Of all the sights and sounds during my first six weeks in Mbale, the one that has stuck with me most indelibly* is the incongruent smells of bleach and burning trash in the operating theater.
The smell of bleach is no doubt familiar: clean, but militantly so, the bleach singeing the hair in your nose, indiscriminately attacking the good and bad alike – a carpet bomb of antiseptic. Burning trash, on the other hand, is not well known to many; it causes the same physical reaction as smelling burning hair – the nose puckers as if it’s trying to get away from the smell, an acrid perfume that’s a bit different each time.
I scrubbed in to observe a c-section and had other things on my mind (namely: “don’tfaintdon’tfaintdon’tfaintdon’tfaint”), but the discomfiting smells knocked me back into the present moment with the force of smelling salt ripping someone from unconsciousness. The smell of burning trash was strong – as if it was right outside the door. Which it was.
To be sure, there is plenty from that operation that I’m unlikely to forget – the nakedness of the woman, in what seemed a supreme violation of her privacy, laying in a crucifix position on the green table; the peculiar act of stuffing towels (not gauze) deep into the woman’s incision, as if stuffing a carry-on full of clothes; her blood dripping from said towels when they were taken out, twisted, and squeezed, just like laundry; how dark blue the baby was when it was pulled out by its feet; how it would stay that color.
The odor of burning trash is endemic in Mbale. But there’s something about smelling it while in a hospital operating theater that stirs the mind, that forces it to remain in your nose and your thoughts long after the scrubs are off and the hospital gates are behind you.
And I think it tells a larger story, too. People don’t burn trash for fun, right? They burn it because the other options are to bury it or let it pile up at your home or somewhere near (as in the picture above); it’s not like Waste Management doesn’t come rolling down the street once a week, or once a month; it’s non-existent.
Here’s the thing: in the scheme of things, burning trash isn’t such a huge problem in and of itself; acrid and unsettling and unhealthy and a small causal factor in climate change, sure, but there are more significant issues to tackle, like the health system. Instead, burning trash is a symptom of the disease of civic dysfunction; it’s an inability to provide needed services and a lack of infrastructure with which to carry out those services.
If there was some semblance of a waste management system, it would need infrastructure and money; and, ostensibly, its presence would mean that the more pressing issues were already being addressed. This is, in some sense, oversimplistic; it wouldn’t be difficult to imagine a situation where waste management was done before the other pressing issues, but just done poorly.
So maybe the larger story is only this: when you’re in an operating theater and you smell bleach mixed with burning trash, you’re in an operating theater in a hospital and a health system that reminds you, with overwhelming clarity, why you’re there.
*At the time I first wrote this, anyway. A week later, at the hospital again, I saw a husband watch his wife die through the Post Anesthesia Care Unit window – except the PACU here is a hallway twice the size of an airport bathroom, just enough to fit the stretcher length-wise. His body language screamed “despaired longing” – hand on the window pane, then turned away, slightly slumped on the wall. It was heartbreaking.