Outreach to Russia

At 13 minutes past 11, on the night of June 3rd 1989, two trains whistled passed each other in a valley in the Central Russian district of Bashkiria. By the 4th of June, all 1100 men, women and children on the two trains were either dead or seriously injured. Gas had leaked from the trans-Siberian pipeline filling a valley, in which the trains inadvertently met at the moment the vapour ignited. Tragically, the local farmers had been complaining about the smell of gas for weeks.

Boys and girls from Siberia were contemplating swimming in the Black Sea as the train rattled through the hot, Russian summer night; strangers on another train, heading East, were seeking an inland summer vacation. Little did they know that most would share the same destiny; some the same hospital ward.

Hot, sweating and tired, many children were probably already asleep, their head on their mother’s lap. All were dressed in typical summer attire; shorts and tee shirts for most; some of the girls were in skirts, some of the boy’s and babies were bare-chested. How were they to know that even a thin covering of cotton would decrease the devastation caused by the flames that were about to engulf them. Sadly, for most, the clothes they wore made no difference; the explosion of the arbiter of the outcome of their skin, and their fate.

The news of the train disaster had not rated a mention in the Irish media where I was then a Paediatric Surgery Senior trainee, possibly because a Dublin cat had got stuck up a tree and been rescued by the fire brigade (a jaundiced view of the media), or perhaps because Russia was not terribly forthcoming with the news of a man-made disaster (a cynical view of Russia), and probably because the Chinese had stolen the headlines with their own human-frailty fiasco in Tiananmen Square – the Chinese government had murdered its own people because they were demanding change. The Beijing story was certainly history making, and was important to the world, but not to the families of those killed and maimed by an explosion equivalent to a 10-kiloton bomb, in central Russia. Just as I had initially not heard of the train disaster in Russia, the passengers were blissfully unaware that a crisis had been mounting in the Chinese capital, since April that year. The sleeping children were more likely to be dreaming of building sandcastles by the Black Sea than Chinese freedom protests.

Eventually, I became aware of the disaster; within 48 hours of hearing of the explosion I was in Russia.

On Wednesdays, I usually visited the theatre used by the Plastic Surgeons, to speak with them about mutual patients I had treated the night before; I had an interest in burn injury because it was intended, at the stage, that I return to the Royal Children’s Hospital in Melbourne to take over the position as the head of the burns unit – I have been anointed to the post; I thought.

To improve my skill in the different techniques that plastic surgeons use, I had made myself available to be on-call to treat their patients on the 1 in 3 nights that I was on-call for Paediatric General Surgery. Otherwise, the plastic surgical registrar was on-call every night: the arrangement was a win-win – I expanded my training and experience, the plastics registrar had a life.

So, on 7th June 1989, three days after the explosion, I wandered into the “plastics” theatre to hear, for the first time, the news of the impending visit of a team of Plastic Surgeons, and theatre staff, to Russia; they were to join other doctors and nurses from Scotland and England. After I dutifully reported the events of the evening before, which were only a couple of minor lacerations that had to be sutured, I stayed to observe the unfolding operation. Yes, I know the kids didn’t think the lacerations were minor. Anyway, the consultant surgeon and his team went back to discussing the impending mercy dash to Russia; they bemoaned the need for another scrub nurse, to which I commented. But, before I embarrass myself by revealing the comment, let me set the scene. Firstly, at that time ALL nurses in theatre at Our Lady’s Hospital for Sick Children in Dublin were female, and, secondly, as a member of the pantomime cast in a fundraising show in Dunedin, New Zealand, in 1982, I had been in a beauty contestant as MISS Ireland, wearing, shall we say “a two-peace costume”; another contestant, MISS Russia was a 6’3” hairy male called (with a Russian accent) Miss Over-shoulder-bolder-holder. You get the picture. For reasons of censorship I cannot share the name of Miss Ireland or Miss France. All contestants had less clothing than was descent, but more than a recent Australian Prime Minster, Tony Abbot, would wear while at a beach. The “boys” had also danced to the music of the Sugarplum Fairy from Tchaikovsky’s Nutcracker Suite, music that had premiered in Russia; a country I would visit a second time. Tchaikovsky would probably not have enjoyed the irreverent use of his music, and many watching the ballet in Dunedin would not have concurred when I attempted to gain a place in the plastic surgical team by saying, “I wouldn’t mind coming along, after-all I do look good in a skirt”. Some of the ballet boys were cut quite, impressive figures in their tutu. Preening myself prior to the going on stage was all in the name of raising money for kids’ health.

The plastic surgeon on that life-changing Wednesday was obviously more impressed with my surgery than my one-line jokes; I was invited to join the team. I wasn’t about to tell him I had also plagiarised a Mr Bean skit of getting into my budgie smuggles (speedo bathers) by placing them over a pair of trousers on stage, removing both my trousers and jocks, only to find out years later that Rohan Atkinson did not take off his underwear. The woman on the beach-scene stage, then stood up and tapped her was off stage – she was blind. That thespian episode was another part of my involvement in the fundraising stage show. Going beyond my Black Adder hero’s achievement had certainly focused the audience in 1982. Fortunately, far less was revealed on stage than on this page!

