Across the Wide Zambezi: A Doctor's Life in Africa (23 page)

Popular names for boys were 'Hitler' and
'Stalin'. Knowing nothing of the details of those distant squabbles of the
white men, African parents of the time yet recognised that these names
represented powerful figures in their own circles, and the God of Africa is the
God of Power. It amused me later, in Shabani, to greet my clerk each day with:
'Good morning, Stalin!'

But top of my own collection were the
three little boys I found before my desk one morning in Gwelo clinic, all in
Balaclava helmets, for it was one of those cold days you can get even in summer
on the Highveld: each one smaller than the last like Russian dolls. Their
mother, who sat behind them, presented their cards. I could hardly believe my
eyes. 'Are these their names?' 'Yes,' replied Mother, simply. They were:
'Anyway', 'God knows' and 'Breakfast'.

One day, after six months at Gwelo, Mav
told me I was wanted at Marandellas, as acting superintendent, no less, as the
senior doctor there was on long term sick leave. Marandellas was a 'general
hospital', a breed now extinct - really a glorified district hospital,
augmented with an extra number of European beds, to be found in small towns
with a larger than usual white population. These white beds were used by
private GPs of whom there were a number in the town, apart from those occupied
by the white government patients already mentioned. The hospital had an
establishment of two government medical officers, including the superintendent.
I made the journey with Anderson by train (my car being still in dock) - I
first class, he fourth class: myself at government expense, Anderson at my
expense. Not that I was too mean to buy Anderson a first class ticket, nor was
the section banned to Africans. I knew where he would be most comfortable.

When I arrived at Marandellas hospital,
I stayed in the nurses' home for two weeks until I was able to find a cottage
nearby to rent. There was no servant's accommodation, so Anderson found a bed
in the township and came to my house on his bicycle. I was to stay at this
hospital for twelve months, though when the super returned I reverted to number
two. In the meantime, a succession of locums helped me.

Three Scottish sisters arrived at the same
time, but like the girl in
The Nun's Story
they were not happy to be
assigned to the idle European hospital where they felt, quite rightly, they
were under-used. They all moved later to Bulawayo where they more active and
happy.

Marandellas was always my favourite town
in the country. At 5500 feet it was the highest, with the possible exception of
Inyanga in the Eastern Highlands. It was on the crown of the Highveld, with
vast sunlit views of fine grasslands and distant avenues of tall blue gums on
the white farms. The landscape was broken by many stony
kopjes,
and
winter and summer, the air was clear and bracing.

The town itself was small - I called it
'Stow-on-the-Veld', for a number of reasons, not least because it had the
largest percentage of Britons in the country: around the bar in the club they
outnumbered the Rhodesians. They were mostly old, and I used to say it was a
sort of elephants' graveyard where all the old 'Poms' went to die. It even had
something in the town centre called the 'Green', which was usually brown, and
most of the shops were built around it, apart from those on the main Salisbury
road. But it was the usual spread-out African town, far more spacious than
anything tucked up in the Cotswolds. There was a number of leafy avenues in the
town itself, but houses spread out to a distance of seven miles - each fifty or
a hundred yards apart, in up to ten acres of land. Even the township,
Dombotombo, looked cleaner and more picturesque than most.

Marandellas was famous for its schools,
both government and private, all of which were modelled on the English prep and
public school system, and mostly European. There were good African schools in
the country, but not one tenth as many as were needed. Beyond all spread the European
ranches for about thirty miles, and beyond them, the African tribal lands.

In those lands the hospital covered two
'rural hospitals' - another Rhodesian peculiarity: more than a clinic, as it
had beds, as many as fifty; but was run by medical assistants. The doctor
visited weekly, and saw cases. Emergencies were sent to the main hospital,
after calling the ambulance from that place.

And scattered throughout the district
were small clinics run by the local authority, which were supervised by the
provincial medical staff. These could refer patients to the main hospital with
free bus vouchers. Emergencies at night had to find their own way usually in
the car of the local headmaster, unless the clinic had a telephone and could
summon an ambulance from the main hospital.There was a clinic also in
Marandellas township, run by the local authority.

