How I Learned to Understand the World

by Hans Rosling

  The border officer checked our passports, looked over the two-year contracts issued by the Ministry of Health and welcomed us with a warm smile. Agneta and I knew that we would be working in medicine and midwifery but our contracts had given us no idea of where. We had agreed to be placed wherever the ministry thought we would be most needed. So, while we waited to pick up our luggage, the big question was: where to next?

  We were met at the airport by Ninni Uhrus, our Swedish organization’s local coordinator. Ninni had a perfect plan: she drove us straight to Maputo’s only operational ice-cream parlor. The children’s first African experience was eating ice cream in the shade of a parasol. It went down very well. It also gave me and Agneta time to ask questions.

  We would be staying for a few days with a Norwegian couple, who had a child of Anna’s and Ola’s age and, importantly, a garden. Agneta and I should present ourselves at the Ministry of Health the following day to discuss our placement. The principle was never to send foreigners out without having interviewed them and asking every individual what they wanted.

  “The officials don’t behave like bureaucrats,” Ninni told us.

  The next day we were received by a charming woman from human resources who shared an office with several other civil servants. The health ministry was housed in a modernist building and the brown doors carried proper nameplates.

  She had obviously studied our papers with care. Her first question concerned my cancer treatment. Was I well enough to work? Next: were our children happy about living in Mozambique? She came back to that question several times. We told her of our wish to go to Beira, where we had Swedish friends, and she took notes. Beira was the second largest city in the country and had a wonderful beach, which was particularly important to us. We knew that our work would be demanding, although we had no idea of just how hard it would be. To find a place that would be right for everyone in the family seemed critically important.

  A few days later, we were back in the ministry, this time to meet a still more senior HR official. He was very direct—regrettably, at present there was no requirement for us anywhere near Beira. He would like us to move as soon as possible to the northern province of Nampula, more precisely to Nacala, the fourth-largest conurbation in the country and the busiest port. There was a desperate need there for doctors and midwives, both in the urban area and in the surrounding rural district. Later, I realized the ministry had planned all along to send us to Nacala but they recognized the need to meet us face-to-face first in order to judge whether we would be likely to cope with the pressure. I was still regarded as an inexperienced medic.

  I would be working with Ana Edite, one of the country’s few newly qualified doctors, who already worked in Nacala Porto. Having a colleague meant that I would only be on call alternate evenings, which would be a great advantage. We asked about living quarters but were told that the authorities in Nacala were dealing with that. Our last question: is there a beach? The official laughed, leaned forward and said: “You won’t be disappointed. It’s even better than in Beira.”

  He was right. For the next two years, the beach would be a joyous place of refuge for us.

  * * *

  Before leaving the building, we were handed our guia de marcha (marching orders): a document we had to present to the Nacala local authority. As in so many other aspects of life in Mozambique, the military terminology reflected both the past colonial order and the tensions between the newly independent state and some of its neighbors—notably, the South African apartheid regime and Rhodesia, where Ian Smith, leader of the white minority party, was still the prime minister. Both countries were racked by armed conflicts.

  Our documents showed that we would be replacing a young Italian doctor who had asked to be moved after just one week in Nacala. It sounded worrying but we were reassured that he had arrived with a “naive and romantic” image of Africa, and had complained that “he had expected to live in the real Africa.” The authorities in Nacala would have been understandably offended by the implication that large towns were not part of “real Africa.”

  Filling in a growth chart

  I met that young doctor a year later and he admitted that, at first, he had been rather naïve. However, the real reason he had asked to be moved was the exceptionally heavy workload. Nacala was a big town of about 85,000 people, while its large rural district had a population of more than 300,000. The entire area was served by one hospital with around fifty beds.

  Within a few months, I would be the only doctor responsible for this gigantic community.

  All that was in the future as we drove toward Nacala. Our first encounter with it was in the shape of a shantytown crowded with mud huts with straw roofs. It grew more densely populated the closer we got to the city center. The road was lined with cashew trees and palms, and, between the trees, paths wound their way in among the shanties.

  We were on the high plateau but soon began to sense we were coming to the sea. On our right appeared the so-called Cement City, a wealthier part of Nacala, where villas and three- and four-story buildings had been built with cement produced by the town’s own factory. Farther downhill the ocean spread itself out in front of us. The football field and the hospital were on one side of the bay, and high, forested hills rose on the other.

  Nacala had a pharmacy and a post office but its health service was nowhere near adequate. As recently as fifteen years ago, the town had not really existed, so there were hardly any old houses and no one in the adult population had been born there.

  We had been allocated a pleasant, one-story cement house. It needed some work, including an internal coat of paint, but because of the central planning system we were not allowed to pick our own color. There was just one option—pale blue.

  Our part of town had been built for the Portuguese population in the years before independence. Along the road from our house to the hospital were rows of little shops selling mostly tools, a paint shop with hardly any goods for sale, and a coconut stall.

  My doctor colleague, Ana, had told me firmly that I was to be driven to work. A car would come to collect me at ten to eight every morning. But the driver turned up almost an hour late on the first morning, so I decided I would walk to work from then on. The hospital staff protested but I insisted and I was thrilled as I set out the next morning: here I was, walking to my new job, and there was so much to see along the road.