Off the theatre stage; onto the world stage.

We arrived in the central Russian town of Chelyabinsk at sunrise, having travelled through the night. Our merry band of good Samaritans began by flying away from Russia, to Shannon Airport on the West coast of Ireland where we were escorted to an Aeroflot flight. Yes, the Russian airline that a few years later had a plane crash because the pilot-father left his child at the controls as he went to speak to the passengers. The Russian ingenuity I was soon to witness was shown by that boy disabling the autopilot, resulting in yet another Russian disaster.

Proud of our goodwill, and feeling special because we were given access to the VIP lounge in Shannon, we were then brought back to reality by finding that the only non-assigned seat in the plane were at the back. The part that is more likely to fall-off. All the seats were separated from one-another. No time for team-building. No problem, we were only flying to London!

In London, we met with the British teams from England and Scotland. We walked in the near empty, late night airport lounge where we met the rest of the group; one of the members of the anaesthetic team said, “g’day”. Hugh was also a trainee in his own “mother” country; so that there were now two Aussie adventurers heading to Russia. The “Bloody Hell, two Aussies”, we both ignored.

Since that night, while travelling to and through developing countries, I have felt more concerned than on the next leg of the trip. But, as a less well travelled surgeon, I found getting into the back of a cargo plane not exactly my comfort zone. It certainly wasn’t comfortable by the end of the three-hour flight. It was dark, cold and noisy. The only heating was from a pipe running along the wall at about hip height. The pipe was hot enough to hurt if touched through even thin clothing, so I made sure my jacket was against the metal, forgetting about the chocolates from the airport lounge; my dinner was liquid by the time I realised the juxtaposition of warmth and nourishment.

A hot, cold, no sleep cargo plane was replaced by the unknown as we shuddered to a halt after a thumping landing on the outskirts of a Chelyabinsk, a city known for the making of tanks and planes during the second world war. Ours was the only plane at the terminal, as the steam rose from the tarmac while the rising sun peaked over the nearby forest. The mist imparted an eerie feeling; the lack of toilet facilities presented a challenge. We had landed in the middle of nowhere.

We were slowly introduced to this strange new-old world. We drove in a minibus from a gaping hole in the forest for planes to land in, to the communist party convention centre that the forest looked to be enveloping. The mood of the collective surgical and anaesthetic skilled group was up-beat, the accommodation down at heal. During the stay the food was sparse, mainly meat; with ample supply of Vodka and Kvas, the latter being a fizzy, low-alcohol, fermented-bread drink that most would sniff, screw up their face and push back from; but it was wet and thirst quenching. The availability of the evening vodka becoming increasing dependent on the availability of something from the west that was hard to get in central Russia, like a spare pair of jeans. With their lack and our excess, it wasn’t hard to hand over some of our surplus luggage.

Drinking vodka was clearly a national full-time occupation, at least for some. Kvas (a local beverage made from bread) was served in the hospital grounds from what would be a coffee cart in Australia. And, when we visited the high-rise home of one of the interpreters, home-made vodka was supplied by a friend from the 22nd floor, and the family we visited made their own Kvas on the window ledge of the 14th floor kitchen. During the weekend day off, after being welcomed into the Kvas making shoe-box – little more than a cupboard with fixtures and fittings – we walked to and through the near-by forest. New friends from Britain and Ireland sharing the warm summer-morning air; talking, laughing, joking. Living away from the horror of the train disaster; away from the reality of the different lives we and our Russian friends lived.

Walking back to the collective of high-rise buildings that were the cramped homes of so many, we noticed a group of boys playing with a Frisbee. Coming closer, we saw a boy crying. He was being taunted by about six others. The Frisbee was large, red and faded; made of quite a hard plastic. Watching the boys play, it became clear that the Frisbee belonged to the boy who was being teased, and that it was now broken; it looked like an odd pizza with one slice cut out. I couldn’t help reflect that possessions, talent, looks, caring are all “things” that others pathetically covert; instead of people sharing the positive, become jealous and move to undermine the advantage of another, destruction usually being part of the formula. Boy, was I going to learn more about that after leaving Russia and years later.

Moving closer to the group of boys, I joined-in the game of Frisbee – it still flew, albeit a little like the Aeroflot plane flown by the pilot’s son. Flying the broken toy was a little like AA Milne’s Eeyore making a game out of his broken presents from Winnie-the-Pooh and Piglet. Winnie got distracted on the way to meet Eeyore to give him a birthday present of a jar of his best honey, eating the contents of the jar on the way. Piglet, chose to give Eeyore a balloon, having tripped and fallen, the balloon exploded under him; after deciding the world, nor he, had ended, he proceeded to disappointedly hand the damp rag to Eeyore. Eeyore was happy to have a jar and something to put into it. The crying boy and I were happy to have a toy that made us laugh at its aeronautic inability.

