African dreams

The past four years, since he began working with Doctors Without Borders, have been eventful ones in Patrick Murphy’s life. The organization, which is based in France and known to most of the world as Médecin Sans Frontières (MSF), is famous for providing medical care in war and famine zones, and the Chico nurse has seen things the rest of us find painful just to imagine.

He’s also seen extraordinary beauty and examples of human courage and endurance that will remain among his memories for the rest of his life.

Murphy, who is 51, had been an Army combat medic in Vietnam and the first Gulf War, so he was accustomed to dangerous work when he went to work for MSF. But he had no clue what he was in for.

Murphy’s first assignment was in the West African nation of Côte d’Ivoire (Ivory Coast). He arrived there in February 2003. The country was then just emerging from a nasty civil war, and tensions were high. Death squads roamed the streets at night.

Murphy was part of a team of doctors and nurses, most of them French, assigned to a prison outside Abidjan, the country’s largest city and chief port. A deadly cholera epidemic had broken out inside the prison. The team’s job was to contain the disease in the prison and then eliminate it.

The prison was in the shape of a huge concrete square about 500 yards long on each side. In the tropical heat, black mold had spread over the earth-colored walls. They were about 60 feet high and topped with razor wire. Built to house 1,500 people, the prison held more than 6,000, most of them political prisoners, some of them women and children, many of them deathly ill, some already dead.

There were no guards in the prison, just in the watchtowers set on the exterior walls about every 100 yards. Otherwise, the guards stayed outside. Inside, the prisoners ran the show. They had their own hierarchy, with various factions, each led by an all-powerful chief and using sheer force to maintain its place in that hierarchy. “If somebody gave the chief lip, his bodyguards would kill that person. It was pretty brutal,” Murphy explained, understatedly, during a recent interview.

Indeed, the MSF team had to ask permission from the inmate chiefs to enter the prison. They were welcomed, though, and the inmates provided security and a labor force.

The first time Murphy stepped inside the walls, he struggled not to vomit. The stench of the dead bodies and the 6,000 unwashed prisoners crammed into a prison without clean water or working toilets was overwhelming.

“I had never worked with the diseases I faced in that prison or with living standards so low as to cause those of us in the West to cry out against anyone doing this to animals,” he later wrote in a short memoir. “Hollywood has never created a horror movie as gruesome as what happens normally in that prison.”

The women and children occupied one of five cell blocks. The women often prostituted themselves, “and rape of all incarcerated parties is a routine occurrence,” Murphy wrote. “This of course included the children.”

Cholera is spread via feces-contaminated water, so the prison was a perfect incubator for the disease, and people “were dying like flies,” Murphy said. The MSF team set to work, first by establishing an infirmary, quarantining the sick prisoners and putting them on antibiotics.

Longer-term, it built rudimentary sewer and water systems, cleaned up the cells, began an anti-malaria campaign and a nutritional program. “It doesn’t do any good to treat people medically if they’re starving to death,” Murphy explained.

He worked every day until his body gave out. The pay was $600 per month that first year (it later doubled to $1,200). “You’re not doing it for the money,” he said, stating the obvious. Nor are MSF workers danger lovers. “I can’t think of anybody I’ve worked with who looked for that,” he said, “but we do experience it.”

After seven months, another nurse arrived to take his place, and he came home to Chico to rest and spend time with his teenaged son, not knowing that his next assignment would be in the heart of a civil-war zone.

Pat Murphy looks bigger than he is. He’s of medium height and slender, but in a sinewy way, and his strong, square-jawed face features a formidable pair of arching black eyebrows under curly black hair. He smiles easily, but his no-nonsense bearing suggests a man who has seen too much of the world to take life lightly.

Murphy has been a wanderer all his life. He grew up in Beirut, Lebanon, the son of a dispatcher for Pan American World Airways who most of the time worked overseas. That’s where Murphy learned the French that has served him so well in Africa. By 1973, civil war was about to break out in Lebanon, and his father was transferred to New York. Murphy was 18 then, so he decided to join the Army. He went to Vietnam as a medic. The war was winding down by then, but he still got plenty of combat experience.

He first came to Chico in 1977 to help his parents, who’d moved here, build a barn. He liked the town, visited often, and when he decided to turn his medic’s experience into a nursing degree, enrolled at Chico State University. He graduated in 1994 and subsequently worked at Oroville Hospital for eight years.

By then he’d met and married a Chico woman and had a son, Paul, who’s now 16. The marriage lasted seven years—"She wanted to live the dream, and I didn’t have a clue,” he explained—but they remain friends and he considers Chico home, most of all because his son—his “touchstone"—is here.

Still, it’s hard to stay in one place. “There’s always something to learn someplace else,” he said, “and I don’t really care where I put my head at night.”

