In the customs they inspected my modest suitcase. On top of my things lay a copy of Cancer Ward, with a bold hammer and sickle on it. 'I'll have to check that book, sir, with that sign on it,' said the customs man. I explained. 'It is an anti-communist book. It has been banned in Russia. It would be an unusual distinction to be banned in South Africa too.' He went behind the scenes to consult his 'Index' and presently returned with more out-going vibes. 'Yes, that's all right, sir.' By the time I had with difficulty re-packed my suitcase, he was postively friendly. 'You'd better buy a bigger suitcase with your first pay cheque, sir.'
I stayed at the Mount Nelson Hotel one night, and was off north in my Fiat in the morning. Jimmy Lennon told me how he had passed the same way many years before. After a hearty breakfast he inquired the way to Salisbury, Rhodesia. 'Just drive down that road for a week,' he was advised. By my time the period was shortened to four days: otherwise the advice held good.
I picked up a young white couple who were going to Johannesburg. Companions are usually an asset on the long and sometimes problematic journeys of Africa, though nowadays I imagine picking people up is more dangerous than it was. Pity!
Cape Town was ringed by fantastic mountains towering into the sky. I thought how my hill-walking friends in England would envy me such breath-taking sights under the glowing blue heaven. The road climbed quickly and I was among the green slopes and vineyards of the wine-growing country, which looks like the south of France, and where the Huguenots brought the first grapes; but before midday I had reached a very different country - the Great Karoo, a country of stone and coarse grassland, semi-desert, stretching 700 miles to the north-east and 500 miles north to the Kalahari.
I made the small country town of Victoria West by nightfall. My companions had a tent and went to a camp-site. I told them to meet me next day at the hotel, where I put up for the night.
After supper I took a short stroll. The sky was clear and starry overhead. This was October, the hottest month, but the Highveld was cool at that hour. One sensed the vast clean distances of the country.
Next morning the sole other occupant of the breakfast room was a middle-aged man: the clean, intelligent-looking type of the best Afrikaner. He looked like a schoolmaster, maybe. We had a word or two between separate tables then got together on the veranda after the meal. He was something of a 'liberal'. He said, 'There are white men in this town who cannot sign their own names, who have the vote, which is denied to an African professor.' He drew the line at some things like intermarriage as the offspring, he believed, suffered a loss of identity. I wonder how he found the new South Africa, if he lived to see it.
I paid my bill to the manager who first greeted me in Afrikaans: 'Gooie more, meneer!'; but switched readily enough to English when he heard he was dealing with a Soutie.
I picked up my friends, and on we went to Kimberley; after which the Karoo became more barren than ever. But soon we were on the wide grasslands of the Transvaal. The land rose to the cool of the Rand, and as night fell I got a photo of the moon rising beside a candelabra tree. I left my friends in Johannesburg and put up at the Celeste in Hillbrow.
Next morning I got a picture of that hustling, towering city from the top floor of the hotel: more like America than anything I had yet seen in Africa.
The third day found me in a country of strange hills, some cone-shaped, some hump-backed, called kopjes (pron, 'copies'). Then the road descended into the hot, steamy Lowveld.
Here I gave a lift to a young black woman, an educated woman, probably a teacher or a nurse. We did not have much conversation. She was very shy, and I was wondering if I was breaking the Immorality Act: just wondering, I don't mean I was afraid. Of course, I was not breaking the act, but it would have been regarded as strange and a little suspicious by the whites in South Africa and Rhodesia in those days, rather like two men sharing the same house, to say nothing of bed, in England since the homosexuals literally queered the pitch. I had the soft look of a missionary, besides being British, both of which would have excused me, as an object rather more pitiable than suspicious in local white eyes. However, much of the black girl's silence would be due to her own embarrassment, as people might have mistaken her part in the situation, not to her credit. I may say the lift was unsolicited and I dropped her in due course with, I felt, some relief on her part, and came after dark to Louis Trichardt, where I spent the night.
