Across the Wide Zambezi: A Doctor's Life in Africa (27 page)

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.

At Umvuma I first met Gareth, who has
remained my good friend to this day. He was a Welshman, who farmed a thousand
acres (a small-holding in Rhodesia), twenty miles out of town. He supplied
vegetables to the hospital and would arrive once a week in his pick-up: a
short, sturdy, dark man with a florid face and heavy moustache, rather like an
Italian peasant. In his youth he had been compared to Anton Walbrook, and in
later life to Joseph Stalin. I thought he looked like Cecil Rhodes. He finally
expanded to Sir John Falstaff.

He had gone to earth in more ways than
one in Rhodesia, having left his second wife spitting venom at him in a
Canadian divorce court. His opinions on the unfair sex were a legend. Over the
years he had polished a number of sardonic aphorisms on the subject, which I
called the Maxims of the Duc de Baker, and even tried my hand at rendering some
of them into French, in which language they seemed to find a natural home. 'If
God ever made anything dirty, it was a woman,' was one; and another, more
subtle: 'The only thing a woman cannot forgive a man is the thought that he can
live without her.'
'Si le bon Dieu a jamais fait une chose sale, c'était une
femme,'
and:
'La seule chose qu'une femme ne peut pardonner un homme
c'est la pensée qu'il peut vivre sans elle,'
were the best I could do for
the French edition. But he refused to be described as a woman-hater, and
indeed, retained his eye for a pretty face. He simply said, he wanted nothing
more to do with them.

Gareth had been in Bomber Command during
the war, and had survived sixty missions over Germany (nearly half with the
Pathfinders): the average survived being fifteen out of thirty. After his first
tour of thirty, Gareth was awarded the DFM and commissioned by a grateful
sovereign. He volunteered for a second tour, in what he described as the
madness of youth, and was duly awarded the DFC, having shown both classes of
courage. After that little lot, he put his name down for the Dam Busters, but
was wisely turned down by the medical officer, who evidently thought that
Gareth had done enough, and duly reported to his CO.

He seems to have been an enlightened
doctor for his time. Lord Moran's theory about the quantitative nature of
courage - it is like capital: it can be depleted and must be replenished - was
unknown then. It would probably have mystified Gareth's CO as much as it did
Winston Churchill when he refused to write a preface to Moran's book. Gareth's
CO obviously did not know how to break the dreadful news to Gareth: the
terrible letters, L-M-F (lack of moral fibre), no doubt hovering in his mind.
His attitude therefore puzzled Gareth. He accused him of 'trying to hog all the
glory to himself' and 'not letting the other fellows have a go', and more in
the same strain, as if they were talking about children's motorboats. It was
not till years after, with a little help from me, that Gareth was able to
understand what was going on.

Gareth came fishing with us but never
caught anything. We used to say his pessimism communicated itself down the line
to the fish and put them off. He played golf at the club and was a regular
Friday-nighter at the Falcon, but not a member of the Diners' Club, having, no
doubt, a more accurate idea of his age than I did of mine.

Gareth had a most mellifluous voice -
officerly, with a touch of Welsh - but assured me he could not sing.

Besides his accomplished
fourteen-year-old daughter, Ted, the stationmaster, had a younger son, David;
and one day Ted and I and Gareth took David and one of his little school
friends for a week-end's fishing at the Zimbabwe Ruins Hotel.

The boys came half-price, which, I
suppose, was meant to accommodate family custom. What it did for the hotel's
profits is another question, as the boys ate twice as much as we did.

In the late afternoon, after our
arrival, we strolled beside the Kyle dam, our fishing venue of the morrow. The
two boys accosted Gareth. 'Can you take us fishing at four o' clock tomorrow
morning, Uncle Gareth?' We did not know that they had already failed with Ted.

In the warm glow of the end of a
tranquil day, with the comfortable prospect of his sundowner and supper before
him, Gareth said, 'Yes, my boys,' and probably meant it at the time.