He’d read about MSF in a novel set in Afghanistan and, on a whim, checked on the Internet to find out if it really existed. When he learned it was for real, he applied. He worried that MSF would look askance on his 20 years in the Army and National Guard, but he needn’t have. “I think the key was that I was someone who they could stick into an insecure situation and know I wouldn’t lose my cool,” he said.

In September 2003, he returned to the Ivory Coast, this time to a mountain town called Danané, near the border with Liberia, to work with the Dutch Section of MSF. Civil war in Liberia was spilling over into the Ivory Coast, which had its own problems with rebel groups, and the region was extremely volatile and dangerous, with ragtag groups of drunk and stoned teenaged soldiers armed with AK-47s roaming the bush and effectively controlling the area.

Of Danané Murphy later wrote that its citizens were terrified, “the rebel groups having the nasty habit of drinking too much and then getting into fights with each other. The problem was that they often waited until midday and the market place to be full [before] they started shooting at each other through the crowds.” He got a lot of experience treating gunshot wounds under less-than-sterile conditions, he wrote.

He also treated dozens and dozens of women who had been raped. “Rape seems to be the one thing guys can do when they are stoned, drunk or both and they have a Kalashnikov rifle,” he wrote.

On one occasion, while on a short trip into Liberia, Murphy and two other men—an Australian nurse and an Afghan doctor—were taken hostage by some rebels. They were tied up for three days and guarded by a 15-year-old boy with an AK-47 and a pistol who seemed to take pleasure in sticking the handgun in their mouths. Finally the “big boss” showed up, established who they were, apologized and gave them tea.

They were then taken to the border and allowed to go, but that meant they had to work their way through the jungle and past other rebels to Danané. They slept in the jungle and skirted around villages where rebels were assaulting women and shanghaiing children into forced service in the guerrilla group.

He was thankful when French peacekeeping forces moved into the area, though he soon learned just how that “peacekeeping” was managed. A Foreign Legion paratroop commander called a meeting of rebel leaders and, decked out in an incongruously well-pressed uniform, proceeded to inform them that henceforth they could not carry any weapons larger than rifles, “or I will kill you.”

When one of the rebels started to complain, the officer calmly pulled out his service pistol and, to Murphy’s astonishment, shot the man dead. Things calmed down in the region after that.

Murphy’s stint ended after nine months, when he contracted the most virulent form of malaria and viral meningitis at the same time and lapsed into a coma. He awoke two weeks later in the American Hospital in Paris, disoriented and so violent at times that he had to be physically restrained. The illness had “scrambled” his brain; he thought the doctors were trying to kill him, but he also knew he was a nurse.

When he finally got back to Chico, it took him five months to recover fully.

For his next assignment, Murphy left tropical Africa behind and went to the hot grasslands of southern Sudan, to a Dinka village called Marial Lou. The Dinka—a tall, graceful people (basketball player Manute Bol is a Dinka)—are nomadic cattle herders who live in mud-and-thatch huts called tulkus.

For more than 20 years, they had been caught in the middle of a vicious civil war between rebel groups in the south and the government in the north. The conflict began when the north attempted to impose Islamic Sharia law on the south, which is polygamist and based around the trading of both cattle and women, a system that has enabled it to survive for centuries in a harsh environment, Murphy said. For the south to accept Sharia would have been to accept the destruction of a way of life.

It’s estimated that as many as 2 million people died because of the war, which caused a famine throughout the region and continues in a similar form today in the Darfur region in western Sudan, with genocidal results.

MSF had built a mud-and-thatch hospital complex powered by solar panels in the village, the only medical clinic for hundreds of miles. It had a water pump, a full-fledged medical-surgery program and a well-baby clinic. People would walk for days, carrying their children, to get to the hospital. There they were treated for things like malaria, guinea worm, “lots of gunshot wounds,” several diarrheal diseases, malnutrition, full-blown starvation and trauma related to falls. They had fallen either from trees, where they were collecting nuts, or into a deep water well, Murphy explained.

The Dinka were barely removed from the Stone Age; they still carried spears and war clubs and went about largely naked, but now they also had the ubiquitous AK-47s. The children had known nothing but war. Schools were bombing targets, so they’d gotten no education, and the boys became fighters early in their teenaged years. Most of the hospital’s local staff was male and under the age of 25, and Murphy was amazed to hear them speaking of battles they’d fought 11 or 12 years ago.

“They were wonderful people, generous to a fault, very easy to get along with,” he said. The village had no electricity, no roads, “no water sometimes, and lots of evil bugs,” and the only entertainment was the occasional tribal dance.

Unless, that is, getting bombed counts as entertainment. The Sudanese Air Force’s old Russian Antonov planes would fly over, and crew members would roll the “bombs"—55-gallon drums packed with shrapnel and gunpowder and with a couple of land mines strapped to the outside—out the cargo bay.

