April 4th, 2006
Another outbreak of Kala Azar has brought MSF (doctor's without borders, Medecins Sans Frontieres) to Bihar, India. Bihar is one of the largest farming communities also the poorest and has the one of the highest illiteracy rates. We, the trained MSF, have been brought in by plane, train, motor bike and boots to visit the poorest of the poor. The ones most desperate for help.
Kala Azar is parasite. It's transmitted by bites from female phlebotomine sandflies—the vector (or transmitter) of the leishmania parasite. We're here to educate and kick it's ass and teach people not to sleep in the same quarters as their oxen.
I hurried to greet a head surgeon from China who had flown in to help teach local doctors. "Hello, you must be dumbass." I wanted to quickly shake that name and also not be rude. "Yes sir. Franklin Dumas." I replied. "I'm going to be your surgical assistant while we're here." He was short, thin, and had an intelligent look about him. "I am Dr. Cho. I am glad to have many hands to help." He turned and walked away with his hands folded behind his back. "Sleep a lot. Have early breakfast. There will be many, many sick." he said walking over mud on stepping stones made from bricks. I was not stepping on those bricks. I was about ankle deep in brown water with no idea of it. This was the moment I realized Dr. Cho had a lot of humor in him. I was Dumbass.
I walked around people in volunteer shirts outfitting hospitals. Some laying straw, others setting up miniature refrigerators with generators for medications. There were people carrying heavy body bags together already. They had been going door to door for weeks before our arrival to find people who had fever and other symptoms of Kala Azar. I could feel how green I was at this. A newbie, traveling to a foreign country for glory. I was Dumbass.
After a long day of laying straw, making beds, setting up hand-crank washing machines etc. I went into the heart of the village to eat and greet. Everyone recognized us from our MSF t-shirts. The people of Bihar were sitting in the open air parts of straw huts. They had woven fans fanning themselves and naked babies. Their smiles were comforting and genuine. I watched four men putting a ring in a calves' nose. The ox did not feel bad about it at all. There were men carrying heavy buckets on a yolk across their tired shoulders. The smell of hay, fresh dung, and human excrement was new for me. After finding the tent for MSF workers, I sat at a table to eat. A tall, platinum blonde with a tight crown braid sat next to me. She smiled "You look afraid." Her accent was thick and Dutch. She was a gorgeous person that looked like she had seen a lot and had much work in her. "It's a culture shock." I held out my hand "I'm Frank Dumas. You can call me Dumbass, I think it's more fitting." She laughed heartily and said "Well Dumbass, I am Astrid Fleming." We ate quietly together after this. Both of us had a lot to think about I suppose. Astrid pulled a bag of candy from her side pack. "Do you want Bilar?" I was puzzled but happy with her "What Is Bilar?" I asked. "It is like, eh, licorice candy." We sat and shared Bilar again, quietly.A Chai Walla came into our tent and offered us lovely tea. I happily took some. I only speak English, so I bowed to show gratitude. The man had a long white beard with a wide smile. Astrid said "Tack min vän." and bowed too. It was a great cultural experience.
When leaving I heard a woman singing. She was standing on a large concrete block and many people had gathered to listen. I did too. She had a beautiful red sari that flapped in the wind as she sang. It sort of took away the ox dung smell just watching her. A man wearing an MSF shirt came up beside me. He had a wonderful Australian accent. "You know what she's singing, yank?" I nudged him with a grin "Hell no, but it's nice." He crossed his arms and laughed. "Yeah, she's singing about why having nets over ya beds saves lives." I stopped smiling, intrigued. "Ya mate, she is Si Bhat. She is a communication and education advocate for us."
I lay awake in my netted bed. What would tomorrow bring? Would there be heavy body bags for me to lift too? It was a long, quiet night. Being alone with thoughts made things very loud in my head, though. I just wanted to turn it off so badly. I'm trained! I know what to do! Stop worrying.
At 0400 hours I was up, cleaning up and packing my side pack. Gloves? Check. Bands? Check. Capped hypodermics? Check. I feel sort of ready. I went out to the surgical tent to find Dr. Cho. He was already hanging saline bags and preparing beds. "Sir, isn't this work for the nurses and volunteers?" Doctor Cho turned to me and with dead seriousness he said "It's work for all of us. Go look outside." I did. There were sick already waiting outside of the clinic around the tent, the queue already seemed endless. "What can I do doctor?" I asked, sweating. "You can do without asking, Dumbass." Dr. Cho smiled a sneaky smile and kept prepping. Volunteers opened doors.
