Surgery at the Bonobo Health Clinic

11/10/09, Kokolopori, Congo. 
Martin Bendeler , Bonobo Conservation Initiative Australia, Director and Founder

The rooster crowed outside my door at about 6.00am this morning and I tried to both ignore it and decide whether we should eat it before it could wake me up again tomorrow. Shortly after, there was a knock on my door. Dr Saidi had arrived to invite me to an appendectomy commencing shortly at the Bonobo Health Clinic (run by local conservation NGO Vie Sauvage and supported by the Bonobo Conservation Initiative, Indigo Foundation and the Kokolopori Falls Church Sister City Program). I had appendicitis when I was 13 and have never experienced anything so painful, before or since, so I had a personal investment in seeing this. 

I threw on some clothes and made my way over in the morning cool. Already some mothers were out, their babies in jackets, making morning fires. Girls were headed towards the forest to gather, large wicker baskets slung across their foreheads. Other girls were returning to their huts with firewood or water. Men slept. 

In the sparse room, where a few days earlier I had seen a baby born, sat Bebeesh Bikoma, 28, with her worried husband, Antoine Lokonga. She was stoically enduring what I knew to be immense pain. Bebeesh and Antoine are both primary school teachers, but Bebeesh was working in her house when the pain in her abdomen became so strong that it paralysed her right leg. She searched for antibiotics but the pain would not go away, so Antoine pulled her 37kms on a bicycle across cratered jungle roads from their village of Yalokengi to the Bonobo Health Clinic of Yalokele. This was her only option. The next nearest hospital was100kms away in Djolu, and even if she could have reached there, it would have cost much more than she or her family could afford. 

The delivery chair reclined and became an operating table (the stirrups discarded to a corner), and the table from Dr Saidi’s consulting room was carried in and covered with a table cloth and the necessary drugs and surgical instruments. The honeyed orange morning light came in through two paneless windows in the mudbrick wall and the large space where the steel roof hand not been sealed (perhaps deliberately for ventilation?). Tubs of water rested on the dirt floor and had been brought by women from the source of a spring, 3 kilometres away, and then purified. A large donated cistern was waiting in the nearest river port of Bifore, 50 kilometres away, but there was not the funds or the fuel to transport it to Kokolopori. I stepped out while the medical staff scrubbed up and prepared Bebeesh for surgery. 

When I returned, she was lying on the table, a blanket of sorts covering her abdomen except for the area of operation. Around her were Dr Saidi and three nurses- Eduard Limboto Losase, Nestor Baelonganoi and Albert Alukana (visiting from Yettee, where he oversees a dispensary)- who were administering a local anaesthetetic (lidocaine?). 

Before making the first incision, Dr Saidi raised his hand and made an impassioned prayer in Lingala, and during the operation he and the nurses sang hymns in beautiful harmony. Dr Saidi later told me he was both seeking God’s blessing and administering psychotherapy for the patient. After awhile Bebeesh begin to suck in air through her teeth, in pain, and ketamine was prepared as a painkiller. One of the nurses used the strap of his stopwatch as a tourniquet and made the injection. 


Given Bebeesh’s suffering, I felt guilty for my own congenital queasiness at the sight of blood, exacerbated by my lack of breakfast and my fasting from the day before (due to my stomach’s treachery), as I sat down next to her husband Antoine for a spell. He said he was nervous but grateful that his wife’s life was being saved. 

Relatively quickly, Eduard presented me with the offending appendix- looking like a thin, sinister, raw sausage covered with mustard. A nurse with a stethoscope checked Bebeesh regularly to ensure there were no complications. While Dr Saidi sutured the incision, he spoke with me about the challenges of rural health in impoverished communities. “As you can see, we are saving lives on dirt floors, delivery chairs and with glassless windows. You are lucky- today, this is our 150th operation in the past 18 months- appendixes, Caesarian sections, hernias, ovarian cysts, tumours, prostates. We are grateful to our partners abroad- Indigo, Falls Church, BCI- who have provided the gowns, gloves, anaesthetics and other equipment for this operation. But we are still challenged by the basic conditions. In terms of medicines, our greatest needs are for anti-malarials, anti-biotics and anti-worm tablets.” 

With nine stitches and around 45 minutes, Bebeesh’s life was saved. Such a simple thing as appendicitis, as common here as it is in the West, kills horribly and almost certainly if not surgically treated. I would have died 20 years ago had I been born here and there was no clinic. Imagine walking into your suburban shopping mall, cocking your finger and thumb into an imaginary gun, and symbolically shooting dead every third or fourth person you see. Such is life and loss here in the absence of medical care. 


Four men carried Bebeesh from the operating theatre to the basic internment building, chickens scattering before them, where Bebeesh’s mother, brother and children waited. They would stay there and look after her for the next 5-7 days while she recovered. Bebeesh’s younger brother, Fidel, is a member of Vie Sauvage’s tracking/anti-poaching team in Yetee, monitoring and guarding a group of bonobos and their range. Saving his sister’s life is probably the most powerful example of the spirit behind Vie Sauvage and BCI’s motto- “Salisa bonobo , mpe bonobo akosalisa yo.” Help the bonobo and the bonobo will help you. 


Tax-deductible donations can be made in America at this address- 
http://www.bonobo.org/howcanihelp.html 

Tax-deductible donations can be made in Australia at this address- 
http://www.bonobo.org.au/how-to-donate.htm