In 1984, we got two new doctors. Jock was still with us, so for one marvellous year, until he retired, we had four doctors on the station, and proportionately lighter work and more time off. The new doctors were Charles, a Zimbabwean, and Stephan, from Germany. Stephan did a three months’ ‘acclimatisation course’ at Harare teaching hospital, where, among other things, they taught him to do caesarean sections, without which a doctor in the districts would be a burden to his colleagues. Charles had had the usual intern training of the country, so was fully equipped for district work.
Both were keen and made first-class district doctors. Charles (as I, eventually) was later forced out of the service by economic necessity (a subject I will return to later); Stephan by the termination of his two-year contract. Stephan is now in occupational medicine in Germany, but must regard his African days as the high spot of his medical life.
The only other German family in town was the Feldwebels. Brünnhilde was now a sister at the mine hospital: not for her the new order in the government service. I have said she was a German of the old school. She had married a German husband from South West Africa, raised three fine children, and had not been back to Germany for thirty years. She and I had many a merry evening singing the jolly old Wandervogel songs, which she had learnt in the Hitler Youth, and I, believe it or not, at the same time, at my Liverpool elementary school: nobody could accuse Mr Baldwin of not trying! Brünnhilde did not blame the British for attacking their German cousins: she probably saw the beauty of a good scrap as clearly as Clausewitz, but did not agree it justified any cause. To the point, she could not see why we did it on behalf of the Poles, whom she described, in her charming way, as the ‘Kaffirs of Europe’.
So Brünnhilde, in the course of duty, and the spirit of friendship, paid a visit to the Moenichs. Stephan had his wife with him and a little daughter. Stephan was a tall man: his wife was a tall woman, and both she and Brünnhilde, for all their Nordic blood, were as dusky as Hindus.
Brünnhilde got a surprise. Another generation had grown up in Germany while her back was turned, and the Moenichs belonged to it. She reported to us, not exactly in horror so much as astonishment, that she had found the Moenichs taking morning coffee with the African ‘garden boy’, as, of course, she continued to call him. ‘They are the most extraordinary people!’ she declared. ‘Nobody in Germany is like that!’
Brigitte Moenich had a different version of the event. ‘This weird woman marched in, with the strangest ideas about Africans and everything else. I couldn’t believe my ears. Nobody in Germany is like that nowadays!’
As the witnesses with the more up-to-date experience, we were inclined to give the verdict to the Moenichs.
The new families became good friends. Charles was a small man, a Tswana, as was his dainty wife, Nomsa. And all the children became friends and attended not only the Christmas party at the mine club, but the Sunshine Nursery School.
At the mine there was also a swimming pool, which afforded a study in racial habits. As at Samreboi, the African children swam in shoals, completely without parental supervision: no African adults appeared at all, in or out of the water. The Europeans came in family groups, as did the Coloureds. So did the Indians, but whereas the men and children swam in smart bathing suits, their women plunged into the water in their saris, and were taken home dripping wet in big cars. The Moenichs found the changing rooms dirty (I thought they were usual British standard), and got changed in the open air, to the astonishment of all other groups.
When I came to Shabani, I was approached by the medical school to take students. After independence, as well as local students on attachment, we had students from overseas, doing their electives. All were supposed to follow the doctor everywhere in his work, and observe, without engaging in any work themselves, or being made use of.
I remember all of them. Most of them were excellent, some otherwise. A pair of the otherwises was a strange American couple: two men who had served with the Selous Scouts, and were now reading medicine at the University of Zimbabwe - which says something for Mugabe’s policy of ‘reconciliation’.
They were like something from a fable: the fox and the wolf. They were older than the usual run of students. Moreover, they took notes, especially on our travels to the rural clinics, something other students did not do, nor were specially required to.
I soon became disabused with this apparent enthusiasm, when they informed me shamelessly that they were preparing to tour the districts themselves, during their vacations, selling patent medicines. After a week (they were down for two), they informed me they had seen enough of district practice (or, as they put it, ‘one district hospital is like another’: whatever they meant by that), and took themselves off, one of them owing me ten dollars I never saw again.
These were the only ones I had to make a bad report on, though I had to threaten another. This was a black lad who stayed at my house (as all did before I was married and had children, when they stayed at the guest house - the house I had stayed in when I first arrived). I knocked up young Barnabas one night to come and watch a caesar, when he informed me that he was only interested in the workings of a district hospital by day - he was going in for public health, anyway. The threat of a bad report got him out of his pit.
Otherwise, as I say, they were all good. Henry and Mike. Henry became a keen district surgeon: Mike gave his name to one of the wards. One night, we admitted a kid with kwashiorkor. After going through my usual routine, I asked for suggestions. Mike said, what about some heat. It was a winter’s night. We moved the kid into a side ward and installed an electric heater, which thereafter became used specially for such cases, and was christened, the Mike Madzima Ward. Butch (white), who was an expert on English football and Middle East politics, as well as his own profession - interesting possibilities! Clips, who went in the air force: David, who became a pathologist. Two black girls from Bulawayo, one with an accent (Bulawayo Convent) like the Queen of England. From overseas, a German girl; Sam and Caspar (white and black together); Debbie and Pat, all from England. Hope I haven’t forgotten any.