The queue began to file in. I gestured for patients to lie down, to let me examine them. Kala Azar makes swollen bites on the body with fever. In extreme cases, the liver swells and makes the abdomen look large. Women cradling babies covered in bites. Men, sunbaked and overworked. Teenagers wanting to get well to go to school. All begging me to help. One man came in with a very protruded stomach. He was being helped by Si Bhat. She led the man to me and pleaded "He will die like this. He's still working the field. Help him." I knew I had many ahead of this man, but none were so bad. I led him to a bed. Si said "He has been swollen for his whole life." I was very puzzled when she said this. It was not like a sandfly bite to make one live with protrusion. He should be dead! I hurried and found Dr. Cho. "Sir, I found this man. He is an anomaly I-- I've never seen anything like it. You must see!" Doctor Cho was very busy but did not have a surgical patient at the time. He looked at Si and the sick man. "Si, how did you find this man?" she bowed and said "I had found him going door to door. I asked how he had lived this way. He was called the pregnant boy and mocked by children. He needs help. This is his only chance."
Doctor Cho checked all of his vitals. Si interpreting for him. He said he could not breathe and thought he would die. "Dumbass!" Cho called. I ran to find him "Yes sir?" Cho said "We cannot leave this man like this. Find the doctors and nurses from Bihar and we will teach them." I nodded and scrambled to do his bidding. Motioning and trying to pull medical staff away from the sick was not easy. Astrid found me. She came and helped. She was more bold than I was. "We need you." she motioned to herself and the operating theater, pulling gently on a doctor.
After everyone we could handle was in theater with Ajeet, the sick man, we began sedating him. Cho slowly explained all of the steps he was taking, his Hindi was rusty as he said. We all used hand signals and pointing to help. We all expected to remove a tumor. He had an extremely protruded abdomen. His navel looked like it would burst. I donned a gown and helped everyone do the same, the whole time Si explained why it was important.
Cho carefully made a bilateral incision near his hip to the bottom of his rib cage. Fluid from the opening poured out like a fountain. Everyone stood back, a little horrified, even Cho. We all put on splash guards and kept cutting. Cho held out his hands and pulled a horrid curled mass from Ajeet. It looked like a baby that had been flattened, rolled back up and covered in hair. The arms and legs were long, with long finger and toenails. Cho stood and stared at what Ajeet had birthed. He looked at me and quietly said "Dumas. This is something you will never see again. I have never seen this. Only read about it. This is Fetus in Fetu. A parasitic twin. He was born with it in him." Astrid fainted right into the enormous puddle of fluid and blood. Si vomited into a wastebasket.
Cho carried the monstrosity to a table to examine it. "Dumas. Please attend the patient." I drained, sutured and medicated Ajeet. I took a long while to look at him. What this man must have went through. What awaits him now?
Letting Ajeet recover, the table quickly became crowded with medical staff and volunteers. I pulled Astrid up. "You have to get clean, friend. Then come see. You must." Astrid said "I will clean, but I will not gaze upon that." She ran out quickly. "No, no Frank. I will not."
We all stared. All too afraid to touch this... thing yet. Si attended to Ajeet as he awoke. He said he never had felt better in his life. Si told him "Please don't look friend. Just rest." She left to help other sick.
Doctor Cho pulled out some clamps and pulled the long, bony arms away from the tightly rolled body. Gasps and cries came from the staff. Cho held up his hand for siclence. I took the clamps from him. We donned new gloves and "unrolled" the parasite. It had a horribly smashed, resemblance of a face. A crooked nose, mouth and closed eyes. We immediately let go and let the thing roll back up. Neither me nor Cho was prepared for this. Bodies would have been a welcome problem in the face of this one.
"We will chill this in a plastic contamination bag. We have to do our jobs now." Cho said without taking his eyes off of the monster. I bagged it, sealed it, chilled it. Ajeet recovered quietly as we explained to him what happened. He did not want to see still. Volunteers helped him to a bed where he could recover alone. I went back to dipstick tests for Kala Azar and giving tablets of medication with pamphlets. The whole time I felt hands on me. Fingernails touching my back. That face looking at me. Dr. Cho came to me and gave me medication for nausea. "Me too." He said stoically as he walked away.
