Across the Wide Zambezi: A Doctor's Life in Africa (35 page)

     Another, more tangential clue, I
thought I saw when I told him one morning: ‘I was saying to my mother - I mean,
my wife!’ Percy chortled at the Freudian slip with what seemed an ancient
wisdom, more than Anglo-Saxon. He would have chortled deeper had he heard my
wife the other day call me ‘son’, and I twenty years older than her.

I have a talent for improbable
friendships, as the reader may have noticed. Koos was a mine captain, a big
Afrikaner, by common consent the strongest man in the town, white or black. His
moustachioed face was like Bismarck’s Pomeranian grenadier’s: I even think he
had a touch of the Zulu in him (one can never tell with those people), of which
he would have been more proud than otherwise, for he had not a scrap of
racialism about him. He had had a hard life - brought up in some South African
orphanage - and he drank too much. But he had soul.

     He painted. He spoke several
languages, including African ones. He played guitar and sang a little, and had
a good collection of books, mainly of the scientific encyclopedia kind. And he
was a music lover. The first record I heard in his house - he had a place with
a bit of land outside town - was the
Hammerklavier.
And then I gave him
Mahler.

     Talk about Chapman’s Homer and the
road to Damascus! Mahler’s music rolled through the big soul of Koos, as he
said, ‘like the surf at Cape Town, crashing over me’, and reverberated like
thunder from the African heavens.
‘Ag,
man! Why didn’t you introduce me
to Mahler before?’

     In the widely-spaced houses of
Africa, you can make as much noise as you like. (Among the closely-spaced
houses of most of the blacks, they don’t care, anyway, and sleep through
anything.) So, black or white, it tends to be a noisy culture. In the pubs and
clubs, the white Rhodesians would bawl at one another across twenty yards. Even
their private conversations could be heard that distance. You could tell the
Pommies by their conspiratorial whispering groups in corners. So there was
never any problem about raising Mahler at three o’ clock in the morning over a
crate of beer, as Koos and I did more than sometimes.

     Koos spent half his time in the TA,
as did all the whites under 56, who were not actually in the army or police
reserve. Out in the bush, he did his duty as bravely as any, but his heart was
not in it.

     His wife owned the main garage in
town. She was a Cockney, name of Byron, and claimed descent from the poet,
which I suppose a lot of people could. Over the garage, they had one or two
flats, one rented by Sister Mutema, from the government hospital.

     Most of the African staff were
either sympathetic, if not actively involved, with the nationalist cause,
though we hardly suspected it at the time. Sister Mutema was a key worker.

     Koos, who knew the Africans better
than most, must have guessed this. Once, he saw a trail of blood leading to
Sister Mutema’s door. ‘Harbouring terrorists’ and ‘failing to report the
presence of terrorists’ were serious offences. Koos got a mop and washed it up.
It was all in character with the man. He could face his enemy in the bush:
shopping people was not his trade.

     He must have been a difficult husband.
Every now and again, he would throw up his job and take off: once to a mine in
the north-west, once to South Africa. He would return to town in strange moods:
one time raging on a fishing outing about God knows what; once, sitting in my
house, where he confessed: ‘Sometimes I wish I could die in my sleep.’ I
remembered Schubert said the same thing.

     On his South African excursion, his
wife, an Italian-looking, passionate woman, herself, who really loved him for
all the terrific rows they had - Anita told me, Koos was working with a couple
of blacks, unloading steel pipes from a lorry, when the blacks suddenly pushed
one of the pipes into Koos’s stomach - for no reason, just the white man. ‘And
there’s no one less racist than Koos,’ cried Anita. Koos ended up in hospital,
but not before he had put his two assailants in
their
hospital as well.

Sister Mutema had a secret lover. The
most unmilitary specimen you ever saw in battle fatigues. He sat in his
camouflage at my table on the veranda of the Shabani hotel and poured out his
sad story to me over his beer.

     This was Cecil, about thirty, some
kind of office worker, trapped in the police reserve. Part of his duties was
guarding the government hospital at night. This was simple enough. Mostly they
sat in the sisters’ common room in the European hospital, drank tea, flirted
with the white sisters a bit, and slept. The black sisters also used this
common room, where Cecil must have met and fallen in love with Sister Mutema.

