Rewired_ The Post-Cyberpunk Anthology - James Patrick Kelly [48]
In my jet-lagged state, it was amazing to find that this abstract place that I’d been imagining for months had solid ground, actual buildings, real people. Most of my second-hand glimpses of Uganda had come from news clips set in war zones and disaster areas; from Sydney, it had been almost impossible to conceive of the country as anything more than a frantically edited video sequence full of soldiers, refugees, and fly-blown corpses. In fact, rebel activity was confined to a shrinking zone in the country’s far north, most of the last wave of Zairian refugees had gone home a year ago, and while Yeyuka was a serious problem, people weren’t exactly dropping dead in the streets.
Makerere University was in the north of the city; Iganga and I were both staying at the guest house there. A student showed me to my room, which was plain but spotlessly clean; I was almost afraid to sit on the bed and rumple the sheets. After washing and unpacking, I met up with Iganga again and we walked across the campus to Mulago Hospital, which was affiliated with the university medical school. There was a soccer team practising across the road as we went in, a reassuringly mundane sight.
Iganga introduced me to nurses and porters left and right; everyone was busy but friendly, and I struggled to memorise the barrage of names. The wards were all crowded, with patients spilling into the corridors, a few in beds but most on mattresses or blankets. The building itself was dilapidated, and some of the equipment must have been thirty years old, but there was nothing squalid about the conditions; all the linen was clean, and the floor looked and smelt like you could do surgery on it.
In the Yeyuka ward, Iganga showed me the six patients I’d be operating on the next day. The hospital did have a CAT scanner, but it had been broken for the past six months, waiting for money for replacement parts, so flat X-rays with cheap contrast agents like barium were the most I could hope for. For some tumours, the only guide to location and extent was plain old palpation. Iganga guided my hands, and kept me from applying too much pressure; she’d had a great deal more experience at this than I had, and an overzealous beginner could do a lot of damage. The world of three-dimensional images spinning on my workstation while the software advised on the choice of incision had receded into fantasy. Stubbornly, though, I did the job myself; gently mapping the tumours by touch, picturing them in my head, marking the X-rays or making sketches.
I explained to each patient where I’d be cutting, what I’d remove, and what the likely effects would be. Where necessary, Iganga translated for me — either into Swahili, or what she described as her “broken Luganda.” The news was always only half good, but most people seemed to take it with a kind of weary optimism. Surgery was rarely a cure for Yeyuka, usually just offering a few years’ respite, but it was currently the only option. Radiation and chemotherapy were useless, and the hospital’s sole HealthGuard machine couldn’t generate custom-made molecular cures for even a lucky few; seven years into the epidemic, Yeyuka wasn’t yet well enough understood for anyone to have written the necessary software.
By the time I was finished it was dark outside. Iganga asked, “Do you want to look in on Ann’s last operation?” Ann Collins was the Irish volunteer I was replacing.
“Definitely.” I’d watched a few operations performed here, on video back in Sydney, but no VR scenarios had been available for proper “hands on” rehearsals, and Collins would only be around to supervise me for a few more days. It was a painful irony: foreign surgeons were always going to be inexperienced, but no one else had so much time on their hands. Ugandan medical students had to pay a small fortune in fees — the World Bank