Across the Wide Zambezi: A Doctor's Life in Africa (22 page)

Presently we came to the Bubye river, a
river of pure white sand now at the end of the dry season. It was so remarkable
a sight I got out to take a picture. I wondered about leaving the keys in the
car, but thought, perhaps quixotically, that it would be insulting to the
honesty of my passengers to remove them. Besides, I reflected, they would not
get very far in a country like Rhodesia, which although the size of the British
Isles, was socially and economically speaking more like Wiltshire. The highly
developed car-stealing industry which has grown up since independence did not
exist then. My act would not have escaped the notice of two such sharp lads,
and I wondered what they thought of me. Probably an old fool. It was not till
many years later that I rediscovered a greater authority to support me, which I
had forgotten:
'Il est plus honteux de se défier de ses amis que d'en être
trompé.'

We came to a motel, the Lion and
Elephant: the usual lovely spread-out African inn. We ordered sandwiches and
lager on the wire tables outside. I told the boys how it was impossible to get
anything less than a five-course meal for lunch in South Africa, through which
the Boer farmers and their wives worked their way with steady industry. The
boys said, 'You're in a civilised country now, Warren.' They seemed to have it
in for South Africa, after being refused entry.

On the road, as I got tired, I let the
boys take a turn at the wheel; and did those lads enjoy driving the new Fiat!
The needle stood at the top of the clock most of the time. As it grew dark,
after Fort Victoria, they asked me if they were driving too fast. I requested,
modestly, if they would stick to 80mph. If I had known about the stray cattle
and kudu one could meet on that road, I would have kept them below that.

We parted in Salisbury, and I booked
into the Selous Hotel. Next morning I stood on the top balcony and viewed the
lovely garden city around me.

I reported to the personnel officer at
the Ministry of Health. He had already recruited me from Zambia. On the wall
was a map of the country with all the hospitals, including the district
hospitals which most interested me. There were thirty-six at that time, and the
name of the district medical officer was attached to each - the sole doctor on
the station, though the larger towns might have one or more private doctors
too. I noted that some of the posts were unfilled.

But first I was destined for Gwelo, the
provincial hospital of the Midlands, as doctors new to the country were both
vetted and given such extra training as they needed to equip them for their
duties, especially those who had opted for district service, as I had, who were
going to work on their own.

I spent another day 'in town' where I
bought new safari suits, among other things. Next day I set off for Gwelo,
where I arrived at midday.

‘Gwelo' was the Matabele name for what is
now called 'Gweru', the Shona name. When the pioneers arrived in 1890 and
established the modern country, they put the Matabele names on their maps (when
they did not introduce English or Dutch ones), I imagine because at that time
the Matabele dominated the country: the Midlands province lying in the Shona
area.

Gwelo was a typical Central African
town, built on a central grid pattern, with the oldest suburbs nearest the
centre, then somewhat dilapidated and occupied by Coloureds and Asians. Further
out lay more opulent and leafy suburbs where the whites lived. Here were two
cathedrals, no less: Anglican and Catholic, and a large boarding prep and
secondary school. And well beyond all were the African townships, which were
sprawling and far from leafy, though the little houses each had a plot of maize
and fruit trees - bananas and paw-paws. There were primary schools full of boys
in khaki shirts and shorts and girls in cotton frocks (there were two African
secondary schools in Gwelo); clinics with waiting crowds, mostly women and
children; stark churches with tin roofs; and beerhalls pulsing with music day
and night.

On arrival, I met first the
superintendent, Dr Plato Mavros, who gave me lunch. 'Mav', as he was known to
all his friends, including his wife, was then half way through a distinguished
career. He was a man of medium height and build, and of Greek extraction, as
showed in his regular features and dark, curly hair. His invariably calm,
gentle manner contained a considerable force of character. His wife, whom he
called 'Boo', was a tall, distinguished-looking woman of pioneer stock, and her
husband's equal in character, although considerably more out-going.

There were about six doctors at the
hospital then, only one a specialist: David Taylor, a consultant physician;
though Mav was a skilled surgeon, in fact, a good all-rounder - the best type
of African country doctor, the model I aspired to myself. David was also
Rhodesian, about Mav's size, lightly built, fair and incisive.

The medical services of the country were
then well-established on a model which, except for important developments which
came later, which I will describe in due course, has remained unchanged, so it
is appropriate to describe them here.

Then, as now, there was a state sector
and a private sector. Then, as now, the state sector served ninety per cent of
the population and comprised a quarter of the country's doctors. The private
sector served ten per cent of the of the population and comprised three
quarters of the doctors - a situation which has remained unchanged to this day,
except possibly to the disadvantage of the state sector. This is the same
throughout Africa. The reasons for this disparity are no doubt personal as well
as economic; but the governments could neither match the incomes nor maintain
the numbers of the private sector.