At the days' end I went to the room with the refrigerator.
Doctor Cho was already there. His back was to me. I stayed quiet, assuming he was dissecting the thing. I didn't really want to see. I backed out slowly and went to find Astrid. She was curled in her bunk, crying. The Aussie I'd met earlier was with her. "Oi, I can't believe that, dear. I'm sorry that you had to see that." I nodded to him. He stood and said "Hey there mate. My name is Jaime. I'm from Sydney." I smiled to him and watched Astrid. We sat on the floor. "I'm Frank, Ohio, good to meet you." We both put a hand on her back to comfort her. Astrid cried "I do not want to be touched. I feel I am being touched all of the time. I can't. Please, no." We both moved and kept our vigil next to her.
Tossing and turning on my netted bunk, I sweat. Not a normal heat sweat. A fever dream anxiety sweat.
I kept reminding myself that I was here to help; no matter what. Who leaves in the middle of the night like a coward? Me. I left my home as fast as I could. I read that astronauts come from Ohio than any other state. Something about that place must make you want to jettison off of the earth. I wanted to leave here. Now. I wanted to go home to my computer and toilet. But, this was something else too-- something was pulling at my head.
That night I slept. I dreamt of a mother, wrapping her babies in her own sari and downing them. When the children had passed she brought them to her breast and they lived again. She turned and showed them to me. One was a normal, charming baby. The other was the monstrous tumor we had removed. I held my hands out. I noticed how beautiful she was. Flowing black hair, red and gold trimmed wraps for clothing and a perfectly pierced nose. She held the hideous, pulsating creature to me. It's long, bony arms reached and hugged me close. I could feel it's cracked, yellowed fingernails on my back. I stared at the beautiful woman. She smiled "He's yours now. He is free. He needs you."
I awoke with a jolt. I felt I could piss.
I crept quietly from my bunk and into the tree line. I stood, thinking to myself "Just one look. One look and I'll be done. I have to cure this morbid fascination, it's only going to happen if I look at it." I tied my pajama bottoms and slunk to the outside of the surgical tent. "Alright conscious, you don't like me and I don't like you-- do I go in or not?" I thought. Before I could re-think anything I found myself walking through the primitive corridor. "Okay, if someone questions me, I'll just tell them I heard something. The generator sputtered. That should work."
I pulled back the curtain to the operation theater.
Cho was still there. I slowly backed out. "Maybe he was curious like me..." I thought to myself. Worried of his mental state I went to our medical supply locker. Thick and plastic. Almost silent to open. I unlocked the cabinet slowly and drew Propofol into a hypodermic needle. I started to mentally do aerobics "Alright, alright. If he's been awake all of this time, he needs this. Not only that; the Propofol will help him forget it." I decided to confront the good doctor. I palmed the capped needle the best I could and walked in. "Doctor...?" Cho lifted his head but did not turn to look at me. "He-hey Doctor Cho, it's me Dumbass. I just wanted too know if you were okay."
Cho turned around. "You had the same dream, didn't you? You saw his mother?"
I immediately froze. "yeah" I hardly squeaked.
I used my thumb to uncap the needle behind my leg. I quickly kicked the cap out of sight. "Why did you dream that, doctor?" I asked very calmly.
"Same as you. This... this child needs me now. He was dead and is now born. I will keep him." I felt the horror coming up my spine and breaking me out in goose-flesh. I swallowed hard "Doc, I think you need some sleep." He stepped a little closer to me, wide eyed "Dumbass. Do not interfere."
I grabbed Cho in a headlock as fast as I could. I was trembling and did not want to hurt the old man. "Listen. Calm down. It's okay. We're going to leave. Now." Cho wrestled me with more strength than I expected. I held his head tight in my side. Then, I remembered the Propofol. I wrestled a hand loose and jabbed the hypodermic in the good doctor's upper arm and pressed the plunger. "Why?! Why do you do this?!" Cho yelled at me "I hate you!" He began to get more and more subdued. Finally, limp in my headlock. I laid him gently on the floor.
I went to the monstrosity.
"Your mother wants me to take care of you." I said very quietly.
