Casuality

Egypt, Winter 2011

Late one afternoon, whilst I was descending a short flight of stone steps in the temple at Karnak, just outside the city of Luxor, I twisted my ankle.

In the fading light, mesmerised by the massive stone columns all around me, the largest in the ancient world, I missed a step, stumbled and fell……

When I got up, my ankle hurt.

That night, back in my room, it began swelling up.

I was staying in a seedy end of Luxor, in a low budget hotel. It reminded me of Old Dehli; there was a maze of narrow streets thronging with people and traffic. I liked the area. It was boisterous, run down, and colourful. It was a place where one could get pleasantly lost in, especially in the evenings, when it was cool and everyone appeared on the streets.

But that evening, I couldn’t go anywhere.

The pain in my ankle was searing.

I hobbled to a small backstreet restaurant but half way through my meal, with the pain throbbing in my ankle, I realised I needed medical attention. It occurred to me that I might have broken my ankle and it that was the case, then my trip was over.

The owner of the restaurant ordered me a taxi and told the driver to take me to the casuality department of the nearest hospital.

Casuality?

All I needed was a doctor. But I was in no mood to argue the point. The taxi appeared and away we went .

The taxi driver hurtled down a rabbit warren of narrow back lanes lined with small shops and cafes and milling with people. He seemed determined to kill me before we got to the hospital.

It was a surrealistic journey.

After what seemed like a prolonged tour of every back alley in the old part of Luxor, I was let out near the hospital. There were cars and people everywhere. There was a large mosque and a bazaar. I was completely lost.

Then I saw the hospital.

I hobbled towards the entrance and was accosted by a man who spoke English and assured me that he worked at the hospital as an orderly and was off-duty.

This might have been true but on the other hand it might have been complete nonsense. A westerner on his own, limping, lost, represented a golden opportunity.

I believed him in any case and thought that I had had a stroke of luck.

His English was reasonable, but he had a problem with his verbs. For example he told me that his wife died next year – I presume he meant last year – but then again, it’s also possible that he wasn’t married at all.

Inside the hospital it was pandemonium, a byzantine world of women of all different ages, dressed from head to foot in jet black, crowding the passageways with screaming children in tow or sitting next to aged parents or parents-in- law. The walls were grimy, the floors dusty, there was no equipment to be seen and no nurses.

He led me passed all these women and their kids and old people and I felt guilty; I was evidently going to the head of the cue.

This wasn’t right.

On the other hand, I badly wanted to find out what was going on with my ankle.

None of the doctors spoke any English. The only person who spoke English was my orderly and he kept on speaking to me in future tense.

‘You will break your leg’

‘I have hurt my ankle’ – pointing at my ankle and saying ‘er, this is an ANKLE’

‘Angle?’

‘Alright, yeah, ‘

‘You will break it.’

‘I have broken it’

‘You will need doctor’

‘Yes!’

He told me that the doctors at the hospital ‘will be his friends’.

They certainly would be after I paid the bill.

I was taken to an empty room lit by a fluorescent tube where black clad women tended old sick relatives.

Then I stood in a line for the x ray machine which looked like it might have been one of the very first models made.

Later, the ‘orderly’ led me to another room where there was a bed, a bowl and a desk. Nothing else.

In the corridors, kids wailed at the top of their lungs.

A doctor appeared with the x ray and announced that there were no broken bones but the ankle was badly sprained. It had to be put in plaster.

The ankle was wrapped in bandage. A white mixture was stirred up in a bowl and applied to the bandage. Whilst this was happening there was an ongoing conversation between the ‘orderly’ and the doctors – probably to work out how much everyone was going to get from the westerner.

My ankle in plaster, I was taken to the cashier, an old man behind a little counter.

More chatter.

The bill came to 110 Euros – an enormous amount in Egyptian pounds.

This was a gouge job, but since it was going on insurance I didn’t care too much. I made sure in any case I got a receipt. At this point I was relieved that nothing had been broken.

Accompanied by the ‘orderly’ who chattered 15 to the dozen in future tense, I went outside and got into a taxi and we went to the nearby bazaar to get a sandal to put my plastered foot into. After getting my foot into the sandal, we went out into the busy street to a pharmacy in order to buy an anti- inflammatory. On the way we passed a mosque where the call to prayer was going up and hundreds of men were prostrating themselves on the pavements.

We got a taxi back to my hotel; I paid the taxi driver way too much and gave the orderly 30 Euros. He had done well for himself (and he had obviously got his cut from the bill at the hospital).

Late that night, I dreamt that a mummy was knocking on my door and demanding to come in. I yelled out to the mummy that I couldn’t get up because my ankle was in plaster.

‘So am I!’ yelled the mummy, voice rich with indignation.

My experience in Luxor, whilst memorable and in hindsight, amusing, was soon relegated to the past. Over the following years, travelling in many different parts of the world, it vanished from my consciousness.

Then one day, out of the blue, it appeared before me vividly.

At the time I was lying on my back with my eyes closed, once again a casualty.

This time however it was in a very different place…..

The Netherlands, Winter, 2016

On a Sunday morning in the winter of 2016 in Rotterdam, I fell off my bike. There was a strong wind and beneath the snow on the bike track there was a hard layer of ice. I wasn’t wearing a helmet, which wasn’t obligatory in The Netherlands (after this incident, I promptly went out and bought one).