  Someone greeted me pleasantly before I reached the garden gate. Turning the first corner, I noticed that most of the other pedestrians, regardless of age, stopped when they saw me. There were a lot of people out and about, and everyone stared at me intently. When I was about to pass anyone, they greeted me politely. This carried on all the way to the hospital and, when I walked home in the evening, it happened all over again. The attention made me feel uncomfortable but I assumed people would get used to me. After a few days of staring and greeting, I asked Mama Rosa what was wrong with me. Mama Rosa, a midwife, had already become my closest friend among the staff. She was older than the rest, self-assured and experienced.

  She laughed: “You are white. You shouldn’t be walking. Ana told you to wait for the car.”

  I thought she must be exaggerating and convinced myself that people would get used to seeing me walking to work within another week.

  Then I had a new idea. It came to me when I opened the enormous wooden crate full of our Swedish things—all possessions we had been recommended to pack before we left. It had been dispatched to Maputo by cargo ship in good time, Ninni had arranged for it to be transported to Nacala, and it arrived for our first weekend. It felt like Christmas for the whole family.

  * * *

  We spent the first Sunday in our new home unpacking our treasures. The children were overjoyed at finding their Lego. Agneta sorted out our clothes and I started to fit together the two bicycles I had taken apart as best I could. We had realized that our salaries wouldn’t stretch to buying a car and reckoned we might anyway be more easily a
ccepted by our neighbors if we didn’t come across as wealthier than everybody else. Some Mozambicans could afford cars but they were few and far between. Besides, we had bikes in Sweden and used them much more than our car. Reconstructing the bikes gave me a strong feeling of being at home and they worked just fine when I tested then in the garden. It was a happy family that went to bed after the first weekend in the new home.

  The large wooden crate has arrived

  Monday morning, I was late for work when I set out. Still, I had my bicycle and would cover the distance faster. As I swung out through the gate at speed, everything seemed to have fallen into place: my family had a house to live in and I was cycling to work.

  It took me only a few seconds to grasp that the strangely powerful noise I heard from behind me was not a truck with a broken silencer—it was peals of laughter. I had to have a look. People in the street, who had greeted me so politely during the past week, were pointing at me and killing themselves laughing. As I cycled toward the hospital, those behind me called out to alert others. I saw grown women literally falling about laughing and twitching.

  The laughter pursued me onto the main street. By then, I was deeply embarrassed. What was so amusing? I checked my flies, and that I had nothing in my hair or on my face that could attract attention. Probably blushing, I reacted by pedaling faster, but that was apparently even funnier. I passed a queue of patients and their relatives, waiting in the yard in front of the hospital. To a man and woman, they all collapsed, screaming with laughter. The noise was so loud that some of the hospital staff came running out before I got off the bike.

  Luckily, as it turned out, Mama Rosa was among them. She didn’t laugh and instead eyed me seriously. We retreated to the emergency reception area where we could talk in private for a moment. I was confused and at a loss, somewhere between laughter and tears.

  “Why is everyone laughing at me?” I almost shouted.

  “Why did you cycle to the hospital?” Mama Rosa replied.

  “Because that’s how I get to work in Sweden.”

  “You’re working in Nacala now and here people have never seen an adult white man who cycles to work. No one from the hospital staff does. The Portuguese used to give bikes to their children. And, yes, there was one Portuguese man who lived uptown and used to cycle when he had had too much to drink.”

  “Come on, it makes sense for me to cycle. I’m not Portuguese. Besides, Mozambique is supposed to be independent now.” I was close to becoming angry.

  Mama Rosa put her hand on my arm and answered: “You must listen to me. It isn’t about being sensible or not. You’ll become a joke and then you won’t function as a doctor here. I’ll tell the cleaner, Ahmed, to wheel your bike back to your house. You can use it to take your children on outings but never again to get to the hospital. We must stop chatting now. I have a woman in the delivery room. She gave birth at home, the baby died and now she is very ill. She has tetanus.”

  Tetanus is a terrible affliction. I knew that I had to convince all the pregnant women here to be vaccinated and I would fail if I became known as the local clown. I had to choose. I decided that cycling was out of the question if it affected my credibility, especially when introducing new ways of protecting the population.

  It would not be the last time I had to ask myself: which changes are most important? And which changes are easy to make?

  A year later, we had succeeded with our vaccination program and no more women or newborn babies were arriving with tetanus symptoms. But I still couldn’t cycle to work. A mantra had stuck in my mind: “At first, change only what must be changed. Let everything else wait.”

  * * *

  My first friend from Africa, whom I’d met years before I moved there, would help me toward new ways of working and thinking. He came from a village in the countryside. His three older siblings had died as newborn infants. When he was born, his mother gave him the name Niheriwa. It was a temporary name—a kind of standby in the local culture, when it was feared that a child would soon die. It meant something like “the grave is waiting for you.”

