The Africans

by David Lamb

  The Weekly Review has never turned a profit, primarily because the advertisers are still gun-shy and ads account for only 20 percent of the content. But at last count the weekly circulation had risen to 35,000, including 1,000 foreign subscriptions, and the magazine had won local and international recognition as a publication of unmatched editorial excellence in black Africa. By 1980 Ng’weno had increased his staff to eight and was also publishing a Sunday paper, the Nairobi Times (circulation 20,000) and a children’s magazine (Rainbow, 5,000). His modest publishing empire comprised the only African-owned and African-managed independent newspapers and magazines south of the Sahara.

  “I’ve written things that have angered the government and nothing has happened,” Ng’weno said one afternoon, his voice rising above the din of traffic and honking horns in the street below his office. “I don’t know how much further I could have gone and gotten away with it, but certainly there is a governmental tolerance toward criticism in Kenya that is absent in most African countries.”

  As Ng’weno sees it, there are three reasons why the Kenyan press has enjoyed a wide degree of freedom. First, any attempt to control the media would throw jitters into the foreign community, which controls a considerable part of the economy. Second, Kenya’s Daily Nation and Standard are part of large foreign-owned businesses with other, extensive investments in East Africa. And most important, Kenyan politicians have learned that there is no such thing as government control; there is only control by a particular faction of government. When that happens, the group that is out of favor loses access to a medium for reaching the public and is cast into the silent exile of the desposed.

  When, for example, the radical left was forced out of the Voice of Kenya, the government’s broadcasting service, in the 1960s, the first thing its members did was run to the same newspapers they had branded “imperialistic agents” to complain that no one was reporting what they said anymore: it was fine to silence the opposition when the radicals were in power, but not when they were the opposition.

  The last time we talked, Ng’weno was cautiously confident that his publishing company, known as Stellascope Limited, could survive financially and could escape government controls. Sadly, he was wrong. In 1981, with advertising dwindling and overhead costs rising, Ng’weno, the majority shareholder in Stellascope, had to turn the company over to a new nonprofit organization, the Press Trust of Kenya.

  The patron of the trust was President Daniel arap Moi, and two of the nine trustees were presidential appointees. Ng’weno remained as editor in chief of the publications with “complete autonomy in all editorial matters.” But clearly, the realities of Africa had caught up with Stellascope and the future seemed predictable enough: President Moi was not going to have the same news judgment as editor Ng’weno.

  * The 1977 study was made by the Center for Communications Studies at the Chinese University of Hong Kong. It was commissioned by the Edward R. Murrow Center of the Fletcher School of Law and Diplomacy at Tufts University in Massachusetts.

  SURVIVAL OF THE FITTEST

  People don’t live long enough in Africa to worry about cancer or the other diseases that concern us in the Western world. In Africa the big trick is to get to be five years old.

  —DR. DAVID FRENCH

  of the World Health Organization

  DR. MICHAEL WOOD hopped into the pilot’s seat of his twin-engine plane. He gave his gauges a quick check and headed down the runway of Nairobi’s Wilson Airport, his Cessna 182 climbing slowly into the choppy early-morning breezes, then banking south over the savannah. In the seat next to him, with an aerial map spread out over his khaki shorts, was Dr. Tom Rees of New York City—like Dr. Wood a noted plastic surgeon. Back in the 1950s, over a bottle of Scotch shared in a farmhouse not far from Nairobi, they had tossed around a novel idea: Would it be possible to scrape together enough money to create a flying hospital for Africans living in the bush?

  Wood picked his way up through the puffy clouds to nine thousand feet. The high-rise hotels and office buildings of Nairobi faded from sight, and soon the giraffes and zebras on the plains below were only specks. Dead ahead stood Mount Kilimanjaro, snowcapped and solitary, its slopes speckled with small fires set by the villagers to turn timber into charcoal for cooking fuel.

  “If you want to be a good doctor in Africa,” Wood was saying to his two passengers piled in the rear seats with the medical gear, “you go to your patients. If you wait for them to come to you, they simply die. As it is, we’re dealing with people who are half dead—or half alive, depending on how you look at it.”

