Across the Wide Zambezi: A Doctor's Life in Africa (4 page)

Late one Sunday afternoon, they told me
there was a casualty on male ward. When I got there, I found a middle-aged man
on a bed behind a couple of screens. He had been hacked about with a cutlass
and was in bad way. He told a strange tale.

It was an old custom in some parts of
Africa that when a chief died, certain people were selected to go with him so
that he should not lack servants in the next world. It was said that in former
times, his actual servants were taken, who viewed their destiny not only
without distaste but with positive enthusiasm; but with the decline in
attitudes of laxer days, they became evasive, to say nothing of the officious
interference of colonialism and so-called 'civilisation', and the authorities
had to look elsewhere for candidates. Modern 'educated' Africans piously denied
the persistence of the custom, but the masses did not share their simple faith,
and it was said that the victims were sought among less traceable persons, such
as vagrants and itinerant traders; but these people learn, and avoided areas where
the chief had recently died, so the death was sometimes kept quiet until the
heads were secured (for only these were buried with the chief, in some secret
part of the forest, sometimes a river being temporarily dammed for the
purpose), but rumour finds a way.

At any rate, when the paramount chief of
the Bruja tribe died in the nearby town of Bongo, there was widespread fear in
the surrounding country. The streets, which normally pulsed with life long
after dark, were deserted at sundown, not only in Bongo itself, but in our town
too. When a friend and I had gone out fishing that day, he, who had been in
India, carried an old Afridi sword with him, though we did not think that
anyone would go for Europeans, as being altogether too conspicuous. Nevertheless,
a passing small boy advised us to be home before dark as the 'executioners'
were in the neighbourhood: these being the officials whose duty it was to
collect the heads.

The dead chief lay in state in a small
room for a week, surrounded by his wives, who were locked in with him, while
the executioners went in search of the twenty heads for which a chief of this
particular rank qualified. A strong body of police had been sent to the town,
as soon as the chief's death became known about, as a precaution against old
African customs.

Our patient told us that someone who had
a grudge against him had attacked him, hoping to kill him and leave his
headless body to be attributed to the work of the executioners.

I ordered him to theatre, where I did
what I could for him, and after two hours returned him to the ward.

  Within a few days the patient
developed tetanus and died, mercifully, of pneumonia.

I heard some news from the Catholic
priest at Bongo, a Dutchman. The missionaries, being fluent in the vernacular
and spending their whole careers among the people, are closest of all Europeans
to the African, and usually have a good idea of what is going on. Father Van
told me they got the twenty heads, and even collected one from the police.

I witnessed a curious sequel to this
tale, some months later. In the neighbouring town of Mango, they were holding
the annual Yam Festival. This takes place in November, at the end of the rainy
season, and no one may touch the new yams or cassavas until it is over. There
is empirical method in this custom, as the unripe plants contain cyanide, and
poisoning has resulted from their premature consumption.

The festival opens with the
witch-doctors, looking very spooky, smeared with white clay, running through
the streets with antelope tail switches to drive away evil spirits. It finishes
with a grand procession of the chief and other important persons and their
wives being borne on palanquins through the crowded streets.

On the great day, music (or something)
was provided by the Mango town band, which comprised drums and bugles. One
could take no exception to the drummers, who performed as to the manner born,
but the playing of the buglers was somewhat idiosyncratic. I could only
describe it as 'action playing', after the manner of the famous school of
action painters. Their method consisted in marching up and down the main street
behind the drummers, 'chucking sound about'.

This was an entertaining interlude
before they headed the main procession, in which they were followed first by a
crowd of young men, firing off the famous 'Dane guns'. These ancient muskets
came, not from Denmark, but Birmingham, and in the sanctity of Victorian trade,
were actually unloaded at a point down the coast, for transport up to Kumasi,
at the same time as Wolseley's troops were disembarking to face the same wares
up country, in the Ashanti war of 1874. But what caught my eye especially were
the two gentlemen who brought up the rear, behind palanquins and all, marching
abreast with sixteenth-century Portuguese helmets on their heads and cutlasses
over their shoulders.

I had a shrewd suspicion who these might
be, but decided to seek confirmation from the bystanders. I asked at least two
men, and in each case, received the embarrassed reply: 'I don't know how to explain
it in your language.'

