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

by Warren Durrant

  The 'railway people' lived on the siding where the railway crossed the main road to the south at an almost imaginary place called Fairfield. One day, George spotted some railway children, distinguishable only to his knowledgeable eye, fishing with bent pins. He pounded bawling across the veld towards them on his bare feet, in imminent danger to his heart, which was not sound. The ragged little brats snatched up their primitive gear and easily outdistanced him, leaving him panting and sweating, pulled up at the end of his puff, while they danced up and down and cried: 'Fat man! Fat man!'

  One morning at seven, I got a call from George's wife. He had a pain in his chest and looked very ill. ‘Would I come and see him?’

  When I got to the house, it was as she said. George was sitting in a chair, looking grey. When I took his blood pressure, I found him in shock. I asked him how long he had had the pain. ‘Since three in the morning’. Why didn't they call me earlier? ‘Didn't want to disturb you, doc’.

  I gave him a shot of pethidine, and within seconds he said: 'The pain's gone, doc.'

  Those were the last words he spoke to me. I ordered him to bed. At eleven o' clock his wife rang me at the hospital to say he had died peacefully in his sleep.

  I attended the funeral. I was held up at work and too late for the service in the tiny church. I waited in the little cemetery on the edge of the bush, and presently the coffin and procession arrived. There, among other obscure colonial souls, they buried George, under the msasa trees, and the blue sky of Africa, he loved so well.

  Beyond the town lay the white farms for twenty miles, and more in some directions; and beyond them the tribal lands (now called 'communal lands'). We covered a number of hospitals and one clinic over an area as large as North Wales, which has since been rationalised to form two districts. There were two mission hospitals, as large as Umvuma; and one of them (Gutu, sixty miles out) was later made into a de facto district hospital.

  Gutu marked one boundary between white farmland and tribal land. We had a rural hospital there, where an ambulance was based to cover two further rural hospitals in the tribal lands themselves. Once a week I would visit Gutu and take in one of the other hospitals, except for the week I visited a hospital in the opposite direction - Chilimanzi. Once a week, on another day, I visited our clinic at Lalapanzi, which will be remembered as one of the railway 'watering points'.

  I travelled to Gutu in my own car along a metalled road. After the usual clinic and ward round, I would be taken in the Land Rover, banging and snapping like a biscuit tin over the rough dirt roads to the outer hospital: Chinyika or Chingombe, each twenty miles further on. Now we were in the typical tribal lands of Central Africa. We passed villages: not the large villages of West Africa, but small family affairs, often bearing the family name: Moyo; or the family totem: Gudo (baboon), Garwe (crocodile), Tsoko (monkey). There was the family hut, made of mud and wattle and thatched, each in its tribal manner; and round, so that evil spirits would have no corners to lurk in (unlike the rectangular huts of West Africa), though richer people had brick houses which were rectangular with tiled roofs. The women built the walls and the men the thatched roof after. People from neighbouring villages cooperated in the building.

  Beside the hut were the granaries, also of mud and wattle and thatched, like tiny huts themselves. There would be the cattle kraal made of wood stakes and woven with branches, to protect the beasts at night. There were overhead holders for storing grass feed. Outside the huts were racks for pots and pans. Everything showed the shapeliness of skilled hands.

  Women hoed the fields and reaped the meagre crops of maize and native corns. The men did the ploughing and planting. Young children minded cattle and goats out in the veld all day. Older children walked to school, sometimes ten miles each way, with no food from breakfast till supper, sometimes crossing fords where crocodiles lurked.

  Evening was a time of much activity. Women and older girls fetched water from dams and rivers, which they carried in buckets on their heads, cushioned with coils of cloth. Older children watered the beasts at the same time, while boys ran about hunting a hare for the pot with their half-wild, skinny, whippet-like dogs. Women fetched firewood which they carried in bundles on their heads. Women pounded corn outside the huts in mortars with pole-like pestles, sometimes two together in rhythm. Cooking fires were lit before the hut. In winter the fire was carried inside and left to smoulder all night in the middle of the floor, while the family slept around it. And people fell into it - drunks, children, epileptics - so that was our main burns season. The huts were so smoky, it was our asthma and bronchitis season too. The toilet was the bush.