Oh, and coming back to the Vodka theme; Hugh and I were working in the intensive care unit, me as a surgical assistance, Hugh as part of the anaesthetic team. That block of the hospital had its own tearoom. Hugh and I were sitting waiting one morning when one of our COMRADS came in. He was a huge man; broad shoulders, thick biceps bulging beyond the short sleeve white hospital uniform; his thigh muscles well defined through the thin white regulation trousers. He smiled; he always smiled: we had learnt to avoid his jovial, biceps empowered slap on the back as a matter of occupational health and safety. Alex was his name. He was one of the anaesthetists in the Paediatric Intensive care ward.

Walking over to the low glass-top table he placed an unlabelled bottle in the centre and put three shot glasses next to the bottle, he took off the lid and poured three very generous serves of a clear liquid. He was standing opposite Hugh and I as we sat on a couch-like arrangement with padding that had previously been good. Alex raised his glass, encouraging us in Russian, English and sign language to do the same. “Surgical spirit”, he said in very clear English. It was no use asking if he meant the fluid used to clean surgical equipment, the words would be lost in a lack of translation. Hugh supplied the answer as he responded to the contents of the glass by taking some into mouth then projecting it across the table, coughing and spluttering as he did so; he hadn’t stopped to contemplate the real meaning of “Surgical spirit”, a name for operating room cleaning fluid. Alex was not referring to comradery; he was describing the fluid. Never-the-less, I drank my aliquot in the Russian fashion; tasting it was obviously a mistake. A second glass was definitely out of the question. After all I was there to learn – I had. I was about to have an even more potent lesson.

I don’t remember her name, perhaps I didn’t know who she was, but I will never forget the image. She was about 12 years old, and may have been quite pretty, but not when I met her. SHE was on a ventilator, with the endotracheal tube exiting her the right side of her charred mouth. Her face was like some hideous horror-movie, leather-face overlay. Her eyes were partly opened, given an impression of being, but not likely to be in the future. Russian voices talked, and talked through the interpreter, although no language could describe the horror of the preteen’s circumstance.

The clean, fresh skin of her bare abdomen was a denial of the disaster, and her pre-teenage chest had only a mild scald. Her arms and legs were much worse; reminders of red-gum logs on a campfire near the end of the night – charcoal; something to not touch for fear the skin would come away with the stroke of your hand, or feel repulsively like dry parchment.


Figure 1: Body parts being loaded onto a relief train after the accident in central Russia.

Many of the poignant photos of the Russian visit are in black and white. However, one event that is etched in colour in the mind of this do-gooder-Australian is about when the unknown, pre-teenage girl was deemed to need a change of the life-giving plastic, endotracheal tube. “Why?”, I thought. Anaesthetic inexperience and a lack of Russia language stifled me forming of the words. What seemed like a crowd, stood around the hissing of the ventilator in a room filled with stressed foreign language; surgeons and anaesthetics had raised blood pressure as the unknown teenage girl dropped hers in response to the lack of oxygen. Standing watching as the lifeblood faded from the burnt lips, I was in silent panic at being devoid of a common language with the rest of the team. The interpreter had left me to my own, inadequate Russian-language devices. Screaming! Yet, making no sound. I performed the life-saving tracheostomy operation several times, but nothing happened. Fantasy doesn’t make real-life changes – I hadn’t moved. No-one from the surgical team had budged while the anaesthetists struggled to pass a tube through the girl’s nose into the lungs. Why? Why? Why? Why, change the tube from via the mouth to via the nose? Why not perform a two-minute tracheostomy rather than a 10-minute change of tube that was being done to enable the stitching of the trachea to the skin – a tracheostomy. It seemed like medical insanity. “Oh Shit, she is going to die – for God sake”, wasn’t heard except by my weeping, wailing, externally cool, calm collected surgical self.

The unknown girl didn’t die then, she died a few days later. So did a little bit of everyone who had cared for her.

The memory of that little girl has blurred, as does the feel of the burning sun on a bush-fire summer’s day when Autumn is in the air. The sadness created by the tragedy has dulled like the passing of the tingle of frosty morning winter fingers after Spring has arrived. There will always be new events to stir the emotions and well the tears.

Months after returning to Australia, when the memory had faded, but the impact had not, I presented a poster about the disaster at a burns conference in Australia. “Why bother”, I thought: how can anyone appreciate such carnage from a few photos and words on a sheet of cardboard. I wish I hadn’t presented the poster. It was as if having shared my metaphorical Frisbee, it was broken by the dispassionate response. I didn’t cry while in Russia, I did then.