At Marandellas I did my first brain
operation, having assisted Mav at them before: a man with a head injury with
signs of internal bleeding. These cases can last a day, and they can succumb in
an hour. Potter of Oxford had written: 'Some emergencies are relative: this one
is absolute.' And as to the surgeon to do the operation - 'the first one
competent to do so' - a principle long abandoned in specialised Britain, with
some notorious disasters as a consequence.

I could have sent this case to
Salisbury, an hour away by ambulance, except that I had found you must add two
hours to the time of the journey to include the preparations at either end. And
the man could well have died in that time. Fortified by Potter's philosophy, I
ordered the patient to theatre.

This did not please Sister Fleet. Sister
Fleet was a highly competent nurse, and a very pretty girl besides (though no
doubt that has nothing to do with the matter), but she was the type who would
argue with the doctor. No African nurse would do anything so unwomanly (with
one or two exceptions I have met, and pretty unsavoury specimens they were).
Now I was never too proud to take advice from any quarter, high or low, (or in
between), but I simply did not agree with Sister Fleet, quite apart from her
manner of delivery, which was sharp.

I drilled the necessary hole, evacuated
the blood and sutured the bleeding vessel, and had the feeling I was winning,
when Sister Fleet poked her head round the theatre door.

'He could have been in Salisbury by
now.'

To this nobody replied. Besides myself
they were all Africans in the theatre, and Africans are not in the habit of
making unnecessary remarks.

'Besides, you're using the wrong
instrument.'

She was wrong. I was using a burr.
Perhaps she was thinking of a trephine, an instrument I saw even specialist
surgeons use later. I tried it myself, but found it a clumsy tool. At the time,
I was not sure, so said nothing. Besides, it was not the time for a debate on
the subject.

Sister Fleet and I got over our tiff and
became good friends - especially after I left the hospital. And most important,
the patient made a good recovery.

Then disaster. I was doing a caesarean
section, when the nurse anaesthetist put the breathing tube down the wrong way.
I got a live baby, but the mother died two days later from brain damage. In
cases like this, the senior carries the main responsibility. Unless one knows
one's staff very well, one should always check their work - a principle I was
to learn here the hard way.

There was an inquest before the district
magistrate, when I and the nurse appeared, and I, of course, had most of the
explaining to do. The courts were always very understanding towards medical
people, and the matter was not further referred. Patients and relatives would
show equal indulgence.

This is not to say that the guilt/blame
nexus is absent from African culture. As I have said, nothing is supposed to
happen by accident, and some source of spiritual interference is sought for,
either a witch or an offended ancestor. But the doctor is rarely blamed or
suspected - an attitude, I suppose, we owe to its careful cultivation by the
witch doctors themselves over the centuries; whose business, of course, is to
impute (or deflect) the blame. Witchcraft was never a crime under colonial law
(which did not recognise its objective existence): to acc-

use anyone of witchcraft was - a
position all African countries, to my knowledge, retain to this day. So a
discreet witch doctor would stick to ancestors.

Where a wife was lost, a husband would
quickly find another; African reasons for marriage being more practical and
less romantic than ours. (The man who danced round the theatre in Ghana found a
new wife within months; nor was this a reflection on the sincerity of his
grief. Among the poor, love - and hate - comes through propinquity rather than
inspiration.) When a woman is widowed, it is not so simple.

Sometimes her brother-in-law is obliged
to marry her and take over her children. In other customs (conspicuous in
Rhodesia/Zimbabwe, where there are pressures to change them), the widow is
stripped of everything by the dead husband's family - house, property, children
- and sent back to her own people.

A woman was run over by a bus at the
terminus. Her leg was crushed below the knee. I thought it impossible to save
and said I would have to amputate. She cried and refused. The nurses worked on
her and she dried her tears and bravely accepted.