  The cattle were too many. They were hardly eaten, except on ceremonial occasions, and gave little milk. They were not exactly the sacred cows of India, but they represented a man's wealth and status. They were also bride price. Young men went away to the mines or factories to earn money to buy them for a girl's father. A girl with O levels came very expensive, to say nothing of a teacher or a nurse, though among the middle classes, money was accepted in lieu of cattle. The custom was instituted in the hope that the wife would be cherished.

  The cattle wasted the grass, and the goats finished it off, eating the roots also. The goats were eaten with rather more regularity than the cattle. Chickens also ran around the huts and were eaten, but not their eggs, which were thought to cause sterility.

  Looking always for sources of protein, I asked my driver once if the people drank goat's milk.

  'What, docketa! Do the people drink the milk of the goats?'

  'Yes.'

  'O, no, docketa. The people cannot drink the milk of the goats.'

  'But the Magriki and the Ma-italiani drink goat's milk.'

  'O, docketa! They do not drink the milk of the goats?'

  'Yes. It makes them strong.'

  'No, docketa. The people cannot drink the milk of the goats!'

  As in England, every two or three years we had a measles year, and smaller outbreaks at any time. Measles is a serious thing in the undernourished children of Africa, causing chest infections and worse (unless they are fatal), blindness.

  At one outer hospital I found three little brothers with measles and their eyes in a very bad state, with keratomalacia, or softening of the eye, on the brink of blindness. I ordered them a teaspoon of vitamin A each, and when I returned in three weeks' time, found that each child had one blind white eye and one clear healthy eye. Meantime, I had reiterated instructions to all our medical units to give vitamin A to all cases of measles.

  And we saw cases of kwashiorkor and marasmus: the former swollen and water-logged, due to protein deficiency in children fed on maize alone; the second thin and wasted, due to simple underfeeding, especially in drought years. So I had fresh protocols made out for feeding children with nourishing local foods; though even so, in drought years these were unobtainable.

  And with the rains in November came first malaria, as the mosquitoes were able to breed again; and typhoid, when everything in the unclean villages was washed into the rivers and dams.

  I came to one outer hospital and found a large number of people sitting around outside, huddled in the wet weather in great-coats and blankets. After the clinic I did my ward round. Most of the patients had typhoid. The nurses were handling them as I had instructed. If someone had fever, treat first for malaria, as this was more urgent. If the fever did not go down in three days, when indeed the tell-tale 'step-ladder' temperature chart of typhoid would have shown itself, treat for the second disease.

  I did my ward round, males first, and all seemed under control. The nurses knew how to recognise complications - the commonest, perforated typhoid ulcer, producing severe abdominal pain - or pneumonia; and would send these to the district hospital by the Gutu ambulance straight away. I was about to pass on to the female ward when, as at the Last Day, all the patients able to walk rose from their beds and went outside. Then their places were taken by another lot from the waiting people I had seen. At the e
nd of my second ward round, the same thing happened again. On the female ward it was the same story. One hundred and twenty patients, mainly typhoid, sharing forty beds, God knows how, many on the floor, no doubt. I wondered how many of my old chiefs in Liverpool were ever asked to repeat their ceremonious ward rounds twice in an afternoon, and what they would have said about that.

  The rains were heavy that year - good for crops, not for diseases. I realised something would have to be done about the hygiene of the district. I wrote an agitated letter to the Gutu DC, Mr Menzies, asking about the possibility of making the people dig pit latrines, with fines for non-compliance. I said, if cholera appeared, the district would go up in flames. The DC must have thought, we have a right stirrer here!

