By Dr. Opiyo Oloya
Wednesday, August 18, 2010, AMISOM HQ, Mogadishu, Somalia, 08:40 a.m.
MY second day with the African Mission in Somali (AMISOM) based here in Mogadishu started just outside the screening gate through which Somali patients stream in from all directions to AMISOM base for treatment at the OPD.
The heavily sand-bag fortified gate is manned by the Ugandan contingent forces and the Transitional Federal Government (TFG) at four pointsâ€”TFG police checkpoint about 120 meters away from the gate carries out the initial screening for weapons and potential suicide bombs, then at about 50 meters from the gate another TFG police checkpoint supervised by AMISOM officers carry out further screening; the third checkpoint is just outside the sandbagged perimeters, and a final checkpoint inside the sandbagged walls is carried out by AMISOM officers who separate men and women so that more detailed screening can be carried out by respective gender.
The story is told to me, first by Captain Magezi, the UPDF spokesperson in Mogadishu, and later by General Katumba Wamala how all of this came about.
A very ill Somali man suffering from cholera and close to death had been dumped at the gate of AMISOM sometime in 2007. It was probably a last ditch effort by relatives to save him or perhaps aware of the possibility that he could infect others with the deadly illness wanted nothing to do with him anymore.
In any case, the AMISOM soldiers guarding the Uganda contingent base camp could not just stand by and watch the man die, so they brought him to the doctors who immediately initiated treatment. The man lived, and when he walked out of AMISOM compound a healthy soul, the word spread like wild grass fire.
â€œI was not happy at first because it was not our operational mandate to treat civiliansâ€, said General Wamala, â€œBut the doctor at the time told me bluntly that there was no way he could just watch people in desperate medical need dying and not do something about itâ€”so I gave in, and I am proud to say it has made all the difference with the civilian population in Mogadishu and beyond.â€
Indeed, every Monday, Wednesday and Saturday, the ill and the sick flock in from all corners of Somalia, some from as far away as Baidoah to what I have decided to call the â€˜Gate of Hopeâ€™ in Mogadishu because of the sheer volume of those seeking medical treatment, and for whom the AMISOM clinic staffed by medical teams from the Uganda contingent is the only hope for recovery and better health. On this Wednesday morning, as a slight drizzle fell, I stood watching desperately ill patients being brought through the Gate of Hope.
You can plainly see the glint in their eyes when they clear the second checkpoint and begin to make the forty-five steps to the small opening into the fortified AMISOM compoundâ€”some even give a small triumphant smile as if to say, â€œI have made it this far, now I will live.â€ All of them seem gratefully respectful in their gestures as they shuffle pass the AMISOM Uganda soldiers Cpl. Robert Biryahabwe, Pte. David Masereka and Pte. Steven Rewembembera donning full protective body armours with their weapons at the ready.
Those too weak to stand on their own are carried by relatives. A tall thin young man with sunken eyeballs, looking gaunt and prematurely old with illness is supported by two men who half-carry him through the Gate of Hope.
Another very sick man is brought on a makeshift stretcher of mattress carried by four men. They are ordered by AMISOM officers to leave the mattress far away from the gateâ€”it may contain explosives, I am toldâ€”and bring the invalid on an AMISOM stretcher provided at the gate. A short moment later four women carry in a woman who is so grievously ill and in so much pain that her agonized cat-like moans make me wince.
They too have to submit to security screening, but I notice that the AMISOM soldiers on the outside become impatient when the AMISOM screeners on the inside seem to take too long screening the patients in front, urging the latter to move a bit faster so that the half-conscious woman can be rushed to the emergency. With the screening completed, she is carried away in a stretcher to the clinic.
Inside the gate, but under the veranda, the sick queue up on long benches, men on one side and women on the other side, as they wait to be triaged by the medical team.
Those, like the half conscious woman who are badly off, are moved faster through the pipeline, while those whose conditions are not too desperate sit, waiting patiently to be seen by the AMISOM doctors. None of them complain, all look so hopeful, respectful and grateful to be given the opportunity to see a doctor.
Just outside the entrance to the clinic building I meet Col. Dr. James Kiyengo who is the director of the clinic. He is a short, very young looking and very calm surgeon.
He is wearing full-body armour which reminds me that this, after all, is a war-zone, and there are Somali insurgents out there who would do anything including suicide just to be able to cause havoc inside the AMISOM base. Despite their life-saving work with Somali patients, the doctors and medics at the AMISOM clinic could never be too complacent even inside the fortified walls.
When I point out to the Colonel the irony that he could be harmed by the insurgents while trying to save Somali patients, he laughs easily and tells me that this is part of the daily living in Mogadishu, and one could never know when the threats hit too close to home.
As we talk, we are joined by a second doctor, also in body armour. His round smiling face looks familiar, though I cannot quite pin it down, until he introduces himself as Capt. Dr. Ronald Mukuye.
We met in Toronto many years back, and we quickly reminisce about Toronto before moving inside to see the work being done by a total of five doctors working with a staff of about 200. The clinic is very clean, organized and orderly. In different corners clinical officers like WOI George Katungi, with the help of Somali language assistants are busy attending to the sick.
Some of the medics already speak Somali well enough to ferret out basic information from the patients. â€œIf you hear an AMISOM soldier speaking Somali, you can bet he or she is a medicâ€, Capt. A. K. Birungi, one of my guides tells me. The running joke here is that the Uganda medics have become more Somali than the natives themselves.
Altogether, the AMISOM Uganda medical team sees over 6,000 patients in a month, treating all sorts of ailment including gun-shot wounds, cholera, cancer, fistula in women, diabetes, urinary tract infection, malaria, diarrhea, penile abnormality in children, and even burn.
â€œThere is not one single case, however strange or new, that we turn away from this clinic because we cannot treat itâ€, explains Dr. Kiyengo. â€œIf we do not know how to treat it, we quickly jump on the internet, research it, and then rush back to effect treatment.â€
Patients with serious conditions are admitted for further treatment in the 100-bed facility. On this day in pediatric ward, Maj. Dr. Ibrahim Kimuli assisted by WOII Pascal Etona and Corporal Felix Byamugisha make bedside visits to 9 children admitted for various treatments. Three boys including 8-year old Bashir Mohammed have just had corrective surgeries on their penises.
They are doing well, and their respective fathers look relieved. In the next bed, 14-year old Sidow Muhammad Sidow, whose shriveled looks make him appear much younger than his age has cancer which has caused his left thigh to balloon out like an inflated car inner tube.
â€œWe could amputate the leg up to the thigh, but he would still need chemotherapy to have reasonable chance of survival, and so we are referring him to Kampalaâ€, Dr. Kiyengo tells me simply.
â€œBut we had to first find a sponsor to cover his travelling expense and medical bills which could go as high as $10,000, money his family does not haveâ€, he added. I tried to cheer up Sidow, but he was desolate. His father, seated beside him, looks hopeful but equally without a smile.
I find a smile in the next bed where 9-year old Muhammad Jameel Muktar had his right arm amputated at the upper arm. According to Dr. Kamuli, Muktar arm got caught in a maize milling machine and was severed off, and although the doctors tried to save the arm, the skin had started decomposing, so to save the boy his arm had to be taken off altogether.
Muktar was not smiling, but his father was positively beamingâ€”he still had son. I take a quick picture of Jameel and his smiling father, and then we head out toward the fistula ward where stories of miracles await me (and which I will tell you in another installment from Mogadishu.