here, and that was enough for twelve bodies. ‘It will keep a body for a week, even without refrigeration,’ they said, even in this Central American heat.
Beside the bottles were small plastic bags. They put the intestines inside these. The bags were then sent elsewhere to be burned, and they packed your body with ‘pulverised hardening compound’ instead.
After a while I shook their hands, and they told me to stay, to come back soon, but I wanted to leave. I did not want to know more about plastic bags filled with intestines or skulls filled with balloons. And the smell had long ago seeped into my clothes.
I had seen enough of death’s ugly business – I knew all too well what the gun could do. I just wanted to head back to the land of the living. Or, at the least I wanted to see a glimmer of hope in all of this sunless despair; so I left and sought instead to meet those who had managed to survive the gun’s barbed impact.
3. THE WOUNDED
South Africa – a bedside visit – the gun’s hidden impact revealed – a chat with a trauma surgeon – a blood-tinged night in a Johannesburg emergency ward – understanding how science feeds off the gun’s misery – a trip to the BBC to meet a paralysed correspondent
The boy – for he was hardly a man – lay there and watched me. His chest rose and fell, and my eyes drifted from his handsome face to his stomach, where he had been shot.
It was a hellish place to be hit. The bullet had ripped through his intestines, leaving a gaping and ragged hole. Five weeks had passed since the rushed horror and blood-soaked panic of that night, and the wound still refused to heal. The shit from his bowels was re-infecting the coarse edges of torn flesh, and you knew this because of the stench. The doctor spoke to him quietly in Afrikaans. He was eighteen, and there was a chance he would have to carry a colostomy bag for the rest of his life.
Three other South Africans lay in that room. Each shot. Another six lay in the room next door. These men, too, had been shot. And in the room further along another six lay. By this point you had stopped asking the doctor what had happened to them, whether they had been shot, because this was Cape Town, and this hospital was the main medical centre for one of the largest townships in South Africa. And as such it was home to one of the busiest trauma units in the world for gunshot wounds. Which was exactly why I had come here.
The room was empty except for their beds. No flowers, no cards. One man turned in his delirium and moaned; his back was sweated out, and his head was swollen. His breathing came in low gasps.
There were fifty-one beds in this trauma ward, and sometimes it got so bad the overflow spilled into the waxen, squeaking corridors. There were only four nurses on staff, and that was never enough. Last month, three men were brought in. All were in the back seat of a taxi when someone had fired a single high-velocity shot through the car. They were all hit by that same bullet – six legs to be treated, the round clean through. And that story alone filled up three beds just there.
The ones who lay here, sullen now the pain had passed, were young men. More would come. Tonight was a Friday night, and the weekend brought in the bodies. And I looked at the plastic bag that had been taped over the young man’s stomach and wrote something in my notebook that I later was unable to read.
What this scene reminded me, like the dramas played out in thousands of wards in slum-towns and war-zones the world over, was that the majority of people go on to survive being shot.
It works out as a hidden epidemic of pain and violence. In the US, up to 91,000 people were admitted to hospital with non-fatal gunshot injuries in 2011 compared to 8,583 who were killed in shootings.1 In the UK, it is estimated that 777 people were shot and survived in 2012,2 compared with about 150 killed by gunshot the year before.3
Such harm is hard to imagine, but consider this: about 35,000 American children and teens are said to have suffered non-fatal gun injuries in 2008 and 2009 – six times more than those shot and killed. This is the equivalent to 700 school classrooms of twenty-five students each: a number greater than that of US military personnel wounded in action in Iraq and double the number wounded in Afghanistan.4
Admittedly, the exact numbers might be debatable, but what is not challenged is that each injured child experienced the horror of a bullet crashing and crushing through them. Their tissues and bones and muscles were shredded in the bullet’s path. Their insides were horrifically displaced, as if kicked by a mule. Their bone fragments spun off and lacerated and pierced their young bodies.
Ultimately, these children’s chances of survival were dependent on a host of factors. The speed of their getting treatment was crucial – the so-called ‘golden hour’. In one study in the US, it was found the likelihood of you dying from a gunshot wound was about 25 per cent higher if you were shot 5 miles or more from a trauma centre, and you could not get there within the hour.5
Also important was the wealth of the country in which they were shot. In the US for every person shot and killed, as many as nine survive. In developing countries the ratio is far smaller; more people who are shot will die – about one in three. The World Health Organization estimates that between 50 and 80 per cent of traumatic deaths in developing nations happen before people get to hospital, in part because, in many areas of the world, ambulances are almost non-existent.6
Your chances of survival also come down to factors far beyond your control. The bullet’s weight, the speed at which it hits you, even the pull of the moon has an effect. It is all about the transference of kinetic energy in a chaotic way; variables that determine the final resting place of the bullet or how badly you are hurt are all unfathomable.
Other things matter. If you’re wearing clothing at the time, there’s a greater risk of damage and infection to your body.7 If you are pregnant there are sometimes significant complications.8 And, in the US at least, whether you have health insurance plays a factor. One study said uninsured trauma patients were more likely to die after being shot than those insured.9
It is not just the immediate trauma of the wound that causes harm. Bullet fragments left in the body can also result in higher blood lead levels.10 Or you can go on to develop related health concerns – as in the case of US President William McKinley, who earned the title of being the first reported case of traumatic gunshot pancreatitis.
All in all, getting shot is a terrible lottery. The odds might be in your favour, but it’s one bet never worth taking. Thank God, then, for doctors.
In a closed room behind a steel-barred door the medic and I sat and talked. The room was lit with an ugly sterility, the overhead lights gave off a low buzz, and all around was chrome and glass, instruments wrapped in stark, sterile packages. A bleach-white smell clung to this place. For two years, Dr Taylor, a petite and vivacious young woman, had been the head of the trauma unit here in this rising, brick-built oasis of South African care: Tygerberg Hospital.
Tygerberg. It sounded like the tiredness and despair that had long ago infected the slums surrounding this place. Each month up to 2,000 patients passed into Dr Taylor’s world, fresh from the poverty of the Cape Town flats. And what she saw, endlessly, was the trauma wounds of penetration – gunshots and gunshots and gunshots.
‘In the past we got stab wounds, but now it’s gun wounds. It’s all to do with drug crimes and gangsters.’