I wrapped the wadded humanoid tumor in towels. I grabbed a red satchel left by someone else, the doctor probably. I stepped over the sleeping Cho and clutched the horrible bag to my chest. I was pouring sweat at this point. Where do I go now? What should I do?
I went to my bunk with the thing. I laid on my bed.
"You're safe now." I knew that Cho would find me. I hoped the Propofol would help hinder his memory. Maybe he wouldn't remember me taking him. I slept again. Not a voluntary, 'I'm tired' sleep. A heavy, almost drugged sleep. '
I had a dream.
The mother came to me. Her hands were empty. Her beauty made my heart swim. She spoke slow and breathy "This is your job now." She kissed me and put her hands on the monster. He vibrated with acknowledgement of her. It unrolled itself. All of the horror of the thing made me want to scream. No sound came out. It's long, bony arms and legs fell limp in my hands. The face. The face moved blindly from side to side. Still covered in thick black hair on it's head and back became silky and pleasant in my hands. Mother held my arm "Look, look here." We were standing on steps to the Ganges. There were endless faces in the water. Some decayed to a point where skeletons protruded from skin. Mother said "He knows things. These things. The dead speak. You cannot hear them without help." She put her hands on the monster again. "Hide him."
I again awoke with a jolt. Still not daylight. There was time.
I clutched the bag tight and ran out into the village. The oxen bellowed and pawed the ground. The hungry dogs in the street bared their teeth to me. I went to the "chow tent". I found covered tables. I placed the bag under one. I used a marker and wrote "Personal property" on the bag.
Another day of dipstick tests, pills, and education.
I couldn't stand it. I could look in the eyes of the ill and see their bones. The maggots having their way with the soft parts of their faces. I needed Astrid, or Jaime. I found Jaime. He was giving out mosquito nets. I asked if I could help him. "Aw, of course mate. But, don't you need something else to do? Cho overdosed last night you know." I made a disgusted face. Chills and nausea set in again. "H-how did he do it? Is he okay?" I asked sheepishly. "He'll be alright soon enough I'd imagine. Everyone gets stressed, mate." Thank God for Cho not speaking of the thing. Everyone believed we had disposed of it with medical waste.
We went to eat.
I heard Si singing again. Jaime said "Ah, today it's about not having a shit by your house. She has a lovely voice even singing about that." I looked at Si. She suddenly turned into mother. Her sari blowing in the wind. Her face perfect and stoic. I stared at her. "Let's eat before we can't, mate." Jaime reminded me.
At the mess tent, no one was there. No food was made.
Jaime stopped at the opening of the tent. "I eh, I don't feel hungry.... I think I'll just work until the night time."
I went in. The bag was there, "Personal Property". I picked up the drawstring bag and took it to my bunk. People had to eat. This... this thing had a repulsion even without being known about.
Astrid was there. She was in bed still. I quietly put the satchel under my bunk and went to her. "Astrid? You can't go on like this. Come on. Let's go." She rolled over and snapped at me "This is YOUR fault. I NEVER wanted to see that. My dreams haunt me. I can't stay awake. I'm ill from that thing. Why would you let this happen?!"
"Astrid. We had to help that man. He couldn't live that way. He'd of died. How can you blame me?!" She cried "In my dreams you hurt us because of that-- that thing!" I was taken aback. Would I really do that? Hurt someone? ...I hurt doctor Cho. No. I can trust myself.
We had one more day to help. I rubbed an old shirt all over myself to get rid of the bucket of sweat I had been pouring.
The bunks were empty. Had I overslept? I packed up my side pack and swung the red bag over my shoulder. The thing felt like a thawed pork shoulder slapping against my back. Everyone was at their posts in the medic tent. Everyone seemed unnerved, but busy. Maybe time being in such a different place was getting rough. Cho had left. Morale was down.
I went to the fields with Si. We wanted to do a final sweep of finding people with fever. We carefully walked across stones ruined with waste water to get to shacks and educate those not ill. She and I made it to the home of a farmer. While Si went in, I decided to walk around what looked like a more secluded hut. I found the man's machete. Something in my mind screamed to me to pick it up. "GRAB IT." I saw a flash of Mother "Grab it." I did. I held the freshly sharpened tool in my hands. I slid it into my belt and shirt carefully.