Finally I saw Samson: not the ambulance
driver, but my 'small boy'. A 'small boy' is a second house servant. I first
met him when James crept up to me in his indoor bare feet, after lunch one day,
to inform me that 'someone wants to see you, sah, at the front door'.

There I found a stalwart young man of
about twenty, who mystified me with the statement: 'Please, sah. I am Samson.
Dr Burns make me be small boy in the school holidays.'

Dr Burns was my immediate predecessor,
and I certainly wondered at first what strange experiments he had been up to,
involving the temporary conversion of full-grown men to small boys, before
James, who had silently appeared beside me, explained what Samson meant.

I might also add that many Africans, for
various reasons, mostly economic, like Neddy Seagoon, who came home after
forty-two years at school, spend an indeterminate time on their education.

A few days after engaging Samson (who
James assured me was indispensable), a little old man appeared at the door, who
informed me that 'Dr Burns let me sleep in the Wendy house' (a structure I had
already observed in the garden). So now I found myself with no less than three
servants, including a gardener. Although I was well aware that for a bachelor
this number was superfluous, I was beginning to learn enough about Africa to
realise that such mercenary calculations were beside the point: this was the
proper noblesse oblige of such a 'big man' as a doctor.

Samson, perhaps because of so many years
at school, had the unworldliness of the scholar, and could be relied on to give
an honest answer to a question, if only out of pure naivety. So it was on the
present occasion. When I put my question as to the two mysterious officers to
him, he answered simply:

'Those are the executioners. They cut
the heads off when the chief dies.'

As I said, I can remember the names of my
first main victims. The name of my first hernia was Sammy.

I had received some theoretical teaching
in inguinal hernia repair from my old chief, Howell. This dear man had an
unfortunate career. He slaved for years as a registrar - a system by which the
government got a specialist for rather less than it would have to pay a plumber
- before being appointed a consultant well into his forties. He enjoyed his
post for less than ten years before being struck down in the operating theatre
by a stroke. They found him a sinecure in a convalescent hospital, and it was
at his fireside in this place with his good hand that he produced the
collection of drawings I took with me to Ghana which in due course bore fruit
in the case of the unsuspecting Sammy.

The operation went successfully: at any
rate Sammy never came back for more. I found myself with a back-log of hernias,
which are common on the Coast owing to the depredations of the filaria worm.
(Des, who was a sick man by then, had confined himself to emergencies.) When a
doctor gets a reputation for surgery in Africa, he does not lack customers, and
I found myself doing one a week and becoming a fair exponent of the Bassini,
which is not a concerto grosso but the standard operation for inguinal hernia,
named after the eponymous professor of Padua.

My fame spread. One of the African
managers gave a lift to some ladies in the back of his Land Rover, where he
overheard them singing my praises. 'Did you hear how he fixed Kobina's hernia?
Who would have married him with a thing like that?'

One evening I was called out of the club
to deal with a dead woman: not to pronounce her 'dead on arrival': doctors are
too thin on the ground in Africa for such nonsense as that, which is performed
by the senior nurse on duty. This one had a special problem. She had died in
childbirth, and the afterbirth was retained. Custom forbad burial with such an
unclean object inside her. I found her lying in the back of a lorry, which had
brought her miles across country.

I thought it was superfluous to transfer
the body to the mortuary. I could just as well do the business where she was.
Apron, gloves and a lamp were brought.

'Ah well!' I thought. 'Our work is
altruistic,' echoing the words of one of my old chiefs in Liverpool after
requesting the houseman to perform a manual removal of faeces.

How did our mentors describe the
sensation of removing a retained afterbirth? Like shaking hands with a gorilla?
I wonder how many of them did it on a patient six hours dead and iron-hard with
rigor mortis, and how they would describe that. Having been there myself, I
would compare it to the technique of the rock-climber, Joe Brown, who would
thrust his hand into a crevice, close his fist and swing on it.

I did my best, and removed enough of the
stuff to carry conviction, including the tell-tale umbilical cord. I stepped
down, sweating and shaking with the effort.

I was greeted with contented faces
around me. Honour was satisfied. The family were at ease in their grief.

In the words of Trousseau: 'to cure
sometimes...to comfort always.'

