Across the Wide Zambezi: A Doctor's Life in Africa (3 page)

The scope of the country doctor in Africa
embraces everything from major surgery to public health. Today it was 'public
health'.

Once a month we inspected one of the
company villages where the workers lived. Our little group consisted of myself;
Sam, the chief engineer; Amos, the personnel manager; and Mr Cudjo, the
sanitary inspector. Sam and I were from the north of England. Amos and Cudjo
were Ghanaians.

The village on this day's agenda was in
a bad state. It had been flooded when the river rose thirty feet at the
beginning of the rainy season in May. Many people had been evacuated. Fourteen
of his relatives were crowded into the tiny house of James, my cook. An
African's obligations to his extended family are irresistible; and the family
usually extends very far. James had a shrewd suspicion that his relatives were
spinning things out, no doubt reluctant to get back to the business of cleaning
up their houses. A few days before, he had asked me in a pathetic tone,
'Please, sah, do you happen to know if that village is still flooded?'

We came upon a party of 'spray boys',
spraying under the eaves of the houses against mosquitoes. For some obscure
reason, the spray boys came under the matron, Jenny, the stout and
stout-hearted Scotswoman, who was manfully (if that is the word nowadays)
struggling under her self-imposed burden of stopping Africa from back-sliding.
She used to publish 'spraying programmes' every quarter, entitled 'The Spring
Spraying Programme', 'The Winter Spraying Programme', etc, perhaps in nostalgic
memory of her native heath, regardless of a country which knew only two seasons
- wet and dry, or rather, wet and very wet.

Africa is littered with the wrecks of
white idealism. One of my predecessors viewed with disfavour the extensive
ditches of the town, and declared, quite correctly, that in the rainy season
they must breed mosquitoes. He proposed to the general manager the installation
of powerful (and expensive) pumping machinery to keep the water in the ditches
in perpetual motion. He should have read a little further in his Manson's
Tropical Diseases, where he would have discovered that, while moving water
discouraged mosquitoes, it was highly favoured by the black fly, and if he had
succeeded in reducing malaria (which is very doubtful), he might have replaced
it with river blindness. Not unreasonably, the GM was not impressed with this
scheme, but it did not end there. The doctor was a mad Irishman: the GM was a
fiery Welshman. In the midst of the vast indifferent wilderness, the two pigmy
figures became locked in claustrophobic conflict. The GM wanted to sack the MO:
the MO tried to certify the GM. I think it ended in an unsatisfactory draw.

After a word with the spray boys, we
came upon the 'latrine boys' at work. Some other idealist, an engineer this
time, had installed septic tank latrines for the groups of workers' houses. The
septic tank, of course, is a delicate instrument, and they did not last long in
these circumstances. They were now blocked up, and the principal work of the
latrine boys was to unblock them.

The foreman of the latrine boys
approached us, expanded his dirty singlet, and made a little speech in the
vernacular, which was evidently intended for the new MO. Amos explained. 'He's
letting you know he is the chief latrine boy, doc. He says he is a very good
latrine boy and is glad to meet the new doctor. Say something nice to him,
doc.'

I said something suitable, and as we
walked on, Amos continued. 'The latrine boys have a hard time, doc. We have to
recruit them from the NTs (Northern Territories) because no one from the south
will do the job. The latrine boys are figures of fun. People hold their noses
when they see them, and none of the girls will marry them.'

We came to the end of the village, where
the squatters began. These people, either relatives of company people or simple
opportunists, had set up their own dwellings, made of old petrol cans, bits of
corrugated iron, and other scraps. They lay beyond the reach of even the
battered septic tanks and the exiguous water points of the regular village. I
think they did everything in and out of the bush and the river. Sam, the
engineer, stood and contemplated the scene with disgust.

In Africa, the pillars of society have
their secret nicknames (sometimes an open secret) among the people. Sam was a
tall craggy figure, and his nickname was 'Dee Goll', in which the reader may
recognise the imperious general. The sound of his thunderous voice, or the
force of his powerful personality, may have penetrated the flimsy walls of the
shanties, because a woman presently slipped out of one of them, gathered up her
naked child, and scurried back inside, with a nervous look over her shoulder at
our group.

'The only answer to this lot, doc, is an
atom bomb,' pronounced Sam.

We became aware of a small piping sound
at our feet. Looking down, we saw a very small naked child, standing on a heap
of dubious-looking material. He was looking boldly up at Sam, and chanting:
'Bruni!
Bruni! Bruni!',
which means, 'white man'.

Sam gazed down from his great height at
this phenomenon, with a look of distant curiosity. The phenomenon lost steam,
and the piping dried up. It lowered its head, and contemplated its bare toes,
which it wriggled in the dubious-looking material. After a minute's silence,
Sam retorted:
'Bibini!'
(black man). The phenomenon looked up, with a
grin of relief.

At some point, Mr Cudjo drew me aside,
and confided to me that, in addition to the difficulties Amos had indicated to
the recruitment of latrine boys (or 'sanitary workers', as I think he called
them), was the fact that they were paid less than the 'national average'. I
have wondered since what was Mr Cudjo's interest in the matter. I expect he was
some kind of union official.