Next day I found what looked like a small French town, with its church spire rising among small wooded hills in the mists of morning. It was Sunday and strolling about I passed a small Afrikaner boy and girl, dressed in a kind of folksy style, on their way to church: their Sunday best, rather like something in Germany or Austria. I longed to take a snap of them, but felt it a violation of their privacy.
And the same day I crossed the 'great, grey, greasy Limpopo' into the country that was to be my home for the next eighteen years.
On the Rhodesian side I met two young white men, who asked for a lift to Salisbury. They were from Zambia, and were looking for work in South Africa, but had been refused entry for some reason - perhaps their Zambian passports. One sat beside me, the other behind.
Presently we came to the Bubye river, a river of pure white sand now at the end of the dry season. It was so remarkable a sight I got out to take a picture. I wondered about leaving the keys in the car, but thought, perhaps quixotically, that it would be insulting to the honesty of my passengers to remove them. Besides, I reflected, they would not get very far in a country like Rhodesia, which although the size of the British Isles, was socially and economically speaking more like Wiltshire. The highly developed car-stealing industry which has grown up since independence did not exist then. My act would not have escaped the notice of two such sharp lads, and I wondered what they thought of me. Probably an old fool. It was not till many years later that I rediscovered a greater authority to support me, which I had forgotten: 'Il est plus honteux de se défier de ses amis que d'en être trompé.'
We came to a motel, the Lion and Elephant: the usual lovely spread-out African inn. We ordered sandwiches and lager on the wire tables outside. I told the boys how it was impossible to get anything less than a five-course meal for lunch in South Africa, through which the Boer farmers and their wives worked their way with steady industry. The boys said, 'You're in a civilised country now, Warren.' They seemed to have it in for South Africa, after being refused entry.
On the road, as I got tired, I let the boys take a turn at the wheel; and did those lads enjoy driving the new Fiat! The needle stood at the top of the clock most of the time. As it grew dark, after Fort Victoria, they asked me if they were driving too fast. I requested, modestly, if they would stick to 80mph. If I had known about the stray cattle and kudu one could meet on that road, I would have kept them below that.
We parted in Salisbury, and I booked into the Selous Hotel. Next morning I stood on the top balcony and viewed the lovely garden city around me.
I reported to the personnel officer at the Ministry of Health. He had already recruited me from Zambia. On the wall was a map of the country with all the hospitals, including the district hospitals which most interested me. There were thirty-six at that time, and the name of the district medical officer was attached to each - the sole doctor on the station, though the larger towns might have one or more private doctors too. I noted that some of the posts were unfilled.
But first I was destined for Gwelo, the provincial hospital of the Midlands, as doctors new to the country were both vetted and given such extra training as they needed to equip them for their duties, especially those who had opted for district service, as I had, who were going to work on their own.
I spent another day 'in town' where I bought new safari suits, among other things. Next day I set off for Gwelo, where I arrived at midday.
2 – Gwelo
‘Gwelo' was the Matabele name for what is now called 'Gweru', the Shona name. When the pioneers arrived in 1890 and established the moder
n country, they put the Matabele names on their maps (when they did not introduce English or Dutch ones), I imagine because at that time the Matabele dominated the country: the Midlands province lying in the Shona area.
Gwelo was a typical Central African town, built on a central grid pattern, with the oldest suburbs nearest the centre, then somewhat dilapidated and occupied by Coloureds and Asians. Further out lay more opulent and leafy suburbs where the whites lived. Here were two cathedrals, no less: Anglican and Catholic, and a large boarding prep and secondary school. And well beyond all were the African townships, which were sprawling and far from leafy, though the little houses each had a plot of maize and fruit trees - bananas and paw-paws. There were primary schools full of boys in khaki shirts and shorts and girls in cotton frocks (there were two African secondary schools in Gwelo); clinics with waiting crowds, mostly women and children; stark churches with tin roofs; and beerhalls pulsing with music day and night.