  But Niheriwa had survived. His parents, who ran a small farm, worked hard and managed to keep the boy at school. He did exceptionally well. Throughout his life, Niheriwa kept his “temporary” name because, he told me, he wanted to honor his hardworking mother and remember that all life is fragile.

  Niheriwa became fluent in ten languages and was so successful at school that he was accepted at a Catholic seminary, expecting to be ordained. He ran away from the seminary as soon as the struggle for an independent Mozambique began, and walked all the way to Dar es Salaam in Tanzania, to enroll at the independence movement FREMILO’s headquarters to join the fight for freedom.

  We were in contact for the first time in 1967, when he replied to a letter I had sent to FRELIMO, asking for information. After he had been working in the office for a few years, Niheriwa’s ability was noticed and he was offered the opportunity to study in East Germany. We had kept up a sporadic correspondence and he had visited me in Sweden during his student years in Europe. He eventually graduated as a qualified mining engineer, one of the very first from Mozambique in Germany.

  Chance brought us together again in 1979. My family and I were queuing in Maputo air terminal to check in for the flight to Nacala and just moving on when I spotted Niheriwa in the next queue along. We hugged and greeted each other happily.

  “But where are you going to live?” Niheriwa asked.

  “In Nacala.”

  “Then I’ll come and see you!”

  Niheriwa had just returned home and was going to take up a post as director of a mine in his native province. As a big port city, Nacala was where imports for and exports from the mine would be shipped.

  He came to see us regularly over the subsequent years. Niheriwa was a tall, heavily built man. His expressive face constantly changed, shifting through a whole range of feeling, from great seriousness to vivacious humor. He was a good, dependable friend and advised me on many things. He taught me a trick to stop ambulance drivers from cheating the hospital by trading unused spare parts for old ones. Above all, Niheriwa guided me in the extremely tough task of being the boss of a crew of people in a very poor country, where hardly anyone had the training required for the job they were employed to do.

  He also explained why I shouldn’t keep talking all the time. The best thing, he said, is to stay silent and let other people talk. Ask questions but focus on listening to what people say in reply and try to get to what really troubles them. Once everyone has had a chance to speak, the boss should think things over. The pause will make his staff nervous but, when he breaks the silence, he will tell them he understands what they have said and that this is what they, as a team, will do. Then he will describe how it will be done. Niheriwa insisted this was how to become accepted as the leader and establish discipline.

  * * *

  One weekend, when Niheriwa was staying with us, we went to the beach. Nacala has one of the best deep-water harbors on the east coast of Africa. A curving peninsula creates a wide, protected bay where even the largest ships can enter the harbor. One of the Indian Ocean’s most wonderful beaches is a little farther along and it was our goal that day.

  When we arrived, we parked in the shade of a pine tree, climbed out of the car and took in the view of the many hundreds of meters of sunlit beach in front of us. There were more people on the beach than usual, maybe twenty families.

  “It’s a shame that this place is so busy today,” I said to Niheriwa, who was standing next to me. “Let’s quickly try to find somewhere peaceful.”

  He sighed heavily, grabbed my arm and got serious: “Look over there at Nacala, with its more than 80,000 inhabitants, just a few kilometers from where we are. Roughly half the population of the city are children but here, maybe forty children are on the beach. One child in every thousand! You call that too many? When I was a student in Germany, I’d often go to the Baltic coast near Rostock. Every week
end, the beaches would be full of children, many thousands of them, playing with their friends and family, and having a great time.”

  Then he let go of my arm, walked to the car and helped our children carry their toys and swim fins. I picked up the rug and the sun umbrella and Agneta took the picnic basket. We only had to walk a short distance to find a place to settle on what was actually an almost empty beach.

  Time and time again, my African colleagues have surprised me by demonstrating how my mind keeps following the same thought patterns as most Europeans when they arrive in Africa. Their intentions and Niheriwa’s were the same: to remind me (and all of us Europeans) that, however engaged we are in the struggle to free Africa of misery, we seem hopelessly lost when faced with an Africa where people have the same dreams for their lives as we do for ours. Why should it be so hard to accept that most families, wherever they live in the world, want good lives for themselves? Want to holiday in faraway places? Spend contented, relaxing days on the beach?

  * * *

  One day in the hospital, late in the afternoon, an elderly woman with a leg fracture arrived, carried in by her two sons. She had not managed to get out of the way in time when a tree was felled in her village. The ends of the broken bone were protruding through her skin and I would have to force them back into place. The infection risk was serious, and potentially fatal. It would be difficult to get the bones joined up properly, especially since we had no X-ray machine and had just run out of anesthetics. She was warned that the treatment would be very painful. I cleaned the wound carefully. Two staff nurses then took hold of the patient under her armpits to pull her in one direction, while the strongest junior nurse was told to pull the foot in the opposite direction. After much grappling I managed to line up the fracture surfaces so that they fitted and supported each other. I closed the wound, stitched the skin margins and put the entire limb in a plaster cast, from groin to toes. Finally, because the wound would have to be dressed, I removed the area of plaster covering it. The procedure had taken two hours and had caused the patient intense pain. I left instructions that she was to be put on an antibiotics drip, and told her that she had to stay in bed for a week and not put any weight on the leg.