The fall off my bike was like in a dream. One minute I was on my bike, the next minute I was sprawled flat on the ground. There was no sense of the bike keeling over and me falling. As soon as I got up I knew that there was a problem. There was blood on my clothes and on the snow. The blood was coming from my forehead.

Two other bicyclists stopped and helped me up and offered to phone an ambulance. One of them studied my forehead and said that it would definitely need stitching. For some reason I didn’t want an ambulance. Instead, I held a handkerchief to my head and rode home with one hand. The sunglasses I was wearing helped keep the blood out of my eyes.

When I got back to our apartment, Anya phoned up our local doctor and got a message on the answering machine which advised that cases which needed immediate attention – and could not wait until the Monday – go to the casuality department of the nearest hospital. Anya phoned a taxi and off we went with me holding a piece of cloth against my bleeding forehead. I was ready for a long wait before getting any assistance; after all, it was a weekend and if there were emergency cases (a serious motor accident for example), they would naturally get priority.

I was in for a pleasant surprise.

At this hospital, the situation was different.

On the weekends, emergency cases were taken by the hospital and non-emegency cases (especially people who couldn’t get to their local doctor) by a separate department. I showed my health card and within minutes found myself in a room lying flat on my back on something half way between a bed and a dentist’s chair. A nurse appeared and began cleaning up the wound. There was apparently a deep jagged cut above my right eye.

Whilst she was cleaning up the wound, we chatted.

‘It’s a change to see someone come in here for a good reason….’

‘Good reason?’

‘You wouldn’t believe some of the people we get in here. They come in for the flimsiest reason or really no reason at all. They’ve got a headache or a sore toe or they were driving around in the area and thought they would pop in and have a check-up. When you explain to them that we aren’t here to serve as a general wellness centre, they can get very nasty. They’ll yell about their rights and how they’re going to lodge a complaint and so on. The more you do for people the less they appreciate it……’

She put a large cloth over my head with a small hole which fit snugly around the wound. I couldn’t see anything then, only hear her say before she left:

‘Doctor Rastaffa will be in shortly and stitch it up…’

I heard someone enter the room.

He spoke Dutch with a strong accent but I couldn’t work out what kind it was and of course, I couldn’t see him either. Living in an area where most of the residents belong to a foreign culture, I could usually pick accents but this one was new to me.

He asked me if I wanted a local anaesthetic.

I did, I was no hero.

I felt a series of pin pricks on my forehead. He told me it would take 10 minutes for the anaesthetic to take effect. He left the room.

I closed my eyes. No point in looking at a white blur.

‘The more you do for people the less they appreciate it……’

Then it happened.

Memories of the night at the International Hospital in Luxor came back to me as if I watching a film: the trip to the International Hospital in the mini-van, the orderly with his future tense English, the black burka clad women and the screaming children in the corridor, the empty room with the woman and the old man, the taxi ride to the bazaar, the warm dark night……

In the film however I wasn’t a privileged western tourist getting priority treatment because I had medical insurance and could bribe my way to the front of the cue, no, I was an Arab man with a gaping cut in his forehead having to wait his turn…….

You went to another very different country to go on an adventure, to satiate your inner restlessness, your curiosity, whatever – and then you found yourself confronting what it might mean to be someone born on the other side of the world’s Great Divide…. ..

The doctor reappeared and began stitching.

I could vaguely feel a kind of pulling and stretching on my head. In his accented Dutch he told me he was putting in two levels of stitches, one inside the wound and one outside – 11 stitches in all – to try and minimise the scarring after the wound had healed.

When he was finished he said: ‘I’m afraid that you’ll end up with a scar above your eye. The cut was deep and jagged.’

‘This’ll sound strange’ I offered, ‘But I feel very lucky…’

‘You’ve been lucky alright, you could have died. A wound like that, normally that’s the kind of thing I’d expect to see from someone who’d fallen from a racing bike….you fell in such a way that you only hit the side of your forehead. ’

He misunderstood me.

I told him about my night at the hospital in Luxor and how it brought home to me how all over the world, there were billions of people who did not have access to adequate medical care or really any kind of medical care at all. Here I was in a place where I could get excellent treatment within a short space of time (and what’s more I didn’t need to bribe anyone).

There was a short silence.

I thought he had left and that I had been talking to myself.

Then I heard a voice.

I can still hear it.

‘Physical wounds we can fix…the others, well…there’s no treatment for them… the hate….that’s the worst ….it tears up human beings, women, children…

The worst I have to see here are cuts and bruises, fevers and sore throats…but no one covered in burns, missing limbs…children maimed for life…people dying….’

I didn’t know what to say. It was a very different take on matters than what the nurse had told me.

The Doctor left. He had a patient in an adjoining room.

The nurse removed the sheet from my face and I opened my eyes and stared up a white ceiling. As she applied a large piece of adhesive bandage over the stitches, I asked her about Doctor Rastaffa.

Where was he originally from?

‘Iraq’ she said.

Iraq: at the time it was continually in the news for all the wrong reasons. Suicide bombers, mayhem.

Hate. No cure for that.

In the reception area I met Anya and as we left the casuality department and walked to the nearest bus stop, I had a feeling that I’d been on a long journey which was now coming to an end.

From Egypt to The Netherlands.

When the wound was healed and the stiches removed, another journey would begin….