     Sister Mutema was a handsome woman.
She was a nicer person than Winnie Mandela, but fell little short of her in
force of personality: in other words, she could have eaten Cecil for breakfast.
And, needless to say, she was totally unaware of his existence.

     The rabbit-like Cecil appealed to me.
‘I think Sister Mutema’s got something against me, doc. I can tell by the way
she looks at me. I think it must be this uniform. Honest, doc, I never asked to
be given this uniform. I’ve got nothing against the bloody Kaffirs. I only
wanted to be left alone. Do you think you can make Sister Mutema understand,
doc? I’d like to get to know her, really.’

     I finally had a word with Sister
Mutema -
after
the civil war. At an earlier date, she might have had him
slain, like one of the old queens of Ireland, when their subjects looked too
high. I’m sorry to say, she did not even laugh.

In 1979, Smith held his first one man
one vote election (when Muzorewa became prime minister, or something, under
Smithy’s control), in which even foreigners like Anderson and me were allowed
to vote. I filled in the forms. Anderson’s wife was living with him then. ‘What
is your wife’s name, Anderson?’ Anderson was then polishing the floor. He
straightened up on his knees, smacked his forehead, and exclaimed: ‘Ah,
bassie
!’
He scuttled off to the
kaya
and after a few minutes came back.

     ‘Sarah!’

     There is a love which
need
not speak its name.

Rhodesia was always an easy-going place.
It was in this year, I think, that the secretary for health telephoned me one
morning with the question: ‘Dr Durrant, are you aware that you have not been
registered with the Medical Council for the last five years?’ It was a
rhetorical question: of course I was not aware. The reminders had followed me
around a number of changes of address and then lost me: my own part in the
disaster need not be gone into. I had been practising illegally for five years.
He told me I had better get on to the Council soonest and send them fifty
dollars. I don’t know what happens to one in UK in such a case: it would certainly
make a British doctor tremble.

     Jock also was off the register for
two years. A Dr Scott had died, and the Medical Council buried the wrong man. I
never inquired how it took them (or Jock) two years to discover the error.

It was not long after his arrival in
Shabani that Jock and I did a combined operation. I was wakened at daybreak by
a telephone call. The night sister told me someone was on the line from the JOC
(Joint Operational Command - military, of course, not surgical). But it was not
a war casualty. A man’s voice came on. ‘There’s been a derailment on the Buchwa
line, doc. There’s a guy trapped in the wreckage, and they reckon you’ll have
to amputate his leg to get him out.’

     We were to meet at the small
airport outside the town, where they would pick us up in a helicopter. ‘We’
would include Jock, whom I called to give the anaesthetic. We arranged to meet
in theatre.

     There I got an amputation pack from
the night sister, and Jock collected syringes and Pentothal. I planned to do an
emergency guillotine amputation under tourniquet and finish the job at the
hospital.

     We drove to the airport, and there
was the chopper. We climbed in with the pilot and the gunner, who sat beside a
large Browning cannon. The helicopter was modified to disembark troops rapidly.
It had no seat belts and no sides. I am not very good on altitude. I sat on a
box seat and clutched it with sweaty hands. Jock, the old RAF man, sat
unperturbed. I never knew anything make Jock nervous, anyway.

     We lifted off and sped like a flying
carpet across the tawny earth, already vibrant with the morning light. Below we
could see women outside their huts, about their household chores, and little
naked children. Faces looked up at us.

     Then, about thirty miles ahead,
loomed the great iron mountain of Buchwa, with its mine. It looked as big as
Snowdon from our angle. Soon we picked up the railway, which led to the mine on
its way to South Africa. By following it we should come to the wreck we were
seeking.

     Then, there it was, in a cutting. A
mass of trucks, which looked as if a giant, or a petulant child with his toys,
had thrown them into a heap. It was not sabotage, we learned. There had been a
fault on the permanent way.

     We landed and were met by other
people. About twenty police reservists had been called out to guard the wreck,
and were sitting on top of the cutting, in their camouflage, holding their
rifles.

     Jock and I climbed over the tumbled
trucks, following a guide. And then we found him. A young white man. He had
been taking a shower in the caboose, when the crash caught him. He was hanging
in the wreckage in the crucified position, in nothing but his drawers. His head
was on his chest, and he was quite unconscious. He had been hanging there all
night. The sister from the mine clinic had come out and given him pethidine and
set up a drip. It was this that must have saved him from death by crucifixion.

