Across the Wide Zambezi: A Doctor's Life in Africa

by Warren Durrant

  Mr Mills escaped execution, at all events, as a few afternoons later, when I was into a further chapter of Manson, he entered my office, after first sweeping the landscape with his head-lamp glasses, evidently for any signs of Jenny. He drew after him a plump young female, clutching her arm, like a prize heifer.

  'I hear you want learning Twi,' he began, referring to the local language. 'I dash you my cousin, Comfort. She very good Twi teacher.'

  I recognised the famous 'sleeping dictionary'. The 'dash' is an even older West African institution: a special gift or bribe.

  'Comfort' is a popular local girl's name. Others are 'Blessing' and 'Promise', and it must be said, the owners try to live up to them.

  I was sorry to disappoint them, but explained that I was already receiving Twi lessons from a local schoolmaster.

  One day, Amos rang me up to say that a European manager had complained that he had seen Sackey sitting in the doctor's chair, seeing patients, and seemed to think the world was coming to an end.

  Now Sackey was a medical assistant, which, I have already said, is a sort of mini-doctor. Sackey regularly took over from me while I was doing my ward round, in theatre, or having my meals, etc. In most African systems, the MAs see all the patients first, screening out the more serious cases for the attention of the doctor. I was surprised Amos did not know this.

  I asked him the name of the complainant, but Amos would not tell me.

  Well, I could work things out, just as Amos could, even if my system was no doubt not as highly developed as his. On the day in question, there had only been one European patient. The managers sat in their own waiting room, where he would have seen Sackey in the doctor's room. His name was Bill Cartwright. He had malaria, and I put him off sick.

  The managers enjoyed home visits, which were performed by Jenny, as well as myself. At my request, she attended on Bill next day.

  I asked her how she got on, and took the opportunity to tell her of Bill's offence.

  Jenny's face fell. 'My word! I've put my foot in it!'

  Jenny had entered the sick-room and placed a thermometer in Bill's mouth, as Bill's wife stood by. While Bill sat up in bed in his best pyjamas, cooking the thermometer, a self-conscious silence descended, which affected everyone in the room except Jenny, who stood with arms folded, regarding Bill with a clinical eye. Seeking to fill the gap, Joan Cartwright opened a social conversation with the words:

  'And how are things at the hospital, matron?'

  She got more than she bargained for.

  Jenny had heard of the complaint, but did not know the identity of the complainant.

  'Things at the hospital,' she thundered 'would be a braw sight better if some of the folks in Samreboi would learn tae mind their ain business!'

  She recounted the story of the mystery European manager.

  'Ah doan't know who he is, but ah shall, and when ah do, ah'll tear him apart!'

  One of the main planks in Jenny's campaign of reform was the eradication of public spitting. The African peasantry shared with British footballers an immovable belief in the poisonous properties of their oral secretions, which must be removed at regular intervals, regardless of locality. Although Jenny put up notices and made the most terrifying examples, the offenders never seemed to connect these activities of the strange white woman with the matter in question.

  One morning, Jenny stood outside her office, contemplating her domain, her thoughts upon the same. Her eye fell abstractedly on a small black girl in a body cloth, sitting with her back to her on the edge of the gangway. The almost physical pressure of this powerful gaze seemed to affect the girl, who turned her head and rolled the whites of her eyes at Jenny. As one blinded by the sun, she looked ahead again, but now froze like a small animal under observation. After a minute, she turned her head again, but the sun was still glaring. Once again she looked ahead, but this time, feeling that something was expected of her, filled her mouth with spit. When it was good and ripe, she hoicked it on to the ground a yard in front of her.

  Until that moment, the girl had lain unregistered on Jenny's retina. Now she became only too visible. Jenny rose a foot in the air with a loud bang, or rather series of bangs, representing the names of Miss Lemaire, Mr Sackey, and sundry other persons, including even the disgraced Mr Mills (perhaps to examine the sputum under his microscope).

  A European manager, who had been standing by observing this little comedy, now pulled his pipe out of his mouth and began laughing: 'Ha! Ha! Ha!', until Jenny rounded on him, and he managed to save his life by timeously converting it to 'Ah-tishoo!'

  6 - The ‘Ritual Murder’

  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.'

  7 - Triumph, Tragedy, Victory

  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.