A Small Miracle

A SMALL MIRACLE

Today I witnessed a miracle. A small boy running down a corridor, kicking a ball with his left foot.  Not much of a miracle, you may think. It happens all the time. But this was a hospital corridor. And two weeks ago this small boy was condemned to die, unseen by a doctor and unmourned by any but his family and closest friends. His left leg – the one he was now kicking with – almost entirely decomposed.

For the past five months Mushvig has been lying on his bed unable, even, to stand. His whole left side, from the waist down, rapidly rotting away from the severe burns he received when his family tent caught fire.

Not once had he seen a doctor. His family had no money to pay for any kind of treatment.  All his devoted, but increasingly despairing, mother could do for him was to pour boiled water on his wounds, pick off the necrosed flesh and hope for a miracle. This was the state Mushvig was in when my medical colleague, Shirley Ludlow, and I found him. The miracle was, not that Mushvig might survive, but that he was still alive. It was a miracle the infection hadn’t spread into his bloodstream with the swift, decisive and inevitable result – death from septicemia.  It was obvious Mushvig had been blessed with an almost impregnable immune system. Only this had saved him. It was a miracle he had been found – just in time – by people who could help him.

The rain had been pelting down ceaselessly in the refugee camp at Saatli, Azerbaijan. Shirley and I were drenched and dishevelled after many hours trudging through the thick mud, visiting every tent, every hut, every family, checking every illness, every injury and every disease. And there, in a mud hut, 8 feet square, which he shares with his family,  was Mushvig lying on his bed and smiling at us serenely. His sick grandfather asleep on the floor. The men gathered round, grim-faced, hushed voices. The women weeping silently into their sleeves. A makeshift wooden frame, supporting the pus-soiled bedlinen, lifted the sheet clear of Mushvig’s left side. Like statues in some ancient diorama – trapped in time – tragic – each frozen in his own melancholic thoughts.

Abruptly, disturbing this immovable scene, a bedraggled hen, seeking shelter from the persistent downpour, flapped noisily through the open door, shedding sprays of water and rainsoaked feathers.  For one brief moment the motionless figures relaxed their pose, their eyes following the startled bird’s ludicrous antics around the room.Trapped and frightened it squawked  hysterically before settling itself unsteadily at the foot of the bed, eyes dilated, beak open,  panting nervously.

Wiping away tears, Mushvig’s mother, drew back the sheet to reveal the extent of her son’s injuries . Through an interpreter she whispered she was convinced her son was going to die – and there was nothing she could do.

During this whole semi-tragic, semi-farcical scene, the object of everyone’s attention – Mushvig – was smiling. Through the pain, through the sight of the decaying flesh on his shrunken limb, through his family’s grief and fears, Mushvig was still smiling. Impervious to the confusion around him. Oblivious of the despair he was causing. And, mercifully, ignorant of the very real peril his life was in.

There was no doubt in our minds. Mushvig must get to a hospital as soon as possible. It was only a matter of time before his mother’s conviction would be realised. Left like this Mushvig would surely die – it was just a question of when. Any small infection could set him on a downward spiral from which it would be impossible to save him. There was no time to seek authority from London. We had to make our decision there and then.

That night Shirley and I hatched a plot around the kitchen table. We realised any plan we made would require the signatures of two men – Azerbaijan’s Deputy Prime Minister and Chairman of the International Commission for Humanitarian Assistance, Dr.Izzat Rustamov, and the country’s Minister of Health, Dr.Ali Insanov. We would also need a surgeon willing to operate on Mushvig for free. There was only one surgeon I knew who would volunteer.- Professor Agshin Bagirov at the Academic Institute of Traumatology.

We invited Professor Bagirov to visit the Saatli refugee camps with us. He was very excited at the prospect. He told us he had, as yet, never seen a refugee camp, even though almost a million people, his fellow countrymen, had lived in hundreds of refugee camps and settlements all over Azerbaijan for the past four years  since the end of the conflict with Armenia.

As we approached the camps, the Professor was like a horse champing at the bit. He couldn’t wait to see all the patients we had found, including Mushvig.  During the three hour car journey, he confirmed to us what we already knew, that only those refugees who had relatives who were doctors or surgeons received free, or any, treatment for their conditions. Otherwise they were left to die. It was as simple, as stark and as brutal as that.

The Professor told me simply: “Any refugee patient you and Shirley refer to me I will be their relative.”

The only cost to us would be the medicines, the dressings, the transportation and the food. I was touched by this very genuine offer. Considering that Professor Bagirov, arguably the country’s top orthopaedic surgeon, earns the equivalent of $500 a year and that the country’s health system is so impoverished this was an astonishing gesture.

