We get a call for car vs. pedestrian right near the clinic. The caller reports that the victim is dead. Since it's quiet in the ER (no patients), the attending doctor decides to jump on board. The accident has occurred in a small area right outside the compound called "the Village." It's a collection of houses and shops that evolved from a squatters camp many years ago. Some of the houses are pretty nice now and there can be seen a few expensive cars parked here and there.
As nice as some of the houses are, the side streets are still mostly sand and gravel, there's no real street lighting and the one main road that goes through is not lit at all. Some time in the past, speed bumps were put in the road to keep folks from driving their customary 160 Kph through at all times of the day or night. All this means is that most of the drivers swerve off the asphalt onto the hard sand shoulder to go around them, often without slowing down.
This is obviously what our young driver was doing when he was probably quite surprised to find an old Bedouin in his headlights. It's clear he tried to swerve: there's only impact dents on the headlight and fender, but it wasn't enough. I have to literally shove my way through the crowd of men to get to the victim.
The Bedouin is lying in the sand about a meter from his leg. There's no active bleeding from the amputation site. In the lights from the ambulance, the sand around him looks black from his blood. I don't think there's a liter of blood left in his body. His eyes are glassy and fixed, blood and clear fluid (cerebrospinal fluid) are leaking out of both of his ears and his nose. This means that his skull is fractured inside and the fluid from his brain is leaking out of his head. No pulse, no breathing and his chest feels like a bag full of loose blocks from all the broken ribs. The nearest trauma center that might have a hope of helping this guy is at least 90 minutes away and he's busted up worse than a celebrity divorce.
The Doctor looks at me with her eyebrows raised as I check for a pulse. I shake my head.
"Get me a strip." She says casually. She means and EKG showing if there is any electrical cardiac activity. She's looked at the scene and put it together herself. She's not expecting any and neither am I.
I expose his chest to put on the leads and see that he must have tumbled or been dragged. His clothes are full of rocks and sand. In fact, I have to wipe away sand from his skin to get my electrodes to stick. Just as we expected, he's in asystole (Flat line, no heart activity).
Doc and I pack up and leave our bedouin to the care of his family and friends and the driver to the care of the police.
And that, as they say, is that.
Things are very different here.