  Mike Wood came to East Africa in 1946, a young man just out of medical school. He had intended to stay for six months, assisting a British surgeon. Instead he fell in love with Kenya, was possessed by its beauty and all that needed to be done, and never returned to England to live. “I knew I just couldn’t walk out on the challenge it offered,” he said. So Wood learned to fly, saved enough money to buy a secondhand plane, and with Dr. Rees and another plastic surgeon, Sir Archibald Mclndoe, established the East African Flying Doctors Service, a Nairobi-based organization supported by donations from throughout the world. Since 1960, the Flying Doctors have covered four million miles and treated half a million patients. They have operated by the light of lanterns alongside bush airstrips, rescued hundreds of people mauled by lions or stomped by elephants, held thousands of clinics to teach the most basic standards of sanitation, hygiene and preventative health care.

  By the time Wood swung low over Italal, a collection of mud huts and makeshift cattle corrals 140 miles southeast of Nairobi, the Masai tribesmen—nomadic people not greatly involved with the twentieth century—were lined up at the mobile health unit that had arrived by road a day earlier. Wood landed his Cessna in a nearby field and, speaking in Swahili, told the naked children, who peered at the plane as though it were some kind of strange bird, to cut brush and pack it around the wheels. More than one pilot, Wood knew, had been stranded by forgetting that hyenas love to chew rubber tires.

  The Masai had trekked up to thirty miles for this rare opportunity to see a doctor. There were young mothers with their sickly babies wrapped like corpses in red cloths, unblinking children who seemed oblivious of the flies in their eyes, and elders so ill with malaria that they collapsed at the door of the examination tent, and lithe teenage warriors with spears and long braids matted with red ochre who had killed lions as part of their initiation into manhood but who were too timid to accept a smallpox shot.

  From the back of the group a pretty, bright-eyed girl of thirteen dragged herself toward Wood. She had suffered a compound fracture of the knee in a village accident. The fracture had been treated at home and the leg was grotesquely twisted. Wood, the first doctor the girl had ever seen, asked when the accident occurred. “Seven years ago,” she said.

  Many of Wood’s operations involve plastic surgery, particularly on people clawed by wild animals and on children burned when they rolled in their sleep into the family campfire. But Wood estimates that 80 percent of the Flying Doctors’ patients would never have been sick in the first place if they had cared for themselves properly and had had access to a modern health clinic. “What good does it do to keep dispensing antibiotics if no one ever cleans the water supply?” he asks, pausing for morning tea.

  While Wood and Rees treated the long line of patients, one of their Kenyan assistants held court with the Masai women in a clearing a few yards away. There were nearly a hundred of them (for this was something of a social event), and they sat quietly in the heavy heat of summer, holding their suckling children. The paramedic was trying to explain, in the Masai language, that a combination of salt, sugar and water could cure diarrhea. He held up simple charts with drawings that illustrated each step. The women were silent and puzzled; they could not understand the charts, which to them were one-dimensional abstractions. Later, when my wife took a group picture of several women with her Polaroid, the Masai gazed in wonder at the photograph, giggl
ing and blushing. It passed from hand to hand and was always viewed upside down.

  “You look at all the work there is to be done,” Wood says, “and you know that we are running to catch up. Health standards in Africa today are at about the same stage they were in Europe and the United States during the pre-Industrial Revolution a hundred and fifty years ago. It’s already too late to help the present generation. The question now is, What can we do to help the next?”

  There is nothing more responsible for shaping the character of Africa than health, or more appropriately, the lack of good health. It is the major obstacle retarding Africa’s growth and development, the impartial equalizer that enforces the Africans’ casual, fatalistic approach toward life. “Shauri ya Mungu,” they say—“It’s God’s will.” Whatever will be will be. Life is unchanging, its burdens eternal. The cycles of good and bad are controlled by higher powers, and when death or disease comes unexpectedly in the night, there is always a simple, unemotional explanation: Shauri ya Mungu.