On arrival, I met first the superintendent, Dr Plato Mavros, who gave me lunch. 'Mav', as he was known to all his friends, including his wife, was then half way through a distinguished career. He was a man of medium height and build, and of Greek extraction, as showed in his regular features and dark, curly hair. His invariably calm, gentle manner contained a considerable force of character. His wife, whom he called 'Boo', was a tall, distinguished-looking woman of pioneer stock, and her husband's equal in character, although considerably more out-going.
There were about six doctors at the hospital then, only one a specialist: David Taylor, a consultant physician; though Mav was a skilled surgeon, in fact, a good all-rounder - the best type of African country doctor, the model I aspired to myself. David was also Rhodesian, about Mav's size, lightly built, fair and incisive.
The medical services of the country were then well-established on a model which, except for important developments which came later, which I will describe in due course, has remained unchanged, so it is appropriate to describe them here.
Then, as now, there was a state sector and a private sector. Then, as now, the state sector served ninety per cent of the population and comprised a quarter of the country's doctors. The private sector served ten per cent of the of the population and comprised three quarters of the doctors - a situation which has remained unchanged to this day, except possibly to the disadvantage of the state sector. This is the same throughout Africa. The reasons for this disparity are no doubt personal as well as economic; but the governments could neither match the incomes nor maintain the numbers of the private sector.
As far as other services went, I must not forget the mission hospitals which lay more or less in the state sector. Other hospitals were industrial or private - both in the private sector. Private doctors had access to private beds in the larger government hospitals, which had a separate section for Europeans. The government doctors had some white patients, such as police and the 'pioneer pensioners' - the impecunious descendants of 'pioneers', who were defined as persons settling in the country before 1900. There was also a public health service which came under the state and municipalities.
Gwelo hospital had then about 300 beds. It covered the Midlands Province, which was as big as Scotland and had a population of about 750,000. The province was divided into eight districts (including Gwelo itself), each of the others having a hospital of about 100 beds and one doctor, covering an area as big as a large English county and an average population of 90,000. These figures will stagger anyone familiar with European medical services: for instance, in UK, one GP serves 2000 people, and has access to complete specialist services. And Rhodesia was the most highly developed country south of the Sahara, bar South Africa. How was the impossible balancing act performed?
I have already limned the great African principle of elevation of responsibility, and how it works from the grass roots upwards. The grass roots in this system - primary health care, where the patient makes first contact with the service - were the medical assistants, the mini-doctors heretofore described. These people did the work of GPs and hospital house doctors in England in the district and provincial hospitals: not forgetting the maternity aassistants, who were rather more than British midwives. And alongside them worked the nurses and general hands.
In charge of the medical assistants (MAs) and nurses were the state registered nurses (sisters). These were usually ward sisters and acted as administrators. They existed in delicate, and sometimes invidious, relationship with the MAs. The sisters were 'officers', the MAs 'employees'. The sisters received more than double the salaries of the MAs, but lacked many of the skills they asked them to exercise.
The MAs formed the filter in which major cases were separated for the attention of the general doctors, in district or provincial hospitals, who were trained to deal with most of them, in medicine, surgery, obstetrics and gynaecology, paediatrics, etc, at registrar level in England; but across the board, not separately. Few cases would be referred by the doctors to the specialists: a difficult hysterectomy, perhaps, but certainly not a caesar.
The provincial hospital was supposed to have a full complement of specialists: that is, one in each of the core specialties, but rarely did. At the time I joined there was no gynaecologist, so I was given the job, under Mav's wing, which was a broader one than mine as far as obs and gynae went, and all other things besides.
In the townships and out in the country were clinics and small rural hospitals (run by nurses - a term I shall use in future to include MAs and ordinary nurses), which dealt with patients like general practices and cottage hospitals in England, and could refer cases to the district hospitals (including Gwelo in its own district). These represented the primary health care level. I shall have more to say about them later.
