Leaky pipes

By Missy McCoy

Global Outreach | Missy McCoy

Location: Ngaoundéré, Cameroon
Mission: Finding social context behind disease

Drip.
Drip.
Drip.

Sweat poured like a river out of my pores, streaming down my back as I tugged at the giant tumor with my trembling hands. I held the soaking monster out of view of the surgeon as he meticulously tied one-handed knots around the neck vessels threatening to burst.

Drip.
Drip.

The patient’s blood puddled on the stained floor, swirling into a tributary on its slow journey toward the drain four feet away.

Drip.
Drip.

The mold-encrusted air conditioner gasped, desperately attempting to expel air. A three-inch spider scuttled past. It sank in that I was far away from my pristinely sterilized, disposable-everything, rigorously documented surgical rotation in a world-class teaching hospital.

I focused on this mother of six, with her soft dark eyes, wisps of gray starting to appear in her tightly braided hair. I held her hands before the anesthesia took hold, and remembered how rough and strong they were, hands that told a story of harvesting manioc and groundnuts. I needed her to be strong right now.

More blood dripped.

Her massive tumor, a surgical “zebra,” was caused by iodine deficiency (a rarity in my own country). How ironic, I thought, in sub-Saharan Africa — land of the zebras. I had to remember she was one of the fortunate ones with the meager funds to receive treatment. As I placed a drain and sutured the gaping incision back together, I imagined sewing the broken pieces of her life back together, in this drippy hospital, a part of a gushing broken system.

Drip.
Drip.
Drip.

I walked home, still dripping in sweat, thirsty and exhausted. I was still not accustomed to the baking sun of the dry season of the southern Sahel. A crowd gathered ahead of me on the road. A broken pipe jetted water into the air. The pipes here are practically constructed for failure. Brittle plastic pipes, which beneath the dirt road are exposed by erosion from rainfall. With time, passing vehicles inevitably rupture the pipes, leaving all those downstream affected.

Precious water snaked its way toward my Cameroonian family’s little home at the bottom of the hill. Where does the blame lie in a cracked community water main? Who would pay for this damage and the strain it caused? Surely working through this together would be more useful than making accusations, as was now happening. For now, assigning blame was a purely human response in the face of stress.

The next morning on my walk back up the hill, the water still flowed, my sweat still dripped, and my mind brimmed with questions. How was my dear patient recovering? Would the 54-year-old with charming crow’s feet and the soft, French-speaking voice I had listened to so attentively still remember me? When I arrived, I glanced to her bed. She was nowhere to be found. Odd. My heart pounded. Where had she been transferred?

A vital pipe had burst.
She died in the night.

The surgeon tensely explained to me he was sure the nurses had been negligent.

The nurses found her after the vessel in her neck had ruptured. They desperately grabbed sponges, removed the drain to divert the flow away from her airway, and did the best they could with what they had. It was too late.

Had the nurses been negligent? Perhaps they would tell a different story of poorly written job descriptions, inadequate training, and corruption that had led to missing paychecks for months. This system was leaking in so many places; it was practically constructed for failure.

Drip.
Drip.

Tears streamed onto my green surgical scrubs. My heart threatened to burst, pounding so hard I was sure it would be overheard. Overwhelmed, I sank into an empty rust-covered wheelchair in the cluttered corridor, sobbing. This scene would have played out so differently at home. Anger was palpable in the air around me.

On my way home, the crowd still surrounded the burst water main. Now using buckets and bottles to detain excess water, my neighbors made the most of their scarce resources to alleviate the issue. I wondered, who was responsible? Maybe the manufacturing company was at fault for making such weak pipes. What about the driver who ran over the pipe? Maybe the leak was just another consequence of a government failing to invest in infrastructure for its citizens. How could my neighbors, women selling 10-cent bags of groundnuts for a living, solve all these problems?

Likewise, who was responsible for the tragic death of my humble patient? Was it the powerful surgeon, giving commands from the high ground? Was it the overworked nurses, trying to follow the post-op orders from below? Maybe the lack of functioning equipment was to blame. Looking closer, maybe it was the hospital itself, selling health as a commodity rather than providing it as a human right.

Drip.
Drip.
Drip.

Privilege and power do not easily trickle down. The memory of my patient has inspired me to charge upstream, alongside nurses and neighbors, in more authentic partnership. We must work toward a more cohesive system, one that starts with the problems upstream, in order to stop the hemorrhaging downstream for the ultimate realization of a world with fewer leaky pipes.

Published on March 24, 2015

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