Across the Wide Zambezi: A Doctor's Life in Africa (24 page)

It consists of a large chart which
records the progress of labour, and is crossed by a warning line which prompts
the midwife to seek medical aid if the graph line reaches it. It contains much
more information, such as the foetal heart gradings, which were all explored
for the first time in Rhodesia, sometimes in tragic circumstances, when the
mother refused caesarean section, and the doctors sadly discovered every
milestone on the baby's road to death. This chart is now used throughout the
world.

When a mother, transferred in prolonged
labour from one of the clinics, arrived at the hospital at night, the sister on
duty had only to read out the chart to me over the telephone and I could order
a caesar if necessary and snatch an extra hour's sleep while they got ready.

Only by such rules of thumb could the
system be run so efficiently with non-specialist staff. And by broad standards,
efficient it was.

One morning I arrived at Chiota to find
a lad of sixteen on a stretcher, rocking himself up and down, moaning and
holding his head. Before I did the lumbar puncture which proved it, I guessed
he had meningitis. I filled in a head-sheet and told them to call the ambulance
from Marandellas. When I got back from my rounds in the afternoon, the lad was
on treatment, and in a few days made a full recovery.

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.