A woman was brought in who had suffered
bleeding after childbirth. (I do not remember a baby, which may have died.) She
had been treated by a native ‘herbalist’, who had stuffed a great quantity of
his/her wares into the affected parts, and we first had to remove and wash out
a lot of foul material and exhibit antibiotics, etc.

After a day or two, Mr Sackey approached
me with an expressionless face and announced that 'the patient's condition had
changed' - an ominous formula in the mouth of an African nurse, only exceeded
in menace by 'the patient is gasping'.

I went with him to the ward, and saw
tetanus for the first time in my life. (
This was, of course, before
the ‘ritual murder’).

At that moment the visitors burst in: a
noisy bubbling African crowd. I said to Sackey: 'Mr Sackey, the ward has got to
be kept quiet.'

Mr Sackey turned on his heel and in the
tones of RSM Brittan (who in his day was the biggest voice in the British
Army), bellowed:

'Now, you visitors, listen to me! We
have a very sick woman here. DEE WARD GOTTA BE KEP' QUIET!!!'

As might have been expected, the woman
seized up at once. Her back arched in the dreadful spasms of the disease, and
an invisible hand seized her throat and began to choke her.

Fortunately, the instruments were
already prepared in the duty room, and I set about the first tracheostomy of my
career.

I dispensed with local anaesthetic and
cut down on the wind-pipe, separating the flesh with the fingers of my free
hand, until I was rewarded with the in-suck of breath, followed by the
explosion of air and blood that announced my entry into the trachea. I held
open the cut with the unfamiliar forceps, which work outwards, and slipped in
the tube. For the time being the woman was safe. Easier than I had expected.

I ordered Largactil and phenobarbitone,
and gave antitetanic serum intravenously. It came in an enormous ampoule from
Russia, which must have contained 50ml. I began working out how much drugs we
would need out of our limted stocks. When the monthly drug order arrived at
that place, in the universal ambulance, driven by Samson, it felt like the
relief of Lucknow, and even casual bystanders cheered accordingly.

     But all our efforts were of little
avail beyond securing a comparatively comfortable death for the victim.

I performed a caesar on a little woman
who had been in obstructed labour for five days. (It must have been her first
or the uterus would have ruptured.) The baby was of course dead. In those days
we had not developed the method for dealing with peritonitis which was so
successful later - a method ridiculously simple in principle which consists in
washing out the abdomen with saline. This brilliant idea had lain dormant in
the dull brain of man since the dawn of surgery.

At any rate, when the little woman's
stomach swelled up two days later, I knew what was the matter with her, and
that she was very ill indeed.

I gave intravenous antibiotics. I
discovered that she was anaemic. At that time I secured blood for transfusion
by organising a whip-round among the managers, before I hit on the more
economical method of bleeding the relatives.

I got a couple of pints out of the
evening drinkers at the bar. The blood must have been well medicated, as the
little woman fell soundly asleep half way through the second pint.

At any rate, they pulled her through.
She hung between life and death for ten days, before making a good recovery.

When I first tackled the question of
blood transfusion , as I implied, I first raised a list of volunteers, white
and black, from among the managers, and most of my touting was done at that
convenient venue, the club bar.

One of the first on the list was Horace,
of the engineering department, which surprised everybody, as this was the first
pint Horace had even put his name down for, still less stood in the club;
though he had never been known to cause offence by refusing one. On top of 
which he had the cheek to call himself Lovewater.

I will not labour the point that Sam put
him in charge of the swimming pool: but one day in the club he asked me what pH
I preferred.

Being a bit tired at the end of day, I
thought for a wild moment he was offering me a drink, until it dawned on me he
was referring to the swimming pool.

I rejoiced in the catholicity of my new
job, but this was a bit of a facer. However, resourcefulness is the first
quality required in an African country doctor, and I decided to exercise some.

'What pH did Dr Burns prefer, Horace?' I
asked, in a discursive tone.

'Dr Burns preferred a pH of 7.5, doc.'
(I hope I have got that right.)

'I'm sure a pH of 7.5 is just right for
this climate.'

Meantime, Mills the lab boy was going to
work on the blood groups of the volunteers. When the list was complete, I
announced it (probably in breach of confidentiality), more or less openly, to
the interested parties round the bar.

(One thing the reader must understand:
the existence of a certain blood group called universal recipients. In a word,
while most people can give blood to most other people, universal recipients can
give it only to members of their own exclusive circle, but they can take it
from anybody.