     When we climbed down to him, I saw
that he had a compound dislocation of his right foot. His left leg was buried
up to the hip in the wreckage.

     I realised this was going to be
tricky. For a start, I was worried about giving him Pentothal, which I feared
might finish him off. Nor could I see how I was going to get at his leg. I
thought I would try and get him into a handier position.

     I asked the railway people to lower
a rope. They found one and did so. I got it under the man’s arms and round his
chest, and made a bowline, as I still remembered from the Boy Scouts.Then I
told them to lift.

     They did so, and his leg came free
without a mark on it!

     Surely, we must be told somewhere
in our medical training, never to take a third party’s word for granted!

     We got him onto a stretcher and
into the chopper, where there was now less room than before. The gunner kindly
let me have his seat in the forward bubble. He sat on the edge of the floor,
and swung his legs in the air. They told me cheerfully, you can’t fall out of a
helicopter, because of the upward thrust, or something.

     As we sped towards Shabani, I told
the pilot on the intercom that we could land at the hospital, as we had a
helipad there. He asked me, where was the hospital? We were then flying west,
towards Bulawayo. ‘On the Selukwe road,’ I shouted.

     He banked the machine to 45
⁰
,
and swung north. I found myself staring down the chimneys of the Nilton Hotel.

     We landed in front of the hospital,
and I was grateful for terra firma and my own familiar operating theatre. The
foot did not present much difficulty: a good wash-out, and the tarsus slipped
together like a Rubik’s cube. I closed the skin without tension.

     A few days later, he went out with
a plaster and crutches. He lived in Salisbury, so I referred him a with letter
to his own doctor, and never saw him again.

     Nor did I tell him about the
amputation he so narrowly escaped.

Early in 1977, the war came to Shabani. I
heard for the first time the shattering roar and whistle of a helicopter,
bringing in the wounded, or ‘casevacs’, as they called them: a sound that my
stomach never got used to over the next three years.

     The first was a civilian (they were
mostly civilians), ‘caught in the cross-fire’. A man of forty, shot through the
thigh: the bone smashed and the artery severed. I had not then learned how to
do a vein graft, or I would have attempted it. Later, a surgeon was to teach
me, verbally - at the annual bush doctors’ refresher course at Bulawayo.

     (In Africa, the old adage, ‘an
ounce of practice is worth a ton of theory’, is reversed. The man with the
knowledge in his head can do something: the man without it, nothing.)

     I took the man’s leg off with
eleven centimetres to spare: I could barely get the tourniquet above his wound.
He needed nine pints of blood, but he lived.

     (By now, as the risks of hepatitis
became better known, we drew our blood supplies for transfusion exclusively
from the National Blood Transfusion Service.)

I was sitting in a friend’s house one
Sunday afternoon. I got a call from the hospital: a woman with a gunshot wound
of the arm. My friend was a medic with the TA, so I took him along for the
experience. The upper arm bone was shattered, but nerves and arteries were
intact: a relatively simple wash-out, debridement and packing, and application
of a U-plaster and sling. My friend, a mechanic, was most impressed. When we
got back to his house, he told his wife: ‘Warren just did his job like I do
mine.’

Some doctors in Africa show their
friends operations as a form of entertainment. Needless to say, this is
unethical, and although I may have done it in my earlier days, I soon realised
this and stopped it. People like military medics, Red Cross, etc, I regarded as
students, and would allow them to watch. It was well understood that all
government hospitals took students.

     However, one Saturday night, I was
in the mine club with Koos when a call came: another gunshot wound.

     ‘Man!’ pleaded Koos. ‘I’ve always
wanted to see an operation.’

     Well, I reflected, he sees active
service in the TA: gunshot wounds are his business. I decided to bend my rule.
‘But you’d better pretend you’re an army medic.’

     On the ward, I studied the X-rays:
a forearm wound this time. I showed them to Koos. ‘You can see the joint is not
involved. That’s very important.’

     Koos took the X-rays from my hand.
He pointed them out to the nurses who were present. ‘You see, the joint is not
involved. That is very important.’

    
 
I said, ‘Cool it, Koos.
You’re supposed to be an army medic, not a visiting consultant.’

     Koos donned boots, mask and gown,
and stood well back in the theatre, like a good boy, very interested. When it
was over, we met Sister Feldwebel, outside the theatre. She was a German lady
of the ‘old school’, meaning the ram-rod type. Koos greeted her in what he
thought was German, and got a cup of coffee for us in the duty room.

