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

ACROSS
THE WIDE ZAMBEZI

A
DOCTOR'S LIFE IN AFRICA

BY 

WARREN DURRANT

Copyright  @
Warren Durrant

Warren Durrant
has asserted his right under the Copyright, Designs
and Patents Act 1988 to be identified as the author of this work.

KINDLE edition

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First published in Great
Britain in 2013.

PublishNation, London.

www.publishnation.co.uk

For my wife

The personnel manager swept his hand over
the beetling crag of West Africa on the wall, where a green swath ran across
the lower part of the map, and announced: 'This is the rain forest.' He pointed
to a spot on the line of a river, a name, and added, 'And this is Samreboi.'

I was forty, unmarried, and, after ten
years in general practice, was looking for a change. I had long had an interest
in Africa, so when I saw the advertisement in the British Medical Journal for a
medical officer for a timber company in Ghana, I applied. I later discovered
that I was the only applicant. So much for the spirit of adventure in the old
country The year was 1968. (
This is unfair. I doubt I would have left
the country while my parents were still alive (they died before I was forty);
and certainly not if I were married with young children).

Here I was in the London office of the
great United Africa Company, which many called the real government of West
Africa.

Besides the personnel manager, the chief
medical officer was present. He enlarged on the duties briefly indicated in the
BMJ.

I would be sole medical officer to the
company employees and families, and to the rest of the population of the town
and a considerable area of the surrounding countryside. I would have a small
hospital, where I would undertake some surgery: caesarean sections and hernias
were mentioned.

My sole surgical experience then,
consisted of the minor procedures of hospital casualty and general practice, and
a handful of appendix operations, performed under supervision as a houseman.
This experience, though limited, had given me that most important surgical
initiation, the 'feel of the knife' - a breaking of the ice (to mix the
metaphors), which confers that all-important first strengthening of the nerve.

Nevertheless I asked the doctor if I
should try and get some more surgical ex-perience before I left. He said it
would probably put me off. In fact, no training appropriate to African practice
(embracing both surgery and obstetrics for a start) was available in England.

He explained that in my Herculean task I
would have the help of medical assistants  - a breed special to developing
countries: half nurse and mini-doctor. These men and women receive two or three
years' training in diagnosis and simple treatment. Some receive further
training to take X-rays or give anaesthetics, work in laboratory or pharmacy,
etc. Some girls train as maternity assistants, and not only manage normal
deliveries, but twins and breeches also. All in all, they are the backbone of
African medical practice, and without them, the task of the thinly spread
doctors and even more thinly spread specialists would be impossible.

For I was also informed the nearest
hospital with specialists was a day's journey away: too far for emergencies,
and with too few specialists to deal with any but the most difficult cases.

I had a good idea of all this when I
applied for the job. It was because I was looking forward to this kind of
challenge that I applied in the first place.

In those days, one flew to West Africa
by daylight, in a VC 10. By midday we were over the Mediterranean, and as the
lunar mountains of the Atlas appeared, I knew I had left the bounds of Europe
for the first time in my life - the bounds of law and safety, for the perilous
world beyond - a romantic notion, both true and not so true. And then we were
over the Sahara.

The plane seemed to be flying through a
vast furnace, whose rising fires obscured the horizon and met in the smoking
zenith. Clarity prevailed only far below on the desert floor, where from time
to time mountain ridges appeared, which would have made delightful walks in the
friendly Lake District, but here were lost in the appalling emptiness of a
planet inimical to life. Dunes showed in tight ripples like the tide-ribbed
beaches of home. Even lonely roads were seen, leading to the occasional
ant-heap of an oasis, like a space station on the moon. Beyond all was the sea
of sand. After some hours of this hellish progress, the sun wheeled for a few
minutes in the starboard windows, before drowning in the brown shadow, rising
from the earth. Lights came on in the cabin. The stewardesses served drinks.
The kindly human world was restored.

Landing at Accra was like going back to
the beginnings of the world (in Conradian phrase) - the moist and muddy world
of the dinosaurs: one almost expected to see one lumbering out of the black
African night, the blackest of all nights. The first thing I noticed on
stepping out of the plane was the smell - no, not a bad smell: what I can only
describe as a 'boiled' smell, the smell of a laundry, as if the whole country
had been boiled and reboiled from the day of the Creation, which I suppose in a
way was true. A sinister smell, with a certain burnt edge to it: a disgraceful
smell, where morality was unheard of - abandoned on another planet. In the days
that followed, this smell would come and go as I went in and out of
air-conditioned buildings, themselves feeling as sinister as the cold of a
morgue, until one got used to it and no longer noticed it, and it became lost
even to memory, like the romance of first impressions.

The airport building was then little
more than a large shed, awash with a sea of black faces, as if the night had
invaded the building and threatened to overwhelm the feeble electric lights. At
the barrier, one of the black faces lighted up for me: 'Dr Durrant?' This was
Mr Aggrey, the company representative, who led me to a battered car. We both
sat in the back, which was the proper place for 'masters' like us, and the
chauffeur drove us to a large bleak hotel.