Perhaps because our God has taught us it
is more blessed to give than to receive, this particular group is not
numerous.)

'Horace has a most rare and interesting
blood group,' I said. 'He is AB positive, which means he is a universal
recipient.'

The laugh which followed this was not as
big as the next one, which was raised by the chief of the club wags, Danny
Wilson.

'Horace is a most rare and interesting
person!'

Horace had the cheek to join in both
laughs, but perhaps he had no option.

Another caesar I performed on a hunchback:
a victim of Pott's disease, Tb of the spine. This had to be a classical
operation, as the lower segment operation was physically impossible on the
doubled-up little body: Ten days later, she marched off, proudly bearing her
prize in her arms. It was also impossible for her to carry the baby on her
back.

The police brought in a man with an
arrow stuck in his upper arm. He was a thief and had been shot by an 'NT', a
guard from the Northern Territories, who watched the company premises, armed
with a bow and arrow. One could recognise these little people by their almost
Mongolian or Bushman-like features.

I knew that this arrow was barbed, like
a fish-hook. I gave the man a shot of Pentothal and simply pushed it through: I
could see there were no vulnerable structures in the way. There was a gush of
venous blood, soon staunched with a pressure bandage.

In the inevitable crowd that gathered
outside the theatre on this interesting occasion was Alassan, the little old
cook of my fishing companion, Les Cady (who, incidentally, was the European
manager who nearly died laughing at Jenny in the spitting crisis). Something
did not add up as far as Alassan was concerned. I must say he was an 'NT', and
in his part of the world thieves were usually dealt with by nailing them to a
tree by the head.

Later he questioned Les on the matter.
'Massa,' he asked. 'Wha' for dee docketa go make dat boy better? Dun dee
docketa nebba savvy dat boy be tiefman?'

Nigerians were the greatest exponents of
'pidgin'. A large Nigerian lady (I recognised her by her turban, instead of the
headscarf of the Ghanaian women) sat down in the chair before me. 'Docketa,'
she announced. 'I nebba see my flower tree munt. I tink I go catch belly.' I
will simply say the subject was obstetrical.

Blackwater fever (that dangerous
complication of malaria) is rarely seen nowadays. Nevertheless we had a case in
a little fellow of ten. I assembled the regulation rack of test tubes, and we
watched his urine samples turn from port wine to normal over the next few days,
as the treatment took effect. We also transfused him and monitored his
haemoglobin by the only method available to us  - a finger prick and the
Talquist coloured papers.

He was duly discharged, and his father
asked to bring him back for review a week later. Faithfully they turned up. I
looked the little fellow over, said, 'fine' and his father led him away. This
was not good enough for the little chap. He doubled back, stood before me and
pointedly tapped his thumb. I obediently sent him for another blood check. That
lad should go far.

Towards the end of a hard day, Miss
Lemaire found me and informed me: 'We have a woman with severe abdominal pains.
She is overdue her period by two weeks.'

'Wearily I commented: 'An ectopic!
That's all we need.'

I examined the patient  and made a proof
puncture: a needle thrust into the abdomen. Sure enough, the syringe filled
with blood, making the diagnosis very probable. I ordered her to theatre.

At that time, I was still using spinal
anaesthetics for everything major, until my neighbour, the young Dutch mission
doctor at Mango, warned me of their dangers in cases of potential shock. At any
rate, I got away with it in the present case.

For those interested, our anaesthetic
resources, besides spinals, consisted of an EMO miniature ether machine, which
broke down early on and had to be sent to England for repair. We were not to
see it again for a year, most of which time it lay on the docks at Takoradi.
Meantime I did the best I could with various substances per rag and bottle, and
combinations of local anaesthetic and morphine.

Incidentally, the less sophisticated
Africans (and some of the other kind) preferred to stay awake during their
operations and had a profound suspicion of general anaesthesia. True, the
doctor spun you some yarn about 'putting you to sleep', but what kind of child
did they think they were talking to? Everyone knew that you could not operate
on someone in his sleep. Obviously, that injection the doctor gave you was
poison which killed you. Only then could he go to work on you with all those
knives and things. When he had finished, he gave you some more medicine to
bring you back to life again. The whole business seemed altogether very
uncertain. Much better to stay awake, when you could keep an eye on things and
have a nap now then when you felt safe.