As far as other services went, I must
not forget the mission hospitals which lay more or less in the state sector.
Other hospitals were industrial or private - both in the private sector.
Private doctors had access to private beds in the larger government hospitals,
which had a separate section for Europeans. The government doctors had some
white patients, such as police and the 'pioneer pensioners' - the impecunious
descendants of 'pioneers', who were defined as persons settling in the country
before 1900. There was also a public health service which came under the state
and municipalities.

Gwelo hospital had then about 300 beds.
It covered the Midlands Province, which was as big as Scotland and had a
population of about 750,000. The province was divided into eight districts
(including Gwelo itself), each of the others having a hospital of about 100
beds and one doctor, covering an area as big as a large English county and an
average population of 90,000. These figures will stagger anyone familiar with
European medical services: for instance, in UK, one GP serves 2000 people, and
has access to complete specialist services. And Rhodesia was the most highly
developed country south of the Sahara, bar South Africa. How was the impossible
balancing act performed?

I have already limned the great African
principle of elevation of responsibility, and how it works from the grass roots
upwards. The grass roots in this system - primary health care, where the
patient makes first contact with the service - were the medical assistants, the
mini-doctors heretofore described. These people did the work of GPs and
hospital house doctors in England in the district and provincial hospitals: not
forgetting the maternity aassistants, who were rather more than British
midwives. And alongside them worked the nurses and general hands.

In charge of the medical assistants
(MAs) and nurses were the state registered nurses (sisters). These were usually
ward sisters and acted as administrators. They existed in delicate, and
sometimes invidious, relationship with the MAs. The sisters were 'officers',
the MAs 'employees'. The sisters received more than double the salaries of the
MAs, but lacked many of the skills they asked them to exercise.

The MAs formed the filter in which major
cases were separated for the attention of the general doctors, in district or
provincial hospitals, who were trained to deal with most of them, in medicine,
surgery, obstetrics and gynaecology, paediatrics, etc, at registrar level in
England; but across the board, not separately. Few cases would be referred by
the doctors to the specialists: a difficult hysterectomy, perhaps, but
certainly not a caesar.

The provincial hospital was supposed to
have a full complement of specialists: that is, one in each of the core
specialties, but rarely did. At the time I joined there was no gynaecologist,
so I was given the job, under Mav's wing, which was a broader one than mine as
far as obs and gynae went, and all other things besides.

In the townships and out in the country
were clinics and small rural hospitals (run by nurses - a term I shall use in
future to include MAs and ordinary nurses), which dealt with patients like
general practices and cottage hospitals in England, and could refer cases to
the district hospitals (including Gwelo in its own district). These represented
the primary health care level. I shall have more to say about them later.

Small charges were made at government
hospitals and clinics for outpatients and admission, which could be waived in
cases of indigence at the discretion of the superintendent. Private services
were covered by private insurance.

I was given a house in the hospital
grounds at nominal rent (a married man with lively youngsters would have paid
four times as much), and a cook recommended to me. Anderson was a Malawian who
was retiring from the hospital kitchen. In his servant's jacket and trousers
and bare feet (in the house), he was a cheerful little soul. He lived in a
kaya
at the bottom of the garden. His wife lived in one of the townships to secure
his base there. His grown-up children had long since left home. Stove and
fridge were provided. It wanted only to furnish the house at my own expense.

'Boo' offered to go shopping with me,
rightly suspecting that a woman's guidance was needed. She took me to a good
but moderate store and proceeded to equip my house with practical sense and
lively good taste. After dining and lounge suites, carpets and curtains, we
came to beds. I eyed a monastic cot. Boo said, 'O buy a double bed. You're
bound to get married, and anyway, it's much nicer sleeping in a double bed.'
Sheets. I fingered some white shrouds. 'Don't be so British!' commanded Boo.
'Candy stripes!' she ordered, from the attentive Mr Saddler. She brought me
luck: through her orders and her prophecies, in one way or another, I have
slept in a bed of roses ever since.

Mav put us in various departments and
moved us around every six months to save us from the ruination of
specialisation. And each night two doctors were on call: a junior with a senior
to fall back on.

One night I was on call with David
Taylor, when a man walked out of a beerhall under a train, which went over both
his legs. He was going to need a double amputation. Neither of us had done one
before but we were not going to drag Mav from his much-needed rest: that is not
the way of Africa, as the reader will have gathered by now. I volunteered to
mug up the operation from the bush doctor's surgical bible: Hamilton Bailey's
Emergency
Surgery,
while David resuscitated the patient with a view to giving the
anaesthetic.