  He wrote back and invited me to drop into his office on my next visit to the district. Next time, on my way home, I did so. He gave me tea. He was courteous and sympathetic; had noted my concern about the district 'going up in flames'. First he said he understood public health came under the provincial medical officer of health (correct), but could see my point of view as the chap on the receiving end. He agreed that pit latrines were the obvious answer, but there was no question of coercion. I quickly retracted this gaffe. He said he would do what he could - no doubt, what he had been doing long before I came on the scene: the ungrateful task of Jenny's in Ghana of trying to stop Africa from back-sliding. But now he was preoccupied with the security situation. The bush war had already started in the north-east - the 'sharp end'. The first rumours were reaching our part of the country.

  But between us, we had hit on certain principles which were to bear fruit in more propitious times, as I shall relate in due course.

  One week in four I would visit our hospital in Chilimanzi, which was in the parish of Jamie, the agricultural officer. I had a standing invitation to supper and would usually arrive before he was home. The cook would give me a beer and I would settle down with one of Jamie's extensive collection of P G Wodehouse, in the Penguin edition. And in due course, Jamie would arrive.

  He was a large ebullient Scot with a florid face and shock of dark hair. His father had worked in India and Jamie had been sent home to prep and public school in UK. When the Rhodesians asked him if he was really ‘Scotch’, which he did not sound like to them, he would explode: 'You mean "Scottish"; and why on earth does a Scot have to have a Scottish accent?'

  He had a party line which seemed to be permanently blocked by the local Boer farmers. Jamie would get engaged in crossed-line arguments with these people, with most of the heat on Jamie's side (which is saying something), in a perfect natural antipathy which nothing would change.

  He was a member of what we called the 'Diners' Club': which existed among the bachelors, each of us giving supper in our houses to the other members, once a week. These were rowdy affairs which progressed to the town swimming pool, where we would throw a switch to light the place up and all plunge in in the buff. If Jamie was the last, with his huge body he would create a tidal wave which almost left the rest of us on the bank. Jamie was thirty: except for myself, the oldest. I sometimes wondered if I was in the right age group.

  After the swim, into the Falcon, where more booze was consumed and we played darts; when Jamie, who had a Scottish pedantic streak, would argue heatedly about the rules, to the exasperation of the easy-going Rhodesians. 'It's the same rules for everyone, Jamie.' 'Yes, but it isn't logical!'

  He got into an argument one sleepy Sunday afternoon in the lounge of the hotel with an Afrikaner miner, which ended in a brawl among the Illustrated London Newses and the Wild Life Rhodesias, of which I believe Jamie got the worst. Altogether, I think he was a little too hot for the climate and I feared for his blood pressure, though he never asked me to take it. But I was in tune with my fellow Brit and got on splendidly with him.

  In Umvuma that year I did seventy caesarean sections and thirty symphysiotomies. This last operation is limited to developing countries where it has a special application. Briefly, it consists of splitting the pubic joint in the front of the pelvis, under local anaesthetic, to widen the pelvis and allow delivery of the baby in cases of moderate disproportion. When conducted by the correct rules it is an excellent operation: which can be said for any operation in current use.

  It is not as drastic as it may sound. The mothers complain of no pain at any time: nor are there any subsequent ill effects. I asked them to return after six weeks (the only postnatal examination we bothered with), and got them to perform a simple test - an African dance, which all performed with ease and gusto. The joint fills with fibrous tissue and is indeed, stronger than before, so that the operation can never be repeated (which would be inappropriate, anyway). It was usually performed on first-time mothers and next time round, in most cases, they would deliver naturally.

  It has a place in primitive countries, where communications are poor and a woman not always able to get to hospital in time; for a previous caesar - a woman with a scar in her womb - might in those circumstances rupture, to say nothing of those prejudiced against hospital after that operative experience, who might be tempted to go it alone with possibly disastrous consequences. These circumstances were aggravated as the emergency developed and travel by night became impossible. The previous caesars often ruptured: the symphs did well.

  I must have done more than a hundred in my time with consistently good results. When services and communications improved in later times, the operation was less appropriate and I abandoned it.

