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

by Warren Durrant

  We saw meningitis commonly: say one case a month; though never the massive epidemics of the drier regions to the north in Africa. It was most satisfying to treat: this killer disease, which, a generation before, left the doctors helpless; though we sometimes got cases brought in too late, which we were unable to save; or were left with some defect, the saddest being a little boy who turned out to be blinded.

  And in Marandellas I had a case rarely seen in Europe - a full-term abdominal pregnancy, where the baby grows to full size outside the womb - obviously, an ectopic which survives. I saw six cases during my twenty years in Africa (only one of them my own), when six gynaecologists in Britain would hardly see one between them in their whole careers (The first ever in UK was seen in 2008).

  The midwife called me to a case of foetal distress (baby's heart slowing) in early labour. It needed a section. When I opened the abdomen, the first thing I came down on was the baby itself, a full-grown healthy girl. I could not understand it. I thought I had cut too deep - into the womb itself. Then I thought she had a ruptured uterus, and the baby had escaped through the tear and was luckily alive. At any rate, I extracted it, cut the cord and handed the babe to the midwife. Then I followed the cord. It ended at the placenta (afterbirth), which was stuck to the outside of the uterus, itself enlarged to thirty weeks' size and contracting as in normal labour.

  Now this case I had studied in Lawson and Stewart (Obstetrics and Gynaecology in the Tropics). No ordinary British textbook would have helped me. And Lawson and Stewart, as I remember, said: 'if the placenta is attached to uterus or adnexae, it should be removed, together with these structures' (my italics) - otherwise it should be left inside, to be absorbed naturally. The sight before me bore out their advice. The placenta had made a deep erosion in the uterus, which itself, as it contracted, was shedding the placenta and pouring blood from the erosion. I remembered with gratitude the subtotal hysterectomy Andy had taught me in Zambia, and instructing the nurse who was assisting me to apply a towel to the bleeding area, performed it there and then for the first time. It was the mother's first baby. She would never have another, but she had one healthy child, and her life was saved.

  Then a sadder case. A little boy of about ten, with a perforated typhoid ulcer and advanced peritonitis. As he lay back on the pillows, his face sunken with the disease, his mother and father sitting in silence on either side of the bed, I knew the case was hopeless. Nevertheless, I resolved to try.

  I resuscitated him as best I could and ordered him to theatre. I started the anaesthetic myself, but it was too much for his heart, which was affected by the poisons of the disease. He went out like a light as soon as I injected the Pentothal.

  I walked back to my house. I passed the parents, sitting on a rock, the mother silently weeping. I did not approach them: it seemed intrusive. But I broke down myself. I had to remove my glasses to wipe my eyes. They saw my tears. I hope they got some comfort from them.

  Among all his other commitments, the district doctor was also the police surgeon. Our duties were defined by the request forms the police presented to us: assault, rape, postmortem and drunken driving. For reasons of economy, the first two were included on the same form, and to the question: 'Weapon used', in cases of rape, the simpler African constables would faithfully enter, 'Penis'.

  Postmortem requests were mostly for suspected murder. These murders would follow the most trivial causes, as recorded on the police forms: 'He knocked over somebody's beer'; 'He picked up somebody's change'. A stabbing would follow and a postmortem on Monday morning. At Gwelo, Willy received a simple report: 'Found on her way home from a beer-drink with her head cut off'. The PM did not take him long.

  Although so forgiving in most ways, the people seemed to have no forms for propitiating offence (or perhaps it is something they have lost, as we British seem to; and moreover, as indicated, these murders usually took place under the influence of alcohol). One saw this daily in the clinics, where there was often trouble with doorways. Sometimes the pecking order was clear: women gave way to men; lower gave way to upper classes. Age was no privilege (or no longer, perhaps), especially if joined to poverty. More often the issue was obscure, and an ugly scuffle would result, which never failed to irritate me.