They rarely hit their targets, fortunately, but sometimes they did, so the sound of an approaching airplane was terrifying to the Dinka. Murphy remembers one occasion when he was in the midst of doing a C-section birthing. He was just removing the baby from the mother’s womb when every one of his nurses and aides suddenly ran out of the hospital. He hadn’t heard the plane, but they had.

By this time, Murphy had become a fully experienced MSF nurse and promoted to medical team leader. And, like any MSF nurse, he’d developed a range of skills that rivaled those of the doctors he worked with, including delivering babies, setting broken bones, repairing hernias, removing bullets and closing chest wounds. “Anybody who goes into tropical zones has to know these key skills,” he said.

Supplies for the hospital were delivered by mercenary pilots flying out of the town of Lokichokio, in northern Kenya, and it was always a race to get in, drop the goods and skedaddle before the Sudanese Air Force showed up.

All in all, the eight months he spent in southern Sudan “was an incredible experience,” he said. “It was such an eye-opener.”

His next assignment sent him back to the tropics, to the tiny village of Akonolinga in Cameroon, which is located in West Africa just south of Nigeria. The good news was that the country was not at war—and in fact had been stable for many years, although the government was corrupt and local officials acted like an African version of the Mafia. But Akonolinga, which is located in the Congo River jungle, did present him with tropical diseases he’d never seen before, particularly something called buruli ulcers.

Most Americans have never heard of the disease, but it’s fairly common in tropical countries. Related to leprosy and tuberculosis, it’s caused by a mycobacterium that forms large ulcers, usually on the arms and legs, extensively destroying the skin and soft tissue. Besides its gross appearance and the terrible scarring it produces, it can cause long-term functional disability such as reduced joint movement.

Most of its victims are children under the age of 15. It’s treatable through hygiene and changing bandages daily, but the process can take months and simply isn’t feasible in West African villages. This difficulty is compounded by villagers’ belief that buruli is somehow caused by magic.

Murphy had been given the assignment of not only treating victims of the disease, but also doing operational research on it. He was fortunate to have the help of a German surgeon, who taught him how to do skin grafts and excisions and debreed (or clean) the wounds.

Although buruli is bacterial, it doesn’t respond to current antibiotics. Murphy and many others believe research could produce a treatment, but it’s “a neglected disease,” he said, because there’s no profit potential in it, so the drug companies haven’t tried to come up with anything.

Murphy also had to deal with local thugs who were stealing the hospital’s medicines and supplies. At one point he caught an important local official in the act. Later the official, bodyguards in tow, approached him and said threateningly, “You, when you go home, you’ll go home in a coffin.”

For protection, Murphy turned to some of the local chiefs and told them of the thefts and warned that he might have to shut down the hospital if the situation didn’t improve.

The chiefs then spoke to the official. When they returned to talk to Murphy, they said, “We will take care of this problem. He will go away.” The official was soon gone.

“It was wonderful to be to be able to put my life in their hands,” Murphy said. The chiefs are “the wise men of the jungle.” When it comes to surviving in the bush, he said, they are the most sophisticated and intelligent people on earth.

Murphy spent 11 months in Cameroon. “I am proud to say that I beat back the mafia,” he later wrote, “and centered this much-neglected disease a little more on the center stage of all things medical with Doctors Without Borders and the World Health Organization.”

Murphy is now back in Chico for an extended stay until his son graduates high school. He’s working at a local surgery center and, instead of bunking at an old Army buddy’s house as he did during previous stays, has rented an apartment.

But Africa is never far from his mind. “The memories that bother me aren’t the ugly scenes,” he said. “It’s the faces of the kids, beseeching me for help.” He owns a small place on the beach in Kenya, and when his son graduates he has every intention of returning to work with MSF in Africa—or wherever he’s sent.

He speaks affectionately and admiringly of the many people he’s worked with: doctors and nurses from all over the world, as well as local people trained to assist in the hospitals. And he is respectful of the thousands of villagers he met, people who summon great strength and courage every day just to accomplish the act of surviving and caring for their families and remaining, somehow, joyful.

He mentioned, for example, his “logistician,” or facilities manager, in southern Sudan, “a wonderful, highly trained man from Ethiopia” who operated the kitchen and fed starving children, starting by giving them milk made from powder. The several Dinka women who assisted him by day wore their clinic uniforms while at work, but at night they went topless, as was their custom, and it drove the poor man crazy. “I can’t take it,” he once moaned to Murphy.

As far as Murphy was concerned, the Dinka’s lack of clothing, from a medical point of view, “was great. We never had to tell patients to get naked.”

One of the two great lessons he’s taken from his experiences in Africa is that, as he has written, “no matter what culture you come from, if you are just an average member of that culture, you want the same things as everyone else in the world—that is, to raise your kids and if possible to do something to where their lives are a little better than yours.”

The other thing he learned was that “if there is a god, she has to be a black African woman. They are the kindest, longest suffering, most physically enduring and hardest working humans on the face of this planet.”