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Tuesday, 17 July, 2001, 14:52 GMT 15:52 UK
Traumatic cost of poverty
By Mike Donkin in Zambia
This is the story of international debt and one teenage girl's leg - and it starts in a shanty town in Zambia.
The Missisi Compound sprawls around an old railway line out of the capital Lusaka. I'd been taken there by the aid agency Catholic Fund for Overseas Development (Cafod), which is campaigning to have the debts of Zambia and the rest of the world's most impoverished nations finally written off by the ministers gathering for the G8 summit in Genoa.
Missisi is about as depressing as shanties come. The better homes are little tin-roofed boxes, built from cement blocks. The worst are a bit like coalsheds.
The compound has the odd, crowded standpipe for water, stinking lagoons where the pit latrines drain, and there's a haze of smoke from the charcoal fires its 100,000 residents use to cook, and to keep warm on the cooler African nights.
I'd asked to see evidence of the health care crisis I'd been told Zambia suffers because it's saddled with such high debt repayments. So we went to see Caroline Mumba.
She was sitting on the floor of the windowless hut she shares with her mother, grandmother and cousin. And when your eyes adjusted to the half-light you could see Caroline was an attractive girl - 16, her hair neatly braided, in a fresh cotton top. "So what is wrong?" I asked.
Caroline pulled back the cloth covering her right leg. It was - well, a shock. There was gaping flesh from her shin to the top of her foot - a raw, open wound. The ankle was held rigid by a clumsy cage of wires, and what looked like bicycle spokes piercing shattered bone. "So how did that happen?"
"I was crossing the road and I didn't see the truck coming," Caroline said. "It ran over my leg, and when the truck stopped the wheel was on top of it." Her foot was all but hanging off.
Everyone then did everything they could. The truck driver took her to Lusaka's main teaching hospital. Its casualty unit dressed the wound and pinned the bone. But that's when Zambia's harsh economic realities intervened.
The hospital did not have the hardware to make a proper, adjustable leg frame or the drugs to give Caroline - or, rather, sell her - to clean the wound.
There weren't enough nurses to offer a bed so Caroline was sent home to cope in the compound. And that was four months ago - in early March.
Her only return trip to get the wound checked was wasted - the hospital's medical staff were on strike because they hadn't been paid.
After that her family just couldn't afford the transport so Caroline stayed on the dust floor of her hut, flicking the flies off her leg as she aired the wound and keeping it clean with diluted household bleach.
Something had to be done.
I had already met a young doctor from the teaching hospital and heard about the constraints they faced there. She'd told me about the wards without sheets, the pharmacy with no painkillers or antibiotics. But still, I called to ask, could we bring in a patient for her to review?
When we collected Caroline she was waiting out in the sunshine, smiling and hopeful. She'd even painted the toenails on her good foot bright red. We used half an old door as a stretcher to lift her gingerly into the truck. Her mother climbed in too.
Dr Monde and her surgeon colleague took only a short look at Caroline's leg. "She's very lucky gangrene hasn't set in yet," they said. "If she stays in the compound it will soon, and then the leg will have to be amputated. She might even die."
But the doctors told me: "Even if you leave her here she won't be much better off. We still don't have what we need to treat her."
That's when luck looked like it might be changing for Caroline. The doctors had been trained by an orthopaedic consultant who also practised at a private Italian Catholic hospital, and the truck filled up for a trip across town to find him.
We went to an establishment that sits in pretty flower-filled grounds, and where Zambian children born with club feet and other deformities are treated with state-of-the-art technology - thanks to cash from a foreign charity. The consultant, Dr Yakub Mulla, explained that these operations were further funded by other patients - who paid.
Legacy of debt
And Caroline? He confirmed his trainees' diagnosis: She must have surgery now to save her leg. She would need to be admitted for a series of operations which would take at least a month - to restore the broken bone and cover that wound with skin grafts.
His best estimate of the bill was £1,500. "You do understand," Dr Mulla said. "We would love to treat patients like Caroline for free, but there are so many cases just as pressing."
We talked briefly about why. The cause-and-effect of the decades Zambia has spent borrowing money it can never afford to pay back; the squandering and corruption which make things worse; the debt relief that the World Bank and richer countries have now conceded.
Would this really trickle down to ease the poverty that turned an accident like Caroline's into a life-threatening crisis?
Then it all just seemed too complicated, and there was a decision to be made.
I handed over the modest down-payment the hospital requested and a trolley was wheeled out. The Catholic sisters transferred Caroline to a bed with crisp, white linen and made her comfortable.
The bill is on my desk now - and I 'm not quite sure how it will be paid yet.
I will set up a trust I will call Caroline's Fund.
Perhaps, though, I should also take the invoice and a picture to Genoa when I cover the G8 summit this weekend. I could ask some of the world's financiers there what they think.
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