     The telephone rang. It was Koos’s
wife, Anita, cooling her heels in the club.

     ‘Is my husband there?’

     ‘Yes, he’s been watching an
operation with me.’  Something innocent, of course.

     ‘Just remind him he’s got a wife,
will you. I’ve been sitting here like a sausage for the last two hours.’

     I passed the message on to Koos.
Sister Feldwebel said, ‘I’ll unlock the front door for you.’

     She had trouble finding the key.
She need not have bothered. Koos had left the room. When we got to the front
doors, we found them swinging in the breeze. Koos had opened them like any
other rhinoceros would have done.

     ‘Just look at that!’ shouted Sister
Feldwebel, who knew Koos of old. ‘And you call that your friend? You, a doctor
- an educated man!’ She stomped away. ‘As for him pretending to speak German!’

By now I had learnt (theoretically, as I
said) to perform a vein graft, and I got my opportunity: a little girl of
eight, shot through the upper arm. The bone was intact, but the main artery was
severed. There was no pulse at the wrist.

     The operation has to be done within
six hours of the time of injury. If I transferred her to Bulawayo, this time,
already short, would be lost. Also, we had a rule not to transfer cases after
four o’ clock in the afternoon, as that was when the shooting season started, when
the guerrillas could mount an ambush and have the rest of the night to get
away. In the early days of the war, the security forces would pursue by night,
but in the total African darkness of moonless nights, they got lost and
sometimes fired on their own members.

     I debrided the wound and trimmed
the ends of the artery. Then I dissected out a section of the long vein of the
leg in the lower part, carefully tying off all the little branches. I flushed
out the graft and the distal (outer) section of the artery with heparin/saline
solution, and stitched in the graft. I released the tapes and a column of blood
pulsed down the graft - and stopped half-way.

      To my despair I realised that I
had forgotten to reverse the graft. A vein has valves opening towards the
heart: a vein graft must be reversed, as an artery conducts away from the
heart. I had even marked the graft with large and small forceps - north and
south. In removing them, I had still failed to reverse the graft. I had been at
work two hours. I was nearly dropping with fatigue in the hot night. I must get
a grip on myself. Now I had to start the whole business again, taking a graft
from the other leg.

     First, I cut out the original
graft. Good job I did so, for, to my relief, blood spurted from the distal
section of the artery. The collateral circulation was intact. Resuscitation and
the anaesthetic had restored the flow of blood. The wrist pulse was now
palpable. I had no more to do than ligate the ends of the artery. The little
patient made a good recovery.

     I had a good excuse for my
absent-mindedness. As I walked back to my house, I felt a pain in my groin.
When I got home, I found a scab on my thigh and tender glands. My temperature
was 38
⁰
C. I realised I had contracted tick bite fever (African typhus).
I must have been near to collapse in theatre.

     A thing like that would not stop me
working. I gave myself a short course of tetracycline, and in a few days was
better.

     But I reckoned I could chalk up my
vien graft as a theoretical success. And if I could do it on the tiny vessels
of a child, I could do it on an adult.

That was my first (and last) vein graft;
but I nearly had another.

     One Sunday afternoon, I was getting
a book out of the white hospital library, when I saw Jock (who was on duty) examining
a patient in one of the wards. I looked in out of interest. It was a white
soldier with a gunshot wound of the thigh. I had heard no helicopter because
the man had been brought in by road by his friends. It turned out the femoral
artery was severed. It needed a graft, and most of the six-hour ‘golden period’
had been lost. Jock meant to send the man to Bulawayo. I debated in my mind
whether to offer my services: I had to balance my slender advantage in time
against the superior skills of the surgeon in the Central Hospital.

     Colleagues who have worked together
as close as Jock and I have an intuitive relationship. This was Jock’s case: I
knew he wanted to send the man away. There was no point in arguing, especially
in front of the patient, even if I felt that sure of myself. So, with
uncharacteristic modesty, I said nothing.

     In the event, the man arrived too
late. The surgeon operated, but the graft did not take, and the leg had to come
off next day. The man was very bitter about it, but the surgeon wrote to his
lawyer (for it had come to that) that Jock had done well to keep him alive, and
so he had.

