rambo

south africa is such an interesting place. things happen here that surely can't happen anywhere else in the world. take illegal mining in barberton for example.

barberton has some of the oldest deep gold mines in the country, maybe even the world. the gold rush in barberton happened long before gold was even discovered in johannesburg. of course the massive amounts of gold in johannesburg drew all the prospectors away and left barberton as a tiny, insignificant lowveld town with ghost mines. as time went on, it once again became financially worthwhile for the mines to be opened, although really only on a much smaller level. but once it became clear that there was still gold in the mines, the illegal miners were born.

it is difficult to fully understand what an illegal miner is. imagine people going down air vents and other such unmapped openings into deep underground labyrinths of once sprawling mines where they apparently stay for up to a month or two at a time illegally. they work mainly at night when the legitimate miners are no longer there and melt into the many unchartered tunnels during the day. being south africa, of course the propensity for violence is always there, so, when you put together your mental picture, add quite a number of ak47 assault rifles smuggled in from neighbouring mozambique.

so of course when the people in power  decided to rid their mines of illegals, it wasn't going to be enough to simply leave pamphlets lying around asking them to please leave. they decided force might be a more traditionally south african option. fortunately after our bush wars in namibia and angola we have an abundance of highly trained soldiers so to find hired guns is no problem at all. and in the end, that is what the mine executives did. they hired guns.

i was on call the night the barberton hospital phoned. they apparently had a gunshot patient shot with an assault rifle they wanted to send to me. it was different from the normal 9mm wounds i was used to seeing so i was frankly quite keen to accept the patient no matter what the injuries. it was going to be exciting, i thought, except of course a head injury. then the doctor said something even more left of the ordinary.

"bongi, they are going to bring him in themselves. it will take too long to wait for an ambulance." i was confused. who were the they he was referring to that were going to bring him in? how were they going to bring him in? was he going to be dead when they brought him in? these thoughts slowly migrated through my mind on their way to my mouth but before i could ask, my colleague had put the phone down. i was left with almost no idea of what to expect, but i at least knew it was going to be interesting.

half an hour later i was waiting at the entrance to casualties in true grey's anatomy style. for a split second i even felt more like an actor than a surgeon and nearly went back inside. but in the end my curiosity got the better of me and there i stood like the leading part in a hollywood production in the warm lowveld night waiting for something that i somehow knew was going to be out of the ordinary.

they arrived. it was out of the ordinary. a bakkie roared into the hospital parking area, apparently totally oblivious of the speed humps in its way. it came to a skidding halt just in front of me. immediately the driver got out and moved around to the back. his most striking feature was the r4 assault rifle strung over his shoulder, but it was only fractionally more striking than the rest of the man. he wasn't a particularly tall man, but he was well built. he wore black leather clothes, contrasted sharply with a dirty red bandana tied around his head. on his belt he had about four magazines for his rifle. quite clearly he was ready for quite a fight. then i noticed his face. it was calm and very nearly devoid of expression.

suddenly i noticed a second man standing on the back of the bakkie. he too was dressed like an action hero out of a low budget eighties movie, complete with assault rifle at his side and once again his face was without discernible expression. they reached down to lift something. only then, only when i heard the soft groan of pain, did i realize that the gunshot guy was lying on the back of the bakkie and this had been the they that were going to transport him. immediately i knew they must be the hired guns to flush the illegals out of the mines. there was ordinary and then there were these guys who were definitely out of it. i was intrigued.

they lifted the injured man and started carrying him to the doors.  they did glance at me as they went past but to them i think i looked too much like a tv doctor waiting outside to be taken too seriously. i scurried in after them, feeling somewhat sheepish.

the patient was in a fairly good condition for someone who had taken an ak47 round somewhere deep in the bowels of the earth and then been transported by rambo and sons over the mountain to our humble hospital, although he had quite obviously taken fashion advice from chuck norris.  i quickly rushed through the preliminary steps  to prepare the him for theater. then i went outside to speak to his colleagues, for quite clearly that is what they were.