Si soon came back out smiling. Thanking me for joining her. "Believe me. It's my pleasure." I said robotically. We walked through a tall field. A shortcut to the medic tent. I fell a few steps behind Si. Maybe if Mother was gone I could get rid of this backpack, these nightmares and visions. Maybe Si really is Mother. With a glint of light off of steel I raised the machete and let it fall on Si's perfect neck and shoulder. She fell instantly and quietly. I however, was now splattered in blood. I couldn't get back without a lot of questions. I threw myself in the first mud puddle I found. I got up, dirty but hidden. I decided the machete may be useful again. I pressed it in the mud as well and concealed it back into my pants and shirt.
At the medic tent Hindi people giggled at my "misfortune" of falling in the mud. I smiled at them. Something about having Si gone lifted something from me. Maybe this was over. I did dipsticks and medications for a few hours then went to my bunk. I set down my red pack. Astrid was gone. Maybe she was working? I didn't even notice her. She was probably training. Jaime walked into the bunks. "What ya think, mate?" he asked "You look awful. Sleeping bad, eh?" I looked at Jaime with redrimmed eyes. My mind was clotted and angry. "Yeah. That's what it is." I managed to say. Jaime looked at the backpack. "Why've you got my backpack, mate?" I raised my stature to him, pressing out my chest. "What do you care?" I asked hotly. "Woo, settle down mate. It's okay. I know being out here is hard." he deescalated "I don't care about me back. Have it. It's just that it looks like it might be wet. Maybe when you fell? If it's medic supplies we have to get them dry, mate. You know that."
"Yeah. Would you help me, I just need to change my shirt. I'm sorry, man. I totally didn't mean to freak out." I said "let me get out of the way and you can unroll bandages." I slipped behind Jaime. He opened the pack and froze. "W-wh-what is.... why? No." He sputtered as he stared at the parasite, now in a "sitting" position, long bony arms at its sides. Jaime swallowed hard as I smiled to myself. The terror he felt, the final moments he has and I can feel cold and afraid he is. It felt good. That's why cancer exists, I thought, God would love to feel this powerful.
Jaime fell to his knees as the machete blow came down on his head.
My teeth chattered. I knew at this exact moment, this is what Mother wanted. It's what he wants. I'm doing the right thing. I decided to find the mess hall again. The cafeteria was clear all for two cooks. A pair of guys from South Africa. I walked in smiling. "It will be one minute, we are not ready." One woman said. I kept walking up to them, smiling. "He doesn't speak English" the other whispered to the woman. "Yoo-hoo" She said with a friendly smile, she motioned to the food and shook her head. I pulled the bloody, muddy machete from behind my back. I slammed the blade into the first woman's neck, cleanly decapitating her. "MOTHER!" I screamed "I KNOW YOU WANT THIS!" I fell on all fours, slamming the second lady to the ground. I pinned her to the wet straw. "I don't mean this personally," I said quietly holding my hand over the woman's mouth "I just have to. I have to for Mother." I freed a hand and plunged the machete into her, sticking her to the ground like a butterfly specimen. I held my hand over her mouth still, waiting for her final moment. "If you knew what this felt like, you would be me." I whispered as she died, stuck to the ground.
I pressed a boot hard on her breast and shoulder pulling the machete free.
"This will still work." I stood for a moment, breathing hard. I was covered in the blood of others, not from helping, but hurting. Blood dripped off of me with the mud. I slicked my hair back with blood stained hands. Astrid. I was going to find Astrid.
I stabbed the knife into the canvas tent ripping a new entryway for myself. I did the same at the bunk. Astrid had my baby. I was slick with blood and furious. "What are you thinking?" I growled. "That is MINE." I could see her trembling. "No." her voice was shaking. "This has to be gone. You need hospital. You are sick, Franklin." My eyes were so wide I couldn't feel myself blink anymore. "Set. It. Down Astrid." She did. "I never wanted to touch it. I hate this! I HATE these thing. You are sick, Jaime is dead. This monster is in your bed." She was shaking. "Astrid, I can't say I give a damn what you think."
A lunged at her, slashing the machete. She held up her arms in an "x" to defend her face. I felt something sharp, then something that made my skin burn like fire at the injection site. She had drugged me and I knew it. I raised the machete as high as I could and brought it down as hard as I could; feeling myself getting weaker. I pulled the needle out of my arm and collapsed on top of Astrid. I know I am dying. My moment of clarity came to me "Mother finds all of us in different ways."