Small charges were made at government hospitals and clinics for outpatients and admission, which could be waived in cases of indigence at the discretion of the superintendent. Private services were covered by private insurance.
I was given a house in the hospital grounds at nominal rent (a married man with lively youngsters would have paid four times as much), and a cook recommended to me. Anderson was a Malawian who was retiring from the hospital kitchen. In his servant's jacket and trousers and bare feet (in the house), he was a cheerful little soul. He lived in a kaya at the bottom of the garden. His wife lived in one of the townships to secure his base there. His grown-up children had long since left home. Stove and fridge were provided. It wanted only to furnish the house at my own expense.
'Boo' offered to go shopping with me, rightly suspecting that a woman's guidance was needed. She took me to a good but moderate store and proceeded to equip my house with practical sense and lively good taste. After dining and lounge suites, carpets and curtains, we came to beds. I eyed a monastic cot. Boo said, 'O buy a double bed. You're bound to get married, and anyway, it's much nicer sleeping in a double bed.' Sheets. I fingered some white shrouds. 'Don't be so British!' commanded Boo. 'Candy stripes!' she ordered, from the attentive Mr Saddler. She brought me luck: through her orders and her prophecies, in one way or another, I have slept in a bed of roses ever since.
Mav put us in various departments and moved us around every six months to save us from the ruination of specialisation. And each night two doctors were on call: a junior with a senior to fall back on.
One night I was on call with David Taylor, when a man walked out of a beerhall under a train, which went over both his legs. He was going to need a double amputation. Neither of us had done one before but we were not going to drag Mav from his much-needed rest: that is not the way of Africa, as the reader will have gathered by now. I volunteered to mug up the operation from the bush doctor's surgical bible: Hamilton Bailey's Emergency Surgery, while David resuscitated the patient with a view to giving the anaesthetic.
The patient had of course taken his own 'premedication' at the beerhall and a good deal of the main anaesthetic besides, so in fact, David kept him comfortable with intravenous pethidine and Valium, an invaluable t
ool in Africa.
I took off the first leg below the knee, a proceeding which took me about an hour. Then I changed gown and gloves and returned to the theatre, saying to David: 'Now for Henry the Fourth, Part Two.' (The seeming frivolity which sometimes affects surgeons about their lawful occasions is, of course, a cover for emotions which are by no means frivolous.) I amputated the other leg above the knee, which took me even longer.
All went well and I saw the patient in a wheelchair a few days later, with the undefeated grin of Africa on his face. He was of course no longer my responsibility, being surgical. I think they fitted him up with something in the way of peg-legs and crutches.
We were joined by Willy and Kate, an English couple. Kate was a small dark, very pretty woman with a special knowledge of anaesthetics. Willy was half way to being a gynaecologist. Nevertheless, Mav let me work out my six months in the maternity department, true to his system.
Willy was a short stocky man with a black fan beard, who looked more like a trawler skipper than a doctor, and had chronic difficulty in looking 'presentable'. He did his best for a court appearance - in sports jacket and flannels, a black shirt which might have been discarded by Mussolini, and a rustic-looking tie. The prosecutor took one look at him and addressed the magistrate: 'Excuse the doctor's appearance, your worship. He has just come out of the operating theatre.' As Willy had done no such thing and the prosecutor had no right to say so, Willy was rather ruffled, but recovered enough to tell the tale against himself afterwards.
We worked hard and were on call one night and one week-end in three, but had leisure to get around. I explored the surrounding country with Willy and Kate. We did a round run to Bulawayo and Shabani and back, via Selukwe - three hundred miles, which shows what can be done in Africa in half a day. We had supper in Shabani in the big bare hotel. After the meal we took a stroll in the dark empty main street. My heart sank as I thought how lonely it would be as a bachelor in a dorp like this. Little did I know that within a few years I would be district medical officer here, come to call it a 'sweet little town', and find a wife there.
Across the Wide Zambezi: A Doctor's Life in Africa Page 18
