjane.  Just little kids headed home from school. The boy was placed next to her and a chitenge put over to cover both.

I stayed a little longer to see if there was anything I could do.  The cleaning crews came in and slowly people drifted back to their stations.  Everyone stunned.  

I went back to the pediatric ward.  I did quick bedside rounds with the nurse as everyone had been left unattended.  Everyone was stable and doing fairly well. Catherine had been in town and had heard about the accident.  She arrived as we finished. Marleen was with her. Marleen's housekeeper was still missing a son. I described the little boy with the broken leg-he was near the same age, spoke English, and I could tell them he was wearing green underwear.  But when I discussed that someone had driven him away, they stated it could not have been him.

We ended with 3 adults and 4 children that had not survived here. Some died at the scene and others here. One women had one child die at the scene and the other was the young boy I had found.  They were her only children. The little girl is still not identified.

When I finally left, I found many hugs waiting for me at the inn.  Amelia was here and even Jonas was giving hugs. I spent a lot of time with Patricia cuddling.  She may well have lost some friends today. It really was only on my arrival that I heard the story of the accident.  A few miles down the road, a truck had evidently tried to pass a car and ran straight into the packed minibus carrying both adults and kids.  The vehicles were demolished. Throughout the evening, news has continued to come in. The boy with the broken leg was Samuel, the housekeepers son.  He is also related to Christina our housekeeper here at the inn. He is stated to be in the ICU but expected to live. Someone from the village was just looking out for him and was the transport.  The driver, a pregnant woman, and another child have passed away at KCH. I am sure numbers and stories will clarify in time. But, oh, our hearts are so heavy.

Nicole, has a new baby in her home, this little girl is related to one of Nicole’s adopted daughters so she may eventually end up adopting this one as well.  My calming therapy was feeding and snuggling with her.  

I want to end this in some way that causes those I love not to worry.  The truth is that at this moment I want to just run screaming from this place.  I want to be home. And then I am hit with how in this community I am the least injured, the least effected.  The rest are at home explaining this to their young children or grieving the children no longer with them. All of them are hurting.  Please pray for Nkhoma. Pray that they will turn to God and not away with this tragedy.