     Later, I learned from one of his
friends how the man had come by his injury. They were ‘bounty-hunters’. Not
satisfied with their statutory duties in the TA, etc, these desperadoes went in
for the sport of man-hunting, which, apart from the pleasure Sir Garnet
Wolseley so enthused about in West Africa, was here profitable. In short, if
they brought back a communist weapon from their expeditions they got $1000 for
it. And no doubt it was an exciting substitute for the other shooting and
fishing they used to do, which the war had curtailed.

     So, on the Saturday afternoon, they
drove out into the countryside (a party of half-a-dozen, or so), left their
vehicle, and marched off into the bundu, arriving under cover of darkness at a
spot they had marked beforehand: a
kopje
overlooking a village. There
they fed and watered, and lay up till next day.

     After sunrise, they watched the
village for any sign of guerrillas. The sun mounted to its furious zenith in
that part of the country, bordering the Lowveld: and they ran out of water.

     They got thirsty. Around midday,
our patient (I will call him George), to the astonishment of his comrades, and
before they could stop him, staggered out of cover and down the hill to the
village, carrying his rifle and his water-bottle.

     Whether he found water, I did not
ask. The guerrillas, the seemingly ordinary peasants, sitting around, found him
and knew he had not come from nowhere and alone. They let him walk back again
up the
kopje
. Then they pulled their rifles out of the thatch and did a
bit of field-craft of their own.

     They took up a position on another
kopje
,
higher than the first, and the first thing George and his companions knew about
it was when they were fired on from above - an indefensible position.

     George was the only one hit as they
evacuated, and it says much for the devotion of his friends that they got him
out alive.

One night, a police reservist was
brought in, shot in the chest in an ambush. I noted he was the same age as
myself then - 49. He was nearly bled out. He was still conscious and said he
could not move his legs.

     We transfused him. The chest X-ray
showed the left side full of blood and a foreign body in the spine. The
communist bullet had a copper coat and contained lead and a gun-metal cylinder,
called the tumbler. The bullet would shatter on hitting bone, but the tumbler
would penetrate deeper and fly anywhere. The FB in the spine was the tumbler.

     The patient needed an immediate
operation (
on second thoughts, all he needed was a chest drain
)
. This was going to be a tricky anaesthetic. I called
one of the mine doctors who was a skilled anaesthetist. He got a tube down the
windpipe and I opened the chest.

     I evacuated the blood and reached
my hand deep inside. I could feel the tip of the tumbler buried deep in the
spine, impossible to remove; nor would that have served much useful purpose.

     I debrided the wound and inserted a
water-sealed drain - a tube that goes into a bottle of water to release air and
blood from the chest and prevents air returning. I closed the chest and the
anaesthetist re-inflated the lung.

     There remained the problem of the
paralysis. There were two possibilities: one probable, the other just possible.
Most probably, the spine was severed. On the other hand, perhaps it was merely
compressed by a haemorrhage into the spinal canal which might be relieved by
the operation of laminectomy - removing some of the spinal arches: something
beyond my judgement, if not my skill. It might be done even by a general
surgeon at Bulawayo, but no time should be lost to avoid progressive paralysis,
even death.

     As I have explained, our policy was
not to transfer people by night, because of the risk of ambush. I never
required this of our ambulance drivers, to say nothing of exposing the
patients.

     I put the matter to the man’s
comrades, and a gallant police officer volunteered to take him in his car. In
the event, I learned many years later, the ambulance driver got to take him,
with the police officer riding shotgun.

     As it happened, next day, one of
the country’s two neurosurgeons, based on Salisbury, was on his regular visit
to Bulawayo. He took one look at the X-rays and decided that further operation
would be profitless.

     But we had the satisfaction of
saving the man’s life, and for ten years he pursued a courageous and useful
career in business and civic affairs, before succumbing to his injuries.

     What seemed the bitter irony of
this case was that someone left open the back door of the armoured personnel
carrier they were travelling in, and our patient received a bullet through the
fatal gap. Later, I learned that these vehicles were so intolerable in the hot
weather that the door was invariably left open. Very human, and very sad!

     The brave police officer who
escorted him came to a sad end. He survived the war, but in the disturbed
conditions which followed, was killed by a bandit when attempting to arrest
him. And it was so much later that I learned about his gallantry, that I was
unable to thank or even identify the plucky ambulance driver. Let me do so now.