The patient had of course taken his own
'premedication' at the beerhall and a good deal of the main anaesthetic
besides, so in fact, David kept him comfortable with intravenous pethidine and
Valium, an invaluable tool in Africa.

I took off the first leg below the knee,
a proceeding which took me about an hour. Then I changed gown and gloves and
returned to the theatre, saying to David: 'Now for Henry the Fourth, Part Two.'
(The seeming frivolity which sometimes affects surgeons about their lawful occasions
is, of course, a cover for emotions which are by no means frivolous.) I
amputated the other leg above the knee, which took me even longer.

All went well and I saw the patient in a
wheelchair a few days later, with the undefeated grin of Africa on his face. He
was of course no longer my responsibility, being surgical. I think they fitted
him up with something in the way of peg-legs and crutches.

We were joined by Willy and Kate, an
English couple. Kate was a small dark, very pretty woman with a special
knowledge of anaesthetics. Willy was half way to being a gynaecologist.
Nevertheless, Mav let me work out my six months in the maternity department,
true to his system.

Willy was a short stocky man with a
black fan beard, who looked more like a trawler skipper than a doctor, and had
chronic difficulty in looking 'presentable'. He did his best for a court
appearance - in sports jacket and flannels, a black shirt which might have been
discarded by Mussolini, and a rustic-looking tie. The prosecutor took one look
at him and addressed the magistrate: 'Excuse the doctor's appearance, your
worship. He has just come out of the operating theatre.' As Willy had done no
such thing and the prosecutor had no right to say so, Willy was rather ruffled,
but recovered enough to tell the tale against himself afterwards.

We worked hard and were on call one
night and one week-end in three, but had leisure to get around. I explored the
surrounding country with Willy and Kate. We did a round run to Bulawayo and
Shabani and back, via Selukwe - three hundred miles, which shows what can be
done in Africa in half a day. We had supper in Shabani in the big bare hotel.
After the meal we took a stroll in the dark empty main street. My heart sank as
I thought how lonely it would be as a bachelor in a dorp like this. Little did
I know that within a few years I would be district medical officer here, come
to call it a 'sweet little town', and find a wife there.

I went fishing by myself. There were
some lovely dams around Gwelo and though I caught little, it was very pleasant
to spend an afternoon among the sights and quiet sounds of the high open
country. Sometimes little clouds sailed across the hot sky of summer, and I had
recourse to an umbrella to save my skin. Other days were as grey and cold as
Yorkshire (or seemed so), under the peculiar drizzle or Scotch mist of the
country, called
guti
. But always lovely places alone with space and
nature.

Coming home from one dam along a dirt
road I skidded (something one can do as easy as on a wet road, which I did not
know), and after a few turns, ended up in the ditch. Typically, I had lost my
bearings. It was night. I found the Southern Cross and quickly reorientated
myself. The car was bent and undriveable. Some passing Africans told me I was fifteen
miles from Gwelo, too far to walk, and directed me to the farmstead of Mr
Pringle, whom I found watching his Sunday night telly. He kindly took me home,
and we even got a garage man to rescue my car, which they assured me would
otherwise be minus wheels by morning. They had to send to Italy for spares, and
for five months I was 'without wheels' anyway.

That year was a drought year, and one
burning morning succeeded another as I showered and breakfasted and enjoyed the
equally sensuous monotony of Delius's Cello Concerto on my record player. Very
pleasant for me, but I little knew what a threat to life it was to the poor
people in the tribal lands. The country was well-managed, and there was 'corn
in Egypt' for the dry years, but even in Gwelo I saw the effects of
malnutrition: a little boy on the verge of blindness from measles, whose sight
I was able to save with a single dose of vitamin A.

I noted, not for the first time, the
originality of African parents in naming their children. In Zambia, one 'Disgusted,
Bongo Bongo' had complained to the Times of Zambia about 'this practice of
giving our children these ridiculous names derived from the culture of our
colonial oppressors. How can anyone achieve dignity in life with a name like
"Motorcar"?' Needless to add, 'Disgusted Bongo Bongo' was a name
conferred on the writer by himself and not by his parents.

These names would be plucked at random,
it seemed, from the hedgerows of experience. A simple visit to the supermarket
might result in such christenings as 'Weetabix' or 'Fairy Liquid' (the later a
rather lovely name for a girl, though it was mostly the boys who were the
subjects of such exotic experiments: the girls, as the carriers of tradition, I
suppose, usually bearing such old favourites as 'Dorcas' and 'Rebecca'). A
mechanic visited northern Zambia, left his handbook behind, and returned a year
later to find a number of little 'Carburettors', 'Chokes' and 'Big Ends' - all
boys, of course. In West Africa I met a 'Keyboard' Ankrah, and, in Zambia again,
Andy Crookes collected a 'Durex' Musonda: acquired accidentally, perhaps!