  And for my part, I got so used to African nurses, male and female, standing aside for me in doorways, that I sometimes forgot myself and preceded white sisters, which gave rise to comment. Then a Belgian female specialist, who was by way of being a feminist, confused everything by refusing my deference and standing like Balaam's ass in every doorway.

  Capital punishment existed, but for premeditated murders only, which never in my experience involved Africans (except later, as the emergency developed).

  And one day I had a postmortem with very strange connections.

  I always referred to it as the 'muti murder', meaning one committed to obtain muti (medicine) from the corpse, for purposes of witch-craft. The victim was usually a child (presumably for its purity), and the medicine was made from the internal organs by the n'anga (witch-doctor) to bring luck, usually to someone's business venture, such as a new store.

  This murder was not of that kind: indeed, it did not begin as a muti murder at all.

  The police brought in the body of an elderly man, which had been 'found in the veld' and had been dead about forty-eight hours. It was winter time, or even by then, decomposition would have been far advanced in those latitudes, and the postmortem difficult, as well as distasteful.

  The most conspicuous injury was that the face had been removed. I thought it might have been torn off by an animal: a hyena will do this to a sleeping victim. But the policeman said they suspected foul play; whereupon I set about performing a meticulous examination: the only way of avoiding a bad time in the witness box in due course.

  Sure enough, although there was no other external injury and no fracture of the skull, on opening the cranium, I found a bleeding around the brain. This was a sure sign of head injury, and allowed a presumptive diagnosis of death from brain laceration.

  A few months later, I was called to the High Court in Salisbury. There were two prisoners in the dock: an old woman and a man of about thirty. After hearing my evidence, the judge invited me to inspect exhibit A, which was a wooden stick.

  'Could that object have caused the injuries you found on the body of the deceased, doctor?'

  'Yes, m'lud.'

  Thereupon he ordered the male prisoner to be stripped to the waist. He asked me to walk over to the dock and inspect the prisoner's back. There I saw a vertical scar, about a foot long.

  'How old would you say that scar was, doctor?'

  I made an uneducated guess. 'About three months, m'lud.'

  'Show the doctor exhibit B.'

  Exhibit B was a large knife.

  Could the injury you see on the male prisoner's back have been inflicted with that knife?'

  'Yes, m'lud.'

  I noticed another exhibit, 'C', a bloody shirt with a long gash in it. I was not asked to comment on this.

  I got the full story from the local police the following week. On the night in question, Father, Mother and Son had been sitting round the fire outside their hut, very cosy, talking, telling stories and drinking doro (maize beer). Evidently, they took too much of the latter, as a quarrel broke out between Father and Son, in which Son picked up a stick and hit Father over the head with it. Father fell down. Mother hurried to examine him and found him to be dead.

  Now Mother was a n'anga and told Son, we are going to have trouble with Father's spirit. She took a knife and carved off most of Father's face, put it in a pot and boiled it. When the soup was ready, she made Son drink it as a prophylactic against any postmortem operations on Father's part. When Son had taken his medicine, the ever-thoughtful Mother said they had better make it look like Son's action was self-defence against Father's previous attack. 'Turn round!' commanded Mother, and using her all-purpose knife, gave Son a great slash down his back.

/>   These actions seemed to account for all the evidence. I think Son got eight years and Mother three as an accessory.

  At Marandellas I visited the prison, a duty of government doctors, to be described in more detail later.

  Marandellas was an open prison, devoted to farming, where the better behaved offenders were kept. Two of my patients there were the notorious ‘terrorists’, the Chinamanos, a husband and wife team; though anything less terrifying than Josiah Chinamano, a bespectacled little schoolmaster who read Dickens, would be hard to imagine. He became a minister in the post-independence government. His wife was more formidable (though always charming to me), and became a powerful voice in the same parliament, to whom the term ‘independent’ applied more aptly than to the institution itself.