"i'm doctor bongi. i'll be looking after your friend" probably the wrong choice of word, seeing as though i still had seen no display of emotion from any one of these guys, except possibly stoic resignation in my patient. "i think he will be ok." even this didn't move them. they looked exactly the same as they did when they still thought their colleague was sure to be dead by the morning. "tough crowd" i  mumbled to myself.

then i spent a bit of time trying to find out what had happened. i quickly understood their facial expressions.

they were part of a team hired to flush the illegal miners out. the plan was to go down the official shaft after all the legitimate miners had knocked off. then they were to push the illegals back and drive them out through the numerous secret tunnels that only they knew about. the only problem was this was day two of operations, so the illegals were expecting them. i put it together in my mind. a small group was going to go down in a lift into a mine full of armed criminals who knew exactly where they would be arriving.

"you went down in a lift into a war zone?"

"yes." expressionless.

"but they knew where you were going to get out. all they needed to do was wait for you at the lift."

"yes."

"yet you still did it?"

"yes." still no sign of anything close to emotion.

"why?"

"it's our job." did i detect the slightest hint of pride? no. it was probably the outside light reflecting off the wall giving a certain glint to his eyes.

"so what happened?"

"they were waiting for us. when the lift doors opened, they opened fire and hit our friend." i though he was using the word friend in a very broad definition of the word because i was fairly convinced the only interest he had in the survival or otherwise of my patient had more to do with who would they get to replace him when they went down the lift the next night.

"and once they had opened fire, how is it that you guys survived?"

"we fought our way out." at this stage the total lack of any expression on their faces was expected, but still i didn't expect it. it seemed to me that someone who goes into a death trap, sees his 'friend' get shot and then fights his way out to survival should maybe at least have the hint of something in his face at least resembling human expression or emotion.

i operated their colleague. i dissociated myself from his humanity, cut him open and got the job done. and then i realized. in so many senses, i too go down the lift into the dark depths of the earth full of people only out to see my demise. i too put myself in harm's way for some greater benefit and i too face trauma, albeit not my likely death. then i understood their blunted emotions. they were not too different from a surgeon.

steeped in blood

this post is a bit of a diversion from my usual posts but i think it may still be worthwhile. you see i want to promote a book.

i've just read the book steeped in blood (paperback or kindle) by david klatzow. what a stunning book. it really gives insight into the south africa of old and possibly what south africa of the future may end up being like. i really suggest that everyone gets hold of it and reads it.

unfortunately, david, i do feel i must challenge you on one point. towards the end of your book you say one of your surgeon friends told you a story of one of our cuban import surgeons who tried to do a tonsillectomy through the neck rather than through the mouth, the normal way of doing it. i know this story and have heard it often myself in the corridors in pretoria. unfortunately it is urban legend and nothing more.

i have worked with the cubans and they aren't too shabby. don't get me wrong, they are not a scratch on a south african specialist (although the standards are dropping as you rightly pointed out and quite soon they may be far better than home grown specialists) but the point is they wouldn't do something so bizarrely stupid.

i even suspect i know who your surgeon friend might be, especially if he presently finds himself in pretoria rather than johannesburg where you no doubt got to know him.

anyway, still an absolutely brilliant read for anyone who wants to get a peek into the workings of the apartheid government of old. go and buy it now.

bell bottoms

i recently went to prague. what a culture shock. the place is clean and beautiful and safe. i travelled quite a bit on the public transport and not once felt in danger even though i'm south african.

there is generally law and order. on the first day i went on the underground i did not stamp my day ticket because, being south african, i just assumed there would be someone to stop me and check. there was not. they rely on the people there being honest. being south african i rode the whole day essentially for free. then my conscience got the better of me and i bought another ticket so they would not lose money.

you see we south africans have no law and no order. we get away with whatever we can. we all speed and we all jay walk and we all bend all the rules as far as we won't get caught. in prague it is exactly the opposite.

but getting back to the story. one reason it was such a culture shock is because a while ago, to travel on public trains in south africa was quite risky. you see there were gangs that would throw people off moving trains for a laugh. there was also a time when certain trains would get attacked by automatic wielding thugs that would indiscriminately shoot people. these days there is more security (all armed of course) so it isn't quite so bad. there still is the occasional torching of a carriage if it turns up late. let it never be said south africans can't express their anger at trains not being on time.

anyway, while i was safely travelling on the czech (for americans, that is where prague is) public trains, i thought about a few of the patients i had seen. i don't think i'll talk about the guy that got corkscrewed between the train and the platform here. the bell bottom patient came more strongly to mind.