To illustrate this dire situation, Professor Bagirov regularly visits car garages, mechanical workshops and light engineering works to obtain old screws, nuts, bolts and other pieces of scrap metal for use in his orthopaedic practice. Shirley and I had watched him a few weeks before as he illustrated how to clean and sterilise industrial nuts and bolts and rig them into frames for patients requiring mechanical fixation of broken limbs. He had demonstrated how he designed and fitted these contraptions to suit each particular injury. He showed us xrays of how he had lengthened bones up to 30cm without the use of invasive surgery – simply by screwing the bolts tighter every day.

All this was going through my mind as we drove the Professor and his student, Rustam Talichinsky, towards their first refugee camp. I wondered what their reaction would be. I needn’t have worried. The Professor constantly repeated how grateful he was that we were making it possible for him and Rustam to help their fellow countrymen. It was their pleasure and their duty to help those who could not afford the treatment they needed.

By the time we arrived the word had spread around the camp and, although we had taken all necessary precautions to make this visit as secure, as unobstructed and trouble-free as possible, lines of hopeful patients presented themselves to the two surgeons all along the way. Epileptics, diabetics, arthritics, TB patients. Children with broken limbs, old fractures and burns. Babies with hernias, talipese and hydrocephalus. Soldiers with war injuries, psychiatric disorders and nervous diseases. All approached us hoping for a free miracle cure. The camp doctors were unaware of most of these cases and seemed surprised at the sheer number. Despite our efforts to hold the crowd back, the Professor and Rustam refused to turn anyone away. To some they could offer help. To others, sadly, they could not.

At the end of a long day we arrived at Mushvig’s hut. His family still holding vigil at his bedside, still grim-faced, still weeping. But despite his condition having visibly worsen

ed, Mushvig was still smiling serenely. Professor Bagirov and Rustam concurred with our initial opinion. Mushvig needed to be operated on without delay. On their return to the Institute a room would be prepared for him. The burns specialist would be consulted and an agreement secured with the Institute’s Director and staff. The Professor told us he hoped Mushvig would be the first of many refugee patients. And he had no doubt that everyone in his hospital would be prepared to treat any of our referrals free of charge.

The next obstacle was securing the right vehicle to ferry Mushvig three hours away to Baku. There was no way, in his condition, he could be accommodated in the back of a car. He would also require specialist support for the journey. In other words, we decided, he must be taken by ambulance. Both Shirley and I were very low on funds at that point and hiring an ambulance ourselves was out of the question. But there was, we felt,  a solution.

A few weeks earlier we had met Khalid Khan, Director of Save the Children U.S. We had got on very well and he had asked us to call him any time we had a project he could support. This, we decided, was the time and the project. We visited him and showed him and his Medical Director, Jeanne Russell, the photographs of Mushvig. By the time we left the office’s entire staff had gathered around to look at the photos. All, without exception, shaking their heads in disbelief, “how could this boy still be alive?”, gasping with horror at the sight of the decomposed leg, wiping away tears. They simply could not refuse. They promised us our ambulance.

Nurses, doctors, anaethetists and kitchen staff welcomed Mushvig and his mother on  their arrival at the Institute. He was already a celebrity. Everybody had heard of him and everyone turned up for his admission.

During the past weeks Mushvig has become a favourite with them all. And, ever ready for a photo opportunity, even the brother of Azerbaijan’s President Aliyev visited the boy. Mushvig’s smile, his bravery and his determination to get back on his feet and kick a ball have won them all over. His devoted mother cooks for him, cleans for him and remains at his side at all times. She still bursts into tears every time she sees me. She flings her arms around me, clasping me tightly, and sobs in my shoulder. Now they are tears of joy. She will never forget Shirley and me, she says, we have given her back her son.  She wants to go on television and tell the world. Mushvig’s sisters tell me we have given them back their baby brother – the brother they love – they will never forget us. Mushvig’s father also has tears in his eyes. He never expected his son to live, he will always be grateful to us for helping his family when they didn’t have the money to save his son’s life.

The wounds are healed. The anguish and the waiting are over.  Mushvig has just undergone his second set of skin grafts and will go home to Saatli in a few days time. It is the turn of another small patient, a little girl, Nagiz, from Camp I. Nagiz was injured and her baby brother died in their mother’s arms while fleeing from the gunfire of the invading Armenian soldiers. Happily, Nagiz’s injury was not life-threatening but, without proper surgical intervention, she would sustain a permanent and unnecessary disablement. As I leave the Institute both mothers tell me, “All the mothers from the Saatli refugee camps will be eternally grateful to Professor Bagirov and his team. We will never forget his kindness.”

And Mushvig himself ? Smiling he tells me he wants to become an English teacher because two English ladies saved his life!

Caroline Kennedy is the In-Country Programme Director of Leonard Cheshire International in Azerbaijan, working with refugees with disabilities.