The Masked Man was unmasked, lying patiently on the operating table. His left eye slowly closed as the anesthetic drugs flowed into his arm. The right side stayed open, a white moon of sclera showing as the eye rolled back into his head. Once he was sound asleep and positioned for surgery, Pieter exited the room, leaving Ben in charge of anesthesia. Sarah breathed a sigh of relief.
Dr. Marshall’s face appeared on the video monitor. “Good morning from the United States. Everything ready there in Tanzania?”
“All systems are Go here,” said Sarah. “Thanks for getting up in the middle of the night to help us. Are you getting video feed of the patient’s face?”
“Yes, it’s excellent. As we discussed yesterday, we need to start by recreating the original defect. Then we’ll move some tissue in to fill the space, so that he can close his eye.”
Sarah sketched out her proposed incision with a marking pen, and Dr. Marshall approved. Then she sliced along the blue ink lines, peeled back the skin edges, and the wound gaped open.
“Now sew the eyelids shut. That will protect the eye and keep the eyelid in a functional position while we reconstruct his cheek.”
Sarah drew a line extending out from the eyelid. “I’m thinking the cheek advancement flap we discussed will fill in the defect and relieve the downward tension on the eyelid.”
“It looks to me like you’ll need a relaxing incision to get enough rotation.”
“I think you’re right. And we might need a skin graft to fill the defect left by the flap.”
“That would leave a depression and not a good color match of skin. Use a rotation flap from the neck.”
Sarah sketched a curving line. “Like this?”
“Exactly.”
The flaps fit perfectly, and Margo and Ruben began suturing them into place.
“What about his nose?” asked Ruben.
Dr. Marshall said that there was no practical way to reconstruct the nose. “Too much missing tissue. He will do better with a prosthetic nose. Just remove the jagged edges. When the swelling goes down, make a cast of the hole in his face and send it to me. Then I’ll have a new artificial nose made and bring it with me when I come for a visit.”
Sarah clapped her gloved hands. “Yay. You’ve decided to come.”
“Yes, and I’ll bring a resident with me. I think you remember Jeff?”
“Of course, Jeff was on the Honduras mission trip. That’s great. We can line up a bunch of cases for you.”
Sarah was startled by Pieter’s voice. “Nice work.” She wondered how long he had been looking over her shoulder.
“Thanks. We should be through in about twenty minutes.”
Pieter laughed. “That’s what you surgeons always say, ‘twenty minutes.’ When we ask again an hour later, you still say ‘twenty minutes.’”
He patted Sarah’s shoulder—twice. Then he left the room.
ONCE DR. MARSHALL signed off, Sarah made a beeline for the dressing room. No stopping in the lounge for tea. She just wanted to get out of there as fast as possible, without running into Pieter. But when she stepped out into the hall, there he was, leaning against the wall, arms folded across his chest. He was not smiling.
“You met with Dr. Obaye. You discussed our project.”
“Umm … yeah, he seems to think it’s a good idea.”
“This is my project, too.”
“Of course. It—it was just easier for the three of us to get together. You’re so busy. I’ll set up another meeting—"
“Already done. Dr. Obaye called me yesterday. He and I both feel it’s important to include the faculty of our midwife school in the project. We don’t want any pushback from them. And they’d be a big help with the curriculum.”
“Good point.”
“We meet on Friday afternoon, three o’clock.”
“Okay.”
“If you don’t want sex, you just have to say ‘no.’ You don’t have to hide like a little girl.”
“Sorry.” She glanced nervously up and down the hall, hoping no one else heard what he said, her face on fire. She wanted to fall through the floor. She settled for leaving as fast as she could.
Dr. Obaye opened the meeting by thanking everyone for coming. Then he briefly stated the objectives of the project.
The midwives sat stony-faced. Helena, the older one, pointed out that such training had already been tried. “A little knowledge is a dangerous thing. We should follow WHO recommendations and just focus on getting women to deliver their babies in proper facilities.”
Sarah switched on the projector and began her Power Point presentation. “The older studies didn’t prove any harm—they just didn’t prove any benefits.” She reviewed recent research that showed more positive results. Then she showed a photo of Balinda. “Dr. Pieter trained her to take blood pressure, and now she screens all the pregnant women in her village. Balinda recently detected toxemia in one of them and sent her to us. That young mother is alive with a healthy baby, thanks to a little knowledge.”
Helena looked at Pieter. “Do you believe in this training?”
“It’s an excellent idea. I’ve been working with Balinda, and she has become an effective community health care provider. Sarah had the vision to train others, and I am so glad she has the courage to take this on. We hope that the school of midwifery will help us develop the curriculum. And would you allow Sarah sit in on your classes, to help her prepare?”
Helena smiled and nodded. “You have convinced me.”
After the meeting, Pieter helped Sarah store the projector. “I hope you don’t mind that I suggested you sit in on their classes.”
“It’s a very good suggestion. And thanks for making it sound like it was my idea.”
“You would have thought of it yourself.”
“And if I’d spoken to you sooner, you would have told me. I’m sorry for being such a baby.”
“Not a problem.”
“And thanks for editing the proposal. You made it much stronger.”
“I’ve had some experience in writing grant applications.”
“Yeah, I noticed that you have an NIH grant. I didn’t know they funded non-US researchers.”
“My collaborator is American professor. By the way, your plan to use qualitative outcome measures is excellent.”
“Thanks. I got that idea from my sister.” She picked up her backpack and turned toward the door. “I’m really sorry that I’ve been avoiding you. This project is your baby, too.”
“Ah, so we’re having a child together.” He chuckled.
Sarah rolled her eyes and flounced out of the room.