Pat had a special experience. She was sitting beside me in outpatients, when a thin anaemic-looking woman came in. She had a baby on her back, another at her side, and another one inside. When I had got through the medical business, knowing that Pat was rather into women’s lib, I decided to lead the patient verbally through her typical day. The entire interview went through an interpreter for Pat’s sake, as well as mine (although I could have managed the medical part myself).
I looked at her card. (The patients kept their own records, usually in plastic folders, as that way less got lost than when they used to be kept at the hospital.) I saw that she came from the next district, Chivi, which was even poorer than Zvishavane; so poor, in fact, that you could not see a blade of grass at times for fifty miles, and where there was only one doctor, at a mission hospital, further for this woman than ours.
‘What time do you get up in the morning?’
‘At the washing of the elephants.’ (Daybreak.)
‘What do you do then?’
‘Sweep the house.’
‘And then?’
‘Light the fire.’
‘And then?’
‘Cook breakfast.’
‘And then?’
‘Go to the fields.’
‘What do you do in the fields?’
‘Hoeing, picking the mealies.’
‘What do you have for lunch?’
‘Nothing.’
‘When do you finish in the fields?’
She extended her arm to indicate an angle of the sun.
‘Then what?’
‘Fetch water.’
‘And then?’
‘Gather firewood.’
‘And then?’
‘Pound the mealies.’ She worked an invisible pestle.
‘And then?’
‘Light the fire.’
‘And then?’
‘Cook th
e sadza.’ (Porridge.)
‘And then?’
‘Wash the pots.’
‘And then?’
‘Go to bed.’
‘And what does your husband do all day?’
‘Drinks beer and talks with his friends.’
Half-way through this catechism, Pat had been bobbing on the edge of her chair. At the last dreadful revelation, she exploded:
‘It’s about time these Zimbabwean women got their act together!’
Finally, I got a new type of student. The new policy was to take primary health care to the grass roots - to the villages themselves and the commercial farms. The ministry began to train three new cadres: village health workers, traditional birth attendants, and farm health workers. These people continued with their usual lives, being simply country folk with a little more education than their neighbours, who volunteered and were chosen by village councils. The traditional birth attendants (TBAs) were village wise women or female n’angas who had been delivering babies anyway. They all received short courses at the provincial hospital: the health workers in health education, which was the main purpose intended for them in the villages - they would educate the people about health, including nutrition, and teach them to make pit latrines and protected wells: the same on the commercial farms, where necessary. They carried some drugs, including chloroquine for treating malaria. They informed the people about the health programmes (maternity/child health clinics), and encouraged them to use them. The TBAs were given training in deliveries, and provided with fresh razor blades and tapes for dealing with the baby’s cord (to eliminate the dirty practices which caused so much baby tetanus), and to recognise and refer complicated cases. They would keep in touch by attending the antenatal clinics at the rural health centres. All received a small monthly stipend, which fell short of a living wage and was not intended to be. As I said, they were simply villagers with training, intended to be educators.
All these people I encouraged to attend at my clinic visits - not that they would ever deal with more serious cases themselves, as the nurses did, but to inspire them in their work and extend their medical knowledge; and they were enthusiastic attenders. But when a lady had to undress, especially if she was known to them, they would all scuttle out of the room with anxious African modesty.
One day, on the golf course, Percy said: ‘What about doing some prostates together?’ I demurred. Prostatectomy is not an easy business, and is never an emergency. But I decided to have a look at it.
We did the old Freyer’s operation. Percy tried to teach me the superior and more difficult Millin’s, but I could never match his skill: my Millin’s was no better than my Freyer’s, so I stuck to the simpler operation.
But once you start something in Africa, you don’t lack customers. Old gentlemen who had suffered in silence for years came forward in regular numbers. The reasons are complex. First, the doctor must get a reputation, then the thing must be near home. The people did not like being transferred (as had happened with such cases previously) to another part of the country, where they would fall into the hands of doctors and nurses of other tribes, who might do God knows what to them. Moreoever, if you died in such remote places, your family had to pay a lot of money to get your body back for decent burial in the land of your fathers.
Another consideration in favour of my ‘doing it yourself’ was due to the national shortage of urologists. Urology is a superspecialty, and if specialists are thin on the ground in Africa, superspecialists are almost invisible: less than half-a-dozen urologists in the whole country. So if I referred a prostate patient to the urologist in Bulawayo he would be sent home with a catheter to wait as long as a year or more for operation, and though most of them seemed to survive this otherwise unavoidable expedient the inevitable infection did not do them much good.
Then Percy said, what about thyroids? Endemic goitre is common on the high plateau of Central Africa, where, as in all high country, the soil is deficient in iodine. I had now got a contract for Percy at the government hospital, and although he only operated in the worst cases, he was soon doing one a week. But I never dared follow him in this tricky operation, and when he left, the cases themselves fell off to their previous number.
The better answer here was preventive, through iodised salt; but although available, it was four times the price of plain salt.
