That morning in March 2002 I was at Coptic Hospital with Gianfranco. A magnificent sunny day that did not bode well for the upcoming rainy season so desired. We had entered into an agreement with the Egyptian director Aida, to be able to visit and operate some patients from the slums of that city area. Not even a year had passed since the founding of World Friends and the Neema Hospital was then a goal still to be achieved for our young organization.

The Coptic was located on Ngong Road, was of modest size, all single-storey buildings: general clinic, maternity, pediatric, operating block, internal ward and post-surgical hospital. All the compound it was enclosed by high walls. It was accessed by a metal gate bearing the hospital sign, an unobtrusive sign that, passing through the street, was not even noticeable. Today the hospital has been completely rebuilt. The central block of six floors is surrounded by a clinic including all medical and surgical specialties and there is a large sign at the entrance clearly visible.

That day, almost twenty years ago, the first patients to visit were waiting for us, all with surgical or orthopedic problems, children with club feet, umbilical or inguinal hernias and osteomyelitis. The last patient was a 35-year-old man who wore a once-white shirt, a pair of worn-out trousers and the inevitable flip-flops. He smelled of sweat and urine like someone who hadn't been washed for days. More than this I was struck by his dull gaze of those who no longer have certainties and seek at least hope. Saying goodbye he had found the strength to smile at me. I was his hope.

He had a cast that encompassed his thigh, leg, and left foot. The pinstripe boot was broken at the knee and smeared with dried blood and mud. The man reported that he had fallen from a matatu, a crowded minibus, due to the usual crowd to get off near the stop. He had hit his leg against the curb of the sidewalk, causing, in addition to a fracture, also a skin wound that exposed the bone, what we doctors call an open fracture.

Bad thing, I immediately thought. Here, in a high-quality care environment, this trauma mode could cause important complications, especially infection. Let alone how it could have ended up in that context of poor hygiene. Chris, this is his name, went on to tell us that he had been taken to the hospital, I believe Mbagathi Hospital, summarily medicated and put to bed with a wooden splint that blocked his fractured leg. The next morning a doctor had passed who, after having seen the x-rays, had proposed surgery, obviously for a fee, but Chris did not have the required sum. He would never have managed to collect those 70.000 shillings needed for the operation! Could I really have been her hope? I certainly couldn't back down. At this point they had applied that plaster and discharged him. Chris was desperate, he didn't know what to do, having come to Nairobi to see relatives for a job opportunity, which at that point faded badly. He was also far from his home in Busia.

First I opened that cast to inspect the leg: a stench of a corpse hit me. The leg swam in a creamy, milky-coffee-colored pus that came out of the wound along with splinters of bone. You will hospitalize him and schedule a washing and cleaning procedure for the next day. In the operating room, I had to remove several no longer viable fragments of tibia that would have been dangerous to leave on-site, because they would keep the infection. In order to give stability to the leg I therefore decided to implant an external fixator bridging the lack of tibial bone. The second surgery would have been a bone graft taken from the pelvis, but at the time the conditions of severe local contamination represented a clear contraindication. So this second time was postponed until I returned for the next mission, five months later, when the infection would presumably go away.

Chris returned home and showed up on time when I returned to the Coptic. I performed that graft and applied another type of external fixator, which gave more guarantees of mechanical seal. Chris was discharged after a few days and was able to walk home on his legs with a prescription for medications every two weeks until the transplanted bone took root. The management of the patient with an external fixator required close surveillance, which was difficult to achieve in that context, but luckily for me and for his we found the solution: Chris was followed with competence by Henry, a physiotherapist who by happy coincidence was also his neighbor in Busia and that I knew well from having worked with him in the 90's at the Tabaka Mission Hospital in the Nyanza region. Henry and I were and still are friends. I remember I called him explaining the case and he did the rest of the work. He periodically updated me by sending me photos and control radiographs of the leg of our patient, who for eight months wore the external fixator without complications, being able to move independently.

Chris returned for the third time to Nairobi for the removal of the fixator and finally started walking unencumbered: at first with caution, with the help of a cane, then completely free. He returned home by bus, happy to return to the family in full efficiency. Henry has been keeping me updated on his condition ever since.

Two years later my friend moved to Nairobi to work at Neema Hospital as a physiotherapist-plasterer and assist me with orthopedic missions. When we met on his arrival in Nairobi, he showed me a photo of Chris holding his last child, a few months old, to whom he had named Antonio.

It's been over ten years and Chris, through Henry, updates me with their photos. By now the little one has grown up but we still call him "Little Anthony".

Antonio Melotto

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