  The superintendent was ‘Taffy’ Darnley, a little Welshman, who will not object to his name appearing en clair as his cover has already been blown by an even more famous terrorist, Judy Todd (as she then was). Taffy stands as a dreadful warning to authors. Even compliments failed to please Taffy: quite the opposite.

  I have not read Miss Todd’s book, but I understand it refers to the time when she was Taffy’s prisoner, and she describes him as a very decent man who mitigated to some extent the horrors of the Smith regime - that sort of thing.

  Now Taffy did not see himself as a ‘decent man’. He saw himself as the terror of the earth. Saddam Hussein was less well-known then or Taffy would have placed himself in that league, way past such bland figures as General Pinochet. He voiced his indignation long and often in the bar of the Three Monkeys hotel in the town.

  At Marandellas I experienced my first real African winter. Winter in Zambia is a few cold nights in June/July, and in West Africa, the fresher breath of the harmattan. Winter in Rhodesia was the real thing: temperatures down to zero, but so dry I described it merely as 'sports coat weather'.

  But first came the autumn: the grasslands growing tawny and then white, the woodlands grey-green; migrating swallows gathering in thousands on the telegraph lines, the departing white storks flocking on the veld.

  And then, almost in a day, a strange change in the light. A poem I wrote at the time will serve better than my memory.

  The mellow autumn sunlight of southern Africa

  Stands like champagne on the land, bringing the exhilaration

  of champagne,

  Charging the blood with soft electricity, making it race and tingle,

  Filling the lungs with soft fire.

  The snowy light is like silk on the skin,

  Blanches the rooms within the houses:

  Light with a touch of snow, so one feels the country leaning to

  the Pole.

  'A 'diamond light', as Ransford calls it:

  Certainly, the soft burning of a diamond,

  Veiled with a touch of gold, causing dense bronze smoky shadows.

  The air is changed,

  The brassy sky of summer gone high and soft, standing like

  water behind the emerald hills.

  The earth stands still and clear like a heaven:

  Almost one could touch the leaves on the distant trees.

  The dainty feet of the donkeys and the wheels of their little carts

  scarcely ruffle the white soft powder of the roads.

  The evening air is sharp with the scent of wood fires.

  So, even Africa pauses!

  Even she receives this cleansing bath!

  And so into winter, when the soft light hardens into the 'dry white season', and sometimes the south-easter brings grey weather and even a drizzle of guti, and it is very miserable. The men huddle in their greatcoats and balaclavas, the women in their blankets and woolly caps. And the children in similar headgear and such extra rags as their parents can give them.

  But the winter is mercifully short. In the single month of September the brief spring has exploded in the high summer of October.

  First, in the cold days of August, the scarlet flowers of the kaffirboom appear on the bare branches. Then the white clouds of the knobby thorn, the yellow shower of the wild pear. And then the whole country changes as the msasas 'burn red to green'. Yes, the commonest tree of the Highveld does the opposite of its northern cousins. The new leaves are red as an English autumn; but they are not about to fall: they soon turn green, and the false autumn to spring.

  In the towns the exotics bloom: the red fires of the flamboyants, the mauve clouds of the jacarandas, the ivory petals of the frangipanis; in all the avenues and gardens.

  And then the long anxious wait for rain: the thunders and torrents of November.

  Always in Africa one was close to nature. The hot smell of the earth. The rain crashing down like Victoria Falls, after a preliminary bombardment with atom bombs. Once I was caught in my car on a dirt road and had to stop with visibility down to zero in the downpour: at least one is safe from lightning in a car. The thunderbolts fell around me like depth charges round a submarine.

  And above all, the sun. I was returning in the small hours from a late night party in Salisbury, when the sun came up quite suddenly over the veld. I stopped for a leak: when I finished I walked towards it. It was so glorious, I found myself in tears. It was like an ultimate revelation. I had companions in the car, or I would have opened my arms and breast to him and cried aloud, like an Aztec or Inca of old. But it was enough: I had seen the glory of the sun, and it stayed with me many days.