it was in the days of the indiscriminate throwing people off and in front of trains. most died on the scene, but a few got to us. for those who don't know, to get injured on south african train tracks is a sure recipe for sepsis. the trains drop their sewer directly onto the tracks, so to get an open fracture there usually ends up quite a mess. my patient was thrown in front of an oncoming train from the station platform. i suppose the people who threw him there thought it was quite funny at the time. we at the hospital did not.

the poor victim of this senseless crime fell with most of his body over the further track. in fact only one leg lay over the one track. unfortunately he had no time to pull his leg away before the train went over it.

now, to fully appreciate what happened one must realise the patient was fully awake and fully sober. he had in fact started extricating himself when the first wheel cut and mangled his leg about mid thigh. he continued to pull himself away. the second wheel therefore hit his leg about two inches lower down. the next wheel then struck about two inches below that and so on. so the leg was mangled worse than any mangled limb that i have ever seen and more than likely will ever see. it had deep cuts at two inch intervals. the femur was severely broken but it was not nearly as bad as his lower leg. the lower leg spread out like a bloody and distorted bell bottom ending in a very wide flat thing that had once been a foot.

suffice to say he lost his leg that day. (for up and coming south african surgeons, leave the wounds open from train track injuries, like we did. otherwise sepsis will set in and things will get worse.)

so while in prague, i was really confronted by the many acts of meaningless violence we see in our country because i had a clear picture what life could be like in a peaceful place. i honestly wondered what the point is here.

swimmer's chest

the following story isn't really mine, but because the meeting of the two protagonists happened in my presence during an event that i've previously posted about and because it touches on a very relevant south african topic, i thought i would pen it down.

when i was in my training, a very good friend and i had the privilege of treating a pregnant woman with a gunshot abdomen (take a look at the incident here). when we took her back a private consultant who was associated with our firm offered to join us in theater. but he was no ordinary private surgeon. he was one of only a few hepatopancreatobiliary surgeons in town and a particularly good one at that. truth be told, the reason he offered to join us had to do with the fact that i initially thought that the hepatic artery proper had been shot off. as it turned out the artery in question was an aberrant left hepatic artery and didn't count for much so his presence was not needed, but that is beside the point.

the consultant had never met my junior colleague who was a bit late for theater that day because he needed to sort something out in the wards. when he joined us we had just opened.
"sorry i'm late" he said "i just had to sort something out in the wards."
"doctor 'consultant' this is my colleague and friend doctor b." i said by way of introduction.
"are you a swimmer?" asked the consultant. there was a moment of silence.
"no." answered my friend, somewhat surprised.
"you look like a swimmer. you have a swimmer's chest." at this my friend looked down at his own chest concealed by his theater gown as if to see what a swimmer's chest looks like. even in the presence of this prestigious surgeon and, it seems, swimmer enthusiast, i laughed out loud. from that moment on i always referred to him as the swimmer's chest.

time passed. it seems to do that quite well. then in true south african form, the consultant's family was the victim of violent crime. his house was targeted. his daughter and wife were held at gunpoint as the place was cleaned out. by south african standards it went quite well. nobody was shot and nobody was raped. but by standards of humanity it was too much. it helped him with the decision to leave these shores. thus south africa lost a great surgeon.

before he left he gave the swimmer's chest a call. basically he handed his very successful and lucrative practice over to him, lock, stock and barrel. what a gift. what a privilege to just fall into such a tub of butter, rear end first. what an extraordinary result of the ridiculously high level of crime in this beloved country.

sad update

last week i saw a picture in the local paper of god's window, absolutely identical in fact to the one i posted, so i read the article. it was about a tourist from gauteng, one of our provinces, who came to see god's window. apparently it was a lifelong dream of her's. in fact she apparently told friends it was something she wanted to do before she died. she stayed in a local lodge and visited the site. afterwards she signed out at the lodge, telling them she was on her way back to gauteng. it seems she decided to take in the view once more before embarking on her homeward journey. the next morning her raped, murdered body was found at god's window.

this is so typical of the paradox we live by every day in south africa. south africans reading this will be thinking she was foolish to go back at night because we know that that sort of thing is not safe. you might just get raped or killed or both. but why should we be scared in our own country? why is crime so out of control that we actually accept this as not too strange an occurrence? all i can really say is what allan paton said so well; cry the beloved country