In the early months of 1975, I held the position of O.R. supervisor in a 125-bed hospital situated far from any urban area in Rwanda. The hospital was understaffed, with only one doctor – a Belgian general practitioner who could only communicate in French. The region was home to hundreds of thousands of longhorn cattle that roamed freely without any fencing and were not necessarily docile.

One day, a woman was brought to the hospital after being attacked by a cow, which had gored her anus, vagina, and backbone, resulting in a severe and painful wound. Despite my knowledge that the doctor lacked the necessary expertise to treat such a case, he insisted on operating on her. After administering ether to the patient, we began the procedure. However, upon cutting open her abdomen and inserting retractors, we heard a sound that was reminiscent of fingers brushing over bubble wrap filled with small bubbles. This was a clear indication that the woman had gas gangrene, which was a fatal condition. The doctor instructed me to close her up and left the room, and the woman died a week later. I had to shut down the O.R. for three days to clean the room thoroughly, as gas gangrene is highly contagious.

A few months earlier, when I was new to the region, we had to perform surgery on a man who had previously been operated on by the doctor. During the earlier procedure, the doctor had accidentally sewn the man’s stomach to his abdominal wall, preventing him from eating for an extended period. During the second surgery, the anesthetist said something in French to the doctor that I didn’t understand, following which the doctor left the room. The anesthetist also left, which was unusual, but he was from Spain. The task of closing the incision fell to me, and I did so with care, using absorbable sutures to sew the peritoneum and non-absorbable sutures for the fascia. I used nylon sutures to sew up the skin, creating an excellent outcome. However, after removing the surgical drapes and requesting a bandage, I learned from my assistant, who spoke rudimentary English, that the man had died during the surgery. It was the first time I had seen a dead body, and I was traumatized. It struck me as strange that no attempt had been made at cardiac massage, which was markedly different from the hospitals I had worked in the United States.

Subsequently, I learned that the man’s inability to eat was caused by low potassium levels. The doctor had prescribed an injection of potassium before the surgery, which a nurse had administered without noting it on the chart. The anesthetist subsequently gave another dose of potassium, which caused the patient’s heart to stop. It was unclear if anything could have been done to save the man’s life, but no action was taken. After undergoing two major surgeries and spending a month in the hospital, the man’s brother was left with a bill of $40. He asked me if I could hire him as a gardener so that he could earn money to pay the bill. Although I didn’t need a gardener, I hired him anyway. He was not a great gardener and stole my pineapples, but given that his brother had died due to the negligence of a lousy doctor, I couldn’t complain.