One afternoon, at the end of a five-hour session in the operating theatre, I began to feel ill. On my way out, they called me to see a case on the wards. I had to lean on the end of the bed, I felt so faint. When I got home, I felt so tired I thought I must be getting too old for surgery - which has been proved to be as heavy on the heart as manual labour, and not so healthy.
I had supper, and was thinking of an early bed, when I was called to the hospital again: a road traffic accident. Fortunately, the patient did not need more than observation, as I had hardly been able to drag myself to the ward, and on getting home, was only able to stagger into bed. Terry became concerned.
At eleven o’ clock, they rang me for a caesar. I was only able to pick up the telephone: impossible to stand up.
It was Friday night. By a piece of administrative ineptitude, abysmal even for me, even though it was that golden age when we had four doctors on the station, I had let the other three leave for the week-end. Terry got on the line to the mine doctor, who was also alone.
He came and saw and diagnosed - at any rate, guessed - gave me a cocktail injection of all the things he had in his bag, and then the good fellow did my caesar for me into the bargain. Before dawn, Terry had to call him again for an appendix (not me). And he never even put in a bill for his fees.
Next day I felt slightly better, but towards evening, I developed awful stomach pains - no diarrhoea or vomiting - and felt feverish. Terry had started a four-hourly temperature chart, at the suggestion of my colleague, the night before. A dreadful sleepless night was succeeded by a stormy day. I found at last that Doloxene could control the pain, but I still felt feverish.
Then I had a good look at the temperature chart. I saw something that every doctor or nurse in Africa would (and all European ones should) recognise: a rising pattern like a step-ladder or staircase. This meant only one thing: I knew I had typhoid fever.
How I got it, I do not know. It was the typhoid season: there were at least a dozen cases on the wards. Maybe I hadn’t washed my hands often enough; a piece of unwashed fruit from the market. My colleague from the mine agreed and started me on chloramphenicol.
Fortunately, Stephan had only taken one night - on Saturday he was back in time for a busy week-end.
On Monday, the delayed diarrhoea started. I feared for my family, and they put me in the mine hospital for a day or two, until it went off. But I still did not feel well.
It was three weeks before I had the strength to take a turn up the hospital road, and that did for me for another two weeks. My temperature rose every evening for most of five weeks.
I was well enough to read. I studied every morning: I studied whenever I could in Africa - more than I ever did, before or since, after leaving the medical school. I had to. And in the afternoon read The Raj Quartet - all through it. When I was weary of reading, I picked up Poucher’s photos of the Lake District, and re-lived old days on the hills.
And after five weeks, as I said, I was fit for work. It is good for us doctors to sample the diseases we deal in: it shows us the patients’ point of view. And I was writing to people in England: ‘It is at times like this that one appreciates the ‘modern age’ (pace Evelyn Waugh). Fifty years ago you might have got this letter from my widow.’
Until he retired, Jock and I would share a Sunday lunchtime drink on the veranda of the Nilton, or on cold, grey winter days, in the lounge. On the latter occasions, Jock, who hated the cold, would declare: ‘This weather reminds me of Manchester.’ (Where he had been an assistant medical officer of health). ‘The most Gawd-forsaken place on earth! I’d sooner sweep the streets of Bulawayo.’
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People would approach our table. One was Mr Gonzo, a watch-mender, who had a little desk on the pavement in the main street. He looked like Karl Marx, painted black. It was fatal to offer him a drink. He would take a seat and call the waiter himself, who knew his order (at any rate, for treats). An imported Scotch would arrive. Zimbabwe produced its own whisky, which I had described to curious connoisseurs in England in Thurberish terms as ‘a rough colonial blend, but you have to admire its muscle’. It was good enough for me, at any rate, and as much as I could afford: imported being about four times as much. More than once, I instructed the waiter, ‘Mr Gonzo takes Gold Blend when he drinks with me.’
Mr Gonzo (whose name means ‘mouse’ or ‘rat’, according to taste) would look pained and exclaim: ‘But you are my doctor! Aren’t you thinking of my stomach?’
I introduced him to Jock as a ‘watch-doctor’, a description which Mr Gonzo always reinforced: ‘A watch-doctor, not a witch-doctor.’
He demonstrated his political incorrectness when I called him a bloated capitalist. ‘I am a poor man. I am telling you the truth. I would not lie to you. I would lie to my wife; but you are a man. That is another thing.’
Once, when Jock had gone to the toilet, a woman with a baby on her back, who had been modestly sipping a Coke by herself at a nearby table, slipped over to me.
‘You remember me? You save my baby.’
I expressed pleasure at this news.
‘You cut me, and save my baby.’
A caesar. She unfolded the little fellow, and presented him for my inspection. Just before Jock returned, she added:
‘You lack to fack me?’
I explained that that was not our usual fee. With a sly look at Jock, she gathered up her child and slipped back to her place.
‘What was all that about?’
Another day, a black man sat at a nearby table by himself, looking about him in a rather agitated way. Presently, he approached us.
Across the Wide Zambezi: A Doctor's Life in Africa Page 37