  I first heard of it in Ghana from Des, though did not practise it myself until I had learnt the principles and technique from the Rhodesian maternity handbook. Des mentioned it, in a spirit of Irish mischief, to Sir John Peel, the President of the Royal College of Obstetricians and Gynaecologists, at a dinner of the College to which Des had somehow got himself invited. Sir John was horrified - had never heard of such a barbaric proceeding in all his days.

  He would not have been mollified by an article which appeared in the Central African Journal of Medicine which stated that, from the evidence of skeletons, the witch doctors had practised the operation in Central Africa long before the coming of the white man.

  I did a hernia operation on a little fat man. As his blood pressure was high and difficult to control, I did the operation under local anaesthetic. In fat people, the landmarks are less clear. I accidentally nicked his femoral artery. This is not the disaster it sounds: it would have been more serious to nick the femoral vein, which is more difficult to deal with. A single stitch repaired the damage. Meanwhile, a spurt of blood had hit the ceiling.

  'Is that my blood up there?' the little man mildly inquired from behind the usual screen.

  'Yes, madala,' replied one of the nurses. 'You had too much, so we took some away.'

  'Does that mean I am a blood donor?'

  I had two compound (double) volvulus cases at Umvuma. One was an old man brought in by the nuns one night from St Theresa's Mission Hospital. Their own doctor was away. It was a carbon copy of the Marandellas case.

  The nun anaesthetist did a good job and kept the old fellow up to the mark. Again, I took away twenty feet of gangrenous small bowel, as well as the affected large bowel (sigmoid). It was a hot night and half-way through I felt exhausted and wondered if I could make it. And this time I did not omit the double-barrelled colostomy.

  The old man made a good recovery, though he never had a weight problem again, if he had one before, which looked unlikely. After six weeks I sent him to Mav to close the colostomy, though soon I would pluck up courage to do this myself. I must have done nearly twenty such ops in my time in Africa and lost very few patients. I got my operation time down eventually to two hours.

  Another case was hopeless from the start. A young man who collapsed in the fields. He must have been ill for some time before that and carried on in the stoical way of the African. When I opened him up, as well as the affected sigmoid, his entire small bowel was black. I took out as much as I dared and left behind as much as I
dared, which was little. After two days, in spite of copious blood transfusion, he passed a massive melaena stool (of altered blood) through his colostomy, collapsed and died.

  One night, I was called to the labour ward for a retained second twin. Two fat little midwives were in attendance. I had hardly finished, with a happy result, when one of the midwives, who had been hovering about the open door, informed me: 'Doctor, something is at your car.'

  I went outside in my apron and boots. The two fat little midwives stood beside me in great curiosity. In the darkness, I made out a large grey shape just beyond my car, which seemed to be making a strange noise: Raah! Raah! Raah! I said, 'I think that's an elephant.'

  The next second - zapp! zapp! - without a word, the little midwives shot back inside the labour ward, incontinently slamming the door after them, leaving me to contemplate the menace outside.

  Presently I made out the large object as the water tank. The noise was coming from my windscreen wipers which I had left on, it being raining when I got to the hospital.

  I got my first cases of pelvic abscesses in women. One young lady who erupted several litres of pus as soon as I opened the abdomen. Another in whom I attempted to remove a tubal abscess but failed, and worse, severed a ureter: the tube that carries urine from the kidney to the bladder. I was able to repair it satisfactorily and the patient made a good recovery on antibiotics.

  In the Falcon at sundowner time, where I used to unload, I said: 'I hate it when things go wrong.'

  'You should try farming, matey,' replied Ian McArthur. 'Things are always going wrong.'

  Another night at the bar, I suddenly remembered I had forgotten to tie the tubes, as requested, of a woman at caesarean section that afternoon. I was foolish enough to blurt this out. Big roar, and drinks all round on me! It required a second operation next day; which might have cost me (or my defence fund) more than a round of drinks in some other places I could think of.