  By November I had been employed by the ministry for twelve months and was entitled to leave. I decided on a safari to South Africa and Mozambique.

  I set off on one of those cold grey days which even in the Rhodesian summer could remind an Englishman of home, and by late afternoon had come to Fort Victoria, where I put up at the hotel.

  Here some horrible woman was abusing the old waiter. 'You are stupid! You 'ave always been stupid! What are you?' The waiter said nothing but went on with his brushing. The other people in the lounge looked embarrassed, but buried it in their newspapers or their conversation. This was definitely not the Rhodesian way: or at any rate, the Anglo-Saxon way. The Affs came in for more of it from the Dutch breed, to which this woman probably belonged.

  It was a folksy belief among both Anglo-Saxons and Afrikaners that the Africans preferred the Dutch brutality to the Anglo-Saxon hypocrisy; and indeed, an African once told me so himself. I don't think the matter is as simple as that.

  There is a bond between master and servant, as there is between husband and wife, which will take a lot of abuse; but if there is no bond, or it is betrayed, then real hatred can fill the gap. It was these cases that got targetted later in the Civil War. But again, life is not so simple. A lot of good people got targetted too. But I must not run ahead of my tale. I will only say, one felt no such bond in the present case.

  Next day, across the border, and to a town in the northern Transvaal, called Warden. This was solid Boer. I booked into a hotel. I put my foot in it right away when I thought the barman had an English accent, and with all the simplicity of Noddy, asked him if he was English. He served me without another word.

  After the usual hearty supper, I retired to the lounge, which was soon taken over by a lot of men and women in their best clothes, who proceeded to execute an ungainly sort of folk dance to a record player, in which I was not invited to join. If a sore thumb can take an armchair and pretend to read a book, that was me. I took myself off to an early night with Churchill's Second World War: that other prisoner of the Boers!

  Next day, Johannesburg, where I stayed in a small hotel, and the day after, had great difficulty getting myself off the famous ring road that runs round that city. I was heading for the Drakensberg. I ended up in some Coloured area. Thank God, it wasn't Soweto, or I might not have got out alive.

  Then I came, on a dark wet afternoon, to the Wagnerian mountains of the Berg, and put up at the hotel Mont au Sources under the shadow of the Amphitheatre.

  This magnificent terrace of the giants was glowing in the eveni
ng sun as I contemplated it with the young man who worked at the hotel as guide.

  'What about doing it tomorrow?' I asked brightly.

  'How far away do you think that mountain is, sir?'

  'About five miles.'

  'Actually, it is twelve miles, and takes two days to climb it; that is, if you are young and fit:' with a glance at me. 'Otherwise, more like three, or even four days.' One loses all sense of scale in the vastness of Africa.

  'What I suggest, sir, is a gentle walk up to the foot of the cliff and back. That makes twenty-four miles, and will take us all day.'

  Which we did. A party was made up next day, and he led us up the valley of the Tugela river, higher and higher, with the landscape opening up, with its enchanting views, wider and wider around us, in the glowing light of the summer morning. And soon it was hot work. We were happy for the cool of the gorge, where we had lunch by the river. Further up, we swung on a chain ladder across the gorge. Until finally, we were under the towering crags that sailed in the moving sky. Then the long, pleasantly tired slog homewards.

  I spent a few more days here on the lesser slopes, then on to Durban, from where I took the road to Swaziland and on the way picked up a young Englishman, Rufus. He was an agricultural student who had been gaining experience on a South African farm. He was a big country-bred lad and a public schoolboy.

  We saw little of Swaziland, before coming to Mozambique, where we crossed the Motola river and were in a different world: the lazy, decadent, Latin world of Portuguese Africa.

  Lourenço Marques was a beautiful Mediterranean city with handsome streets and pavement cafes. We also noticed the astonishing beauty of the mestizo women: one in a government office, behind her typewriter, I could not take my eyes off and thought about for days: sort of Sophia Loren, only more tropical. And I introduced Rufus to the fado.