When she was resuscitated and under the
anaesthetic, I felt a pulse in her foot. That and a nerve are usually all that
is necessary to save the limb. I went to work with a medical student on
attachment to the hospital (David Hurrell). We cleaned up the wound and even
managed to close the skin without tension. We set the leg in plaster. (Later, I
would learn how to apply traction through a pin in the heel.) Imagine the
woman's joy when she came round! It was cases like that which made me glad I
had come to Africa.

One night an old man was brought in with
a distended abdomen, vomiting and absolute constipation - nor gas nor faeces. I
knew what this was before the X-ray confirmed it. Not only the intestinal
obstruction, which any British surgeon would have recognised by this point, but
the special African kind - primary volvulus, either single or double. The first
type is rarely seen in Western Europe: the second never.

A volvulus is a twist in the large or
small bowel: a double, or compound, volvulus is both together, in one enormous
knot. Why the latter is so common in Africa (the district doctor sees two or
three a year) nobody knows.

I could, of course, have sent this man
to Salisbury, where there were specialist surgeons; but I knew I was going to
be in remote places, where it would behove me to be confident. I decided to do
the operation myself, with David assisting.

When I opened the abdomen, I could see
nothing but a pool of black gangrenous bowel, and felt like closing it again
there and then in despair. I explored and found healthy bowel. Then I went
ahead.

First one excises the affected section
of large bowel, then the same for the small bowel. All this I did, and the
nurses measured twenty feet of black small intestine, leaving about six feet
behind. People can live after such a loss, though they never again have a
weight problem! I joined the healthy small bowel to the large bowel, and then I
turned my attention to the gap in the large bowel.

The proper thing to do next is to bring
it out to the surface in a double-barrelled colostomy, and come back in six
weeks when all is clean and healthy, and close it. In my ignorance, I closed it
there and then.

Next day, the old man was leaking faeces
from his wound. Something had obviously broken down inside. I sent him to
Salisbury, where the surgeon saved him with the colostomy I should have done in
the first place.

I went up to Salisbury to see my
patient, and met the surgeon, who gave me a friendly and instructive talk on
the subject. This surgeon was a brilliant if fiery young fellow from South
Africa. I later learnt that he fell out with the anaesthetist during an
operation. In true colonial spirit, they doffed gowns, etc, and settled it with
a punch-up in the corridor outside, before returning to finish the operation.
Of course, they were carpeted by the 'headmaster', but kept their jobs, which I
doubt they would in England - or even Ireland nowadays!

And once a week, as I said, I visited
the rural hospitals, a hundred-mile morning run in a van, and in my car, when I
got it back: the dirt roads in that district being in good condition.

First stop, Chiota, with a great crowd
of patients standing outside, or packed on the veranda if it was raining. I
would see only selected cases, then do a ward round. So on to Wedza. The little
town of Wedza looked like a Mexican village in a spaghetti Western, complete
with the Happy Hotel, a two-storey shack. The hospital lay outside the town,
and in the distance, Wedza mountain, a large
kopje
, glowed like an
amethyst in the fresh morning air. Wedza provided no food, so the grounds were
always full of relatives at their cooking fires.

And as in Ghana, I considered the first
purpose of my visits was educational. This principle ran through the service
from top to bottom, and from bottom to top, as the doctors could learn from the
nurses about local customs, etc.

So the doctors attended annual refresher
courses at Salisbury or Bulawayo, staying two or three nights at good hotels at
government expense, and getting pumped full of information every day: and given
protocols. There were protocols for everything from obstructed labour to
meningitis. And the district doctors made up their own protocols for the
simpler activities of the rural hospitals (not forgetting the splendid auxiliaries'
handbook produced by David Taylor): though those 'simpler activities' included
the management of typhoid and malaria. And all maternity units, rural and
urban, used that wonderful invention, the Rhodesian partogram.

Many practical contributions to modern
medicine have been first developed in Africa: such as the rehydration salts,
now familiar to every British mother; and the under fives' road to health chart
(less familiar because its main use in Britain must be keeping children's
weights down). But the partogram is the most ingenious.