  Mothers give birth to fifteen or sixteen children in the hope that perhaps half of them will live. “I will lose some but I can always have more,” a teen-age mother told me. Parents cannot believe that a drop of liquid (Sabin polio vaccine) on a sugar cube can control the evil spirits that cripple their children or that clean drinking water has anything to do with healthy bodies. So their children fall sick, and the reason, they say, is that the child’s father or grandfather stole a cow or his uncle wished misfortune on a neighbor. Perhaps the village witch doctor can exorcise the curse, perhaps not. It is, after all, God’s will.

  (In traumatic times this casual attitude can change. When a cholera epidemic struck Chad in 1971 and many villages lost 50 percent of their people, the peasants quickly learned to boil their water on the instructions of Western health experts. Once the threat passed, the villagers lapsed back to their old ways.)

  Daniel Mwangi, a Kenyan I met one day while researching a story on the physically handicapped, knows the results of Africa’s fatalism only too well. His problem started when he was six or seven years old—itchy eyelids, blurred vision, headaches. His father thought the boy had been cursed and took him to his friend, a witch doctor. But the practitioner’s herbs and chants did not help, and by the time Daniel was thirteen he was totally blind, the victim of trachoma, a virus disease that could easily have been cured with proper medical attention. Daniel’s father went to his grave believing that his son was paying for some evil in the family’s past.

  Daniel was thirty-seven when I met him. He had been educated by a European missionary, he had a job as a telephone operator and he read his Braille Bible daily. No, he said, he was not bitter. “What could I be bitter about? My father was an old man who believed in traditional things. Modern medicine and Western doctors were things he could not comprehend. I am blind because of ignorance, but I do not blame anyone. In many ways I am lucky. I have a job, a place to live and I have my Bible.”

  Indeed, he was one of the lucky ones. But for most of Africa’s physically handicapped—in Kenya alone one out of every ten persons is handicapped—there is no future, no work, no education and no special governmental concern. They are the forgotten people of the Third World, a huge minority doomed to live as misfits.

  The streets of every African city and village are filled with an appalling number of deformed bodies; crippled beggars dragging themselves across intersections; leprosy victims whose limbs are stumps; even well-dressed businessmen and college students with braces and withered arms or legs.

  Traditionally the blind, the deaf, the disabled and the insane have been cared for in the rural African society. There was no need for special schools or medical facilities because the extended-family concept embraced all members of a clan. No African was ever alone as long as he had a clan or a tribe to go back to. Only the truly infirm were ever cast out, left behind for the hyenas when the pastoral people moved on in search of better grazing land.

  But as Africa became increasingly urbanized, old values changed. The handicapped poured into the cities to lose themselves in anonymity, to collect survival money on street corners, to seek medical attention. For most of them there is little hope of ever getting a wheelchair or a brace, much less a job other than making baskets or carving little statues of elephants and lions to be sold to tourists. They simply are not yet a priority for Africa’s financially pressed governments, which are understandably more concerned with the able-bodied who can contribute to society.

  The colossal cost of Africa’s health problems in terms of blighted lives seems so needless in this day and age, yet the infant mortality rate in black Africa, 137 deaths per 1,000 live births, is eleven times higher than in the United States. Europe has one physician for every 580 persons. Kenya, one of Africa’s most developed countries, has one for every 25,600 persons; Upper Volta, one of the least developed, has one for every 92,000.

  In several West African countries, children are not even named until they reach the age of two, the assumption being that they probably won’t live that long. Lockjaw, polio, sleeping sickness and other ailments all but forgotten or never present in the developed world still kill hundreds of thousands of African children. Diarrheal diseases alone take the lives of 17 million children under the age of five every year in Africa and Southeast Asia—tantamount to wiping out the entire population of Tanzania year after year, generation after generation. Measles has a mortality rate of 30 percent among African children, and in the rural areas of some countries such as Rwanda, the life expectancy at birth is less than thirty-five years. The task of combating these health problems is so immense that Africa literally does not know where to begin: as recently as 1975, it was spending only $1 per person annually on medical care.