The next two days were all strange old
colonial buildings , the surf and golden sands at the beach club, a lush and
varied landscape, glimpsed from the plane on the way to Takoradi down the
coast. Then another chauffeur: Samson, to take me up country.

I sat in the front passenger seat,
rather to Samson's surprise, the better to chat to him. The tarmac road was not
very good, full of holes and puddles, through all of which Samson charged with
ruthless speed, taking no care of whom he splashed with muddy water - and more
surprisingly, they seemed not to resent it - nor of the agile children who
dodged out of his way. For there were people everywhere, people who seemed to
be made of rubber, so fluid were their movements, so utterly free of the
tensions of the white man: the women in their long skirts, their elegant
head-scarves, some carrying things on their heads, moving like water plants;
the men in shorts and shirts, mostly ragged, prancing along; the darting
children. A cloud of tobacco smoke actually preceded round a bend by half a
minute an old woman with an enormous pipe. A social world full of greetings and
talk and laughter, the talk delivered at the top of the voice, for in Africa,
although I did not know it then, it is considered antisocial to talk quietly
and therefore secretly.

We went through a mining town - Tarkwa -
all hot tin roofs, ugly industrial workings and sheds, winding gear, shabby
buildings of all colours, stores, awnings and colonnades, hoardings, a tranquil
grove of palm trees: as seedy and lively and picturesque as only an African
town can be. Then on to the open road again, which more and more gave way to
earth - and the earth was the colour of gold. For this was the Guinea coast and
the mine was a gold mine: the gold of the guinea pieces, the richest gold in
the world.

Another mining town , Prestea, and then
quite suddenly, the forest.

The rain forest was then in better
condition than I fancy it is in now. Indeed, my son's school atlas seems to
indicate that it has vanished from those parts altogether. Then it was still
magnificent. The road turned to red laterite and became the aisle of a great
cathedral. The forest giants stood two hundred feet high, with some, the
emergents, towering even higher above the canopy: for the great trunks were
naked until they met and joined together above like the surface of the ocean.
The trunks were supported by buttress roots which rose about twenty feet and looked
like the fins of a space rocket. Between, tangled the undergrowth, which it
needed a panga (or cutlass as it was called in West Africa) to get through,
except where well-worn paths had been made and kept open over the years by
people travelling to the forest villages. To me it is the most beautiful forest
in the world and still seduces my dreams.

Suddenly the road opened on a clearing.
Industrial sheds, workers' houses, a few large houses set back in spacious
gardens, where the managers lived. This was an outstation: there were two in
operation at that time. Then the forest closed around us again for another ten
miles.

And then we got there, the town of
Samreboi. A long straggling street, barely tarmacked: a mile long, lined with
the usual flimsy stores and full of people. Then larger buildings: the police
station, churches, and, in a grove of trees, the hospital.

This was a single storey affair: the
main wards and a number of other buildings all joined by concrete gangways,
covered with roofing against the rain. I got out of the car. A tall handsome
white man of about fifty emerged from an office and came towards me. This was
Des Brennan, the locum. The previous incumbent had left some months before.

He shook hands with me and said: 'Dr
Durrant, I presume.'

Well, there wasn't much else he could
have said.

He took me into his office and gave me
tea. Then he took me on a tour of the hospital.

There were a men's ward and a women's
ward. There was a wide veranda, enclosed with mosquito mesh, where the children
were put with their mothers.  On the wards we met Miss Lemaire, a very pretty
black girl, who was deputy matron. And in due course, we met Jenny, the matron
herself, a redoubtable Scotswoman of middle age.

We met Mr Sackey, the chief medical
assistant, a sort of regimental sergeant-major, with no nonsense about him. We
moved on to the maternity unit, which contained a labour ward and two lying-in
beds, where we met Emilia, the petite and dynamic midwife.

There were an operating theatre, a
laboratory, pharmacy and X-ray department: all very rudimentary and staffed
with cheerful, undaunted operatives. Lastly, there was a private ward for the
managers. The hospital had about fifty beds in all, which is not many even for
Africa. No food was provided. Patients were fed by relatives; and always at the
front gate were women ('mammies', as they were called) selling food.

Des took me back to the office for a
final briefing: he was due to leave next day. He waved his hand at an uncrowded
bookshelf. 'There's some operating manuals there if you get stuck.' I may say
he was a bluff Irishman.

He glanced at his watch. 'The bar'll be
opening now. Come along. I'll introduce you to some of the boys.'

Des must have felt I needed the bar by
then, and, by golly, he was right!

On our way to the club, we passed a
group of black children with red curly hair. I had heard that the
malnourishment disease, kwashiorkor, could produce this effect, but these
youngsters were healthy and lively. I asked Des about them, and he said it must
have been an Irish missionary or (with a glance at my dwindling locks and from
my introductory remarks) 'a doctor from Liverpool'.

Next day, in an historic tableau, we
shook hands before a large crowd of black faces, before his car disappeared in
a cloud of dust and cheering small boys.

I never felt more alone.