Where there is No Doctor

When I got to Yemen to start my second Peace Corps tour, I found out that I once again had some freedom in choosing my assignment. Most of the volunteers were to serve as ESL teachers in the mountain villages. I too was to be a teacher, but I had input as to where. Two factors helped my decision: I wanted to be on the Red Sea (I had brought my snorkeling gear), and I discovered that there was a refugee camp in a small village on the coast. I lobbied hard for the refugee camp in Al Khawkha, a small fishing village on the coast. The coastal region of Yemen (named the Tihama)is very different from the rest of the country. It is at sea level, one of the hottest areas in the world, average temperature. It is also much less conservative, more easy going than the mountain regions.
When the Peace Corps officials forwarded my request to the Ministry of Education, it was denied with the following rationale - "The Tihama is too hot, too difficult for western workers, we will place them in large cities where they have access to electricity, but not in villages." I didn't give up though, especially as I learned another volunteer was working in the camp temporarily building a school. We went back to the ministry several times and finally wore them down. As we were leaving, the ministry official said something in colloquial Arabic that made my Yemeni Peace Corps official smile wryly. I pestered him for a few minutes, asking him what it meant. He looked at me and said "I believe the English expression is its his funeral." I laughed as only a 30 year-old fool can laugh.
When I arrived at the village a few months later, no one knew I was coming. It turned out that the ministry official didn't really believe I would move out to such an isolated, hostile place (hostile in the environmental sense). After a few days of confusion, I was given a timetable at the local school, and I went out to the refugee camp (for Eritreans) and met the volunteer. At the end of his allotted time on the school project, we had completed 2/3 of the school. He left the rest for me to finish. I then moved out into the shack in the camp that he had occupied. It had two rooms, one with a bed of sorts and a small table. It would be home.
I won't attempt to describe the heat and humidity of the Tihama, it is impossible to relate. Instead, I can share some reactions of folks who came to visit me. One volunteer, a tall, fit guy from the east coast showed up one evening and told me he planned to stay for a few days. He laid around for two days groaning, and insisted I get him to a phone (two hours away) so he could call the nurse to tell her he hadn't urinated for days. More typically, friends would show up in the evening (there was limited transport into the village) when it was 90 degrees and vow to stay for a few days. Inevitably, they would leave the next day before noon. You couldn't sleep at night, and you could barely breathe. It took me a month to acclimate.
I was living in the refugee camp for a few months before the residents grew to trust me. I worked with the orphan boys to finish the school, and I often entertained the children in my shack at night. When we did finish the school, some of the elders stopped by to congratulate me. One of them noticed one of the two books I had, Where there is No Doctor, a general first aid book given to all Peace Corps Volunteers. My life changed drastically shortly thereafter. There had been a doctor in the camp, but he had been recently arrested on some mysterious charge and was in the local jail. The Eritreans lived in the camp by the grace of the Yemeni. They had no rights per se, as they were not citizens. To this day, I don't know why the doctor was arrested, or what became of him. I do know that my first aid book had been noticed, and that I was to become the medical expert in his absence.
A few weeks after the discovery of my book, I was summoned to the the center of the camp by a group of frantic children. I had a base understanding of Arabic, and was just then learning some Afar, their language. They drug me by the arm to a shack with more than fifty people surrounding it. I was pushed inside where I saw a man laying on a small table in obvious agony. He had come into the village by motorcycle taxi, and had gotten his bare foot tangled in the chain and sprocket. It was mangled, cut to the bone. I was in a bit of shock, and I gradually realized I was being admonished for not bringing "the book." I rushed back to get it and also brought my meager first aid kit.
When I got back into the makeshift clinic, several of the adults were holding the injured man down on the table firmly. They pointed at his foot and told me to get to work. I got out some gauze and hydrogen peroxide and started to swab the cut. These were hard people, survivors of a 35 year civil war. They nodded and told me to clean the wound more rigorously. I reached in and scrubbed the wound feeling muscle and bone. I think I was closer to fainting than the patient. When I had cleaned it as well as possible, I reached in the first aid kit for some more gauze and wrap in order to tie up the wound. There was a buzz in the room that let me know this wasn't to be the course of action. Someone, I don't remember who, handed me a big needle and some fishing line. I was to stitch him up.
I hesitated for a moment (felt like a year) and became aware of hands pushing me towards his foot. I looked at the wound and tried to remember the suturing I had received on some of my own misadventures. If you can imagine how hard the pad of a foot is, particularly one that seldom wore shoes, you can also imagine what the next several minutes were like. I tried to push the needle through the skin and muscle and couldn't. He was screaming and I was pushing. It was a nightmare. Finally, a rusted pair of pliers was brought forward and two of us pushed the needle through. It made a sickening pop as it exited. We repeated this about ten times until we closed the wound. I used all of my hydrogen peroxide trying to keep everything clean. It was the most gruesome (at least at that time) thing I had witnessed, let alone participated in. Some days later, the elders in the camp were able to get permission for the man to leave the camp and go to a hospital three hours away. He recovered, with a limp, and his wife crocheted me a nice colorful cover for my bed.
Months later, at a Peace Corps gathering in the capital, I recounted the story to some of the Peace Corps nurses. They gave me proper suturing tools, but thankfully, I never needed to use them.
This was not my last medical experience in the camp, although I tried in vain to tell them I was not qualified for such things. They would remind me that any help was better than none, given that they had no access to proper treatment. I did buy more medical supplies, learned how to give injections, and worked very hard to get a Yemeni doctor to make visits to the camp. The worst however, was still yet to come.