  Despite the ignorance and the suffering he has endured, the African is astonishingly tough. You will seldom hear an African child cry or an adult complain. The African’s patience and stoicism know no limits. Women give birth in the morning and are back working in the fields in the afternoon. Men undergo major surgery and within a day are on their feet again. The postoperative infection rate for the Flying Doctors is only 4 percent, compared to 15 percent in most Western urban hospitals. One possible explanation is that the sun has therapeutic values which are not yet fully understood; a more likely one is simply that the African is a survivor. He is part of a natural selection process, and only the toughest get by childhood.

  The African’s diet, however, is so inadequate that little resistance can be built up against the continent’s killer diseases. Health experts say that more than half of Africa’s children are malnourished, and Nairobi’s Department of Crop Science estimates that the average East African diet provides only 44 percent of the recommended daily supply of calories, and 18 percent of the protein. Although a well-to-do city dweller may eat an American-style dinner of meat, potatoes and vegetables, the diet of most Africans is dictated by his traditions and what the land will yield.

  Some tribes on the shores of Kenya’s Lake Victoria survive almost exclusively on sun-dried or smoked fish; others nearby never touch fish, get almost no protein in their diet and do not understand why their children die in infancy of malnutrition or disease. The Kikuyu and Kamba near Nairobi eat a maize porridge every day, 365 days a year. The Masai, who measure their wealth in cattle, live mainly on milk mixed with herbs and on blood extracted from their cows by pricking a vein with an arrow point. In Uganda, bush rats are a delicacy; in Zaire, monkeys are a nutritious treat. People all over the world use a Ghanaian word—kwashiorkor—to describe the weakened conditions that result from these imbalanced diets. And without the protein that a child needs for growth and strength, the body has no defense against the parasites or viruses that can kill as stealthily as an assassin.

  One of the first Europeans to study tropical diseases in Africa was the explorer and medical missionary David Livingstone, who used to give malingerers among his native porters a powerful laxative pill called a “Livingstone Rouser.” In th
ose mid-nineteenth-century days, the west coast of Africa was known as “the white man’s grave.” Of 225 Methodist missionaries sent to British West Africa between 1835 and 1907, 62 died of diseases. Half the hundred-odd Baptist missionaries sent to the Belgian Congo from 1878 to 1888 succumbed. The white man, of course, was only learning what the black man had always accepted: Africa was a death trap. Even today, after great advances in tropical medicine, the African remains cursed by terrible diseases that are beyond the comprehension of most Westerners.

  There is one mysterious viral infection called green monkey disease. Victims develop a high fever and start bleeding from the mouth and rectum; death usually follows within a week. Another disease is known as snail fever (schistosomiasis): the larvae of a parasitic worm penetrate the skin of people wading in streams and grow into inch-long worms within the blood vessels; the liver and spleen become enlarged, blood and eggs are discharged into the digestive or urinary tract, and the resultant internal bleeding leads to death. And there are the tsetse flies that carry sleeping sickness, infecting wild and domestic animals as well as humans. (One epidemic that raged through Uganda from 1900 to 1922 killed 330,000 persons.) The symptoms are fever, weakness, tremors and lethargy, and if the disease is untreated, coma and death follow. There is no preventative and no vaccine for sleeping sickness, and curative drugs are toxic.

  In recent years the clearing and draining and spraying with pesticides of areas inhabited by tsetse flies has checked the spread of sleeping sickness, but in Uganda alone, a hundred new cases are still reported every day. There is a district hospital in Iganga, one of the most heavily infected areas, where comatose children lay on filthy mattresses while the district medical officer, Ezra Gashihiri, looked on helplessly. He had no chemicals for doing lab tests, no blood for the blood bank, no intravenous equipment or fluids to nourish the wasted bodies, no one to process the spinal-fluid taps that are essential to determine whether the disease has spread to the brain. Emergency supplies had been shipped into the region by international relief agencies, but Ugandan bandits hijacked them for sale on the black market before they reached the hospital.