At any rate, when at the end of our
first round of visits, I came to compile my monumental public health report on
the state of the company's villages, I inserted an observation, based on this
information of Mr Cudjo's, that recruitment might be prejudiced by the fact, as
I understood it, that the sanitary workers were paid less than the 'national
average'.

A few days after copies of the report
were in the hands of senior management, I received a telephone call from Amos
in my office.

'Doc,' he said. 'I've got your report on
the company's villages on my desk. Look, doc, would you please tell me where
you got your information that our sanitary workers were paid less than the
"national average"?'

I hummed and hawed.

'Look, doc! You might as well tell me.
I've got my spies. I can find out for myself soon enough.'

'Actually, it was Cudjo.'

'Yes, I thought the "national
average" sounded like one of Cudjo's educated expressions. While he was
about it, did he tell you that our sanitary workers only work half days?'

'No.'

'So you might say, in fact, that they
were being paid more than the national average.'

'Yes.'

'Look, doc,' he went on. 'I've got a
deputation of sanitary workers outside my office now, with a banner. It reads:
"DOCKETA SAY MORE PAY FOR LATRINE BOYS".'

'But Amos!' I protested. 'That document
was marked "Confidential"!'

'Doc, you should know that nothing in
Samreboi is confidential for long. Don’t worry. I will deal with it.'

Which was my first introduction to the
politics of public health.

Jenny has been sufficiently introduced as
a representative of a nation which has contributed a disproportionate number of
vertebrae to the backbone of empire.

Unfortunately, she was having a tough
time of it.

One afternoon, in a quiet moment, I was
improving the vacant hour in my usual way, catching up on the vast field of
knowledge required for my unique job. In short I was buried in Manson's
Tropical Diseases.

Along the concrete gangway, came the
sound of 'footprints' (in the old school joke): the sharp tack-tack, in which I
recognised the purposeful steps of Jenny. The door rattled open, and she
propelled into my presence four 'African male adults', as the police reports
described them. Three were poorly dressed, bare-foot, and looked guilty. The
fourth, I recognised as Mills, the 'lab boy', who seemed to be some kind of
witness. He was decently dressed, shod, and bespectacled, and did not share the
guilty look of the others. Indeed, his face bore a look of sanctity which would
have done justice to the 'black saint', the Blessed Martin de Porres.

'Doctor Durrant!' thundered Jenny, inserting
twice the usual number of 'r's' into my designation. 'These are three spray
boys, who were detected in dereliction of duty. Dr Durrant, you must understand
that, when not required for spraying, they are supposed to be engaged in other
useful employment, such as cutting grass to discourage snakes and mosquitoes.
At three o'clock this afternoon, which was well past their statutory lunch
time, they were found in a local tavern - CONSUMING ALCOHOLIC BEVERAGES!'

I was not sure what was expected of me,
either in the matter of judgement or penalty. For my first few months in Africa
I felt like a man in a darkened room with other beings whose nature and customs
were invisible to him. I wondered how the old district officers and magistrates
had managed to deal with these creatures of another planet. In time the darkness
would thin and I would find my way about - at least to a sufficiently practical
extent. But I would never have the social advantages of an African doctor; and
I was even to learn later that a town-bred African would never attain the
knowledge of his poorer colleague, brought up in the rural areas.

It turned out that this demonstration
was for my information only. Such cases were handed over for disposal to the
'secular power': the secular power being Amos, the personnel manager.

The prisoners were removed, and I
settled down with Manson again.

But not for long. Again footsteps. This
time, besides Jenny's tack-tack, I detected softer tones. The door rattled open
again, and Mr Mills was propelled into the room, minus every trace of his
former sanctity. Besides Jenny, he was followed by the elegant form of Miss
Lemaire, the deputy matron.

'Doctor Durrant!' thundered Jenny, with
even more 'r's' than before. 'I was misinformed. The spray boys were discovered
by Miss Lemaire. Mr Mills didnae even know they were missing!'

This seemed to imply a considerable fall
in the fortunes of Mr Mills, the extent of whose duties, apart from the
blameless contemplation of what are known as 'ova, cysts and parasites' under
his microscope, I was not sure of. At any rate, he was quickly marched off in
his turn for the disposal of the secular power.

Mr Mills escaped execution, at all
events, as a few afternoons later, when I was into a further chapter of Manson,
he entered my office, after first sweeping the landscape with his head-lamp
glasses, evidently for any signs of Jenny. He drew after him a plump young
female, clutching her arm, like a prize heifer.

'I hear you want learning Twi,' he
began, referring to the local language. 'I dash you my cousin, Comfort. She
very good Twi teacher.'

I recognised the famous 'sleeping
dictionary'. The 'dash' is an even older West African institution: a special
gift or bribe.

'Comfort' is a popular local girl's
name. Others are 'Blessing' and 'Promise', and it must be said, the owners try
to live up to them.

I was sorry to disappoint them, but
explained that I was already receiving Twi lessons from a local schoolmaster.

One day, Amos rang me up to say that a
European manager had complained that he had seen Sackey sitting in the doctor's
chair, seeing patients, and seemed to think the world was coming to an end.

Now Sackey was a medical assistant,
which, I have already said, is a sort of mini-doctor. Sackey regularly took
over from me while I was doing my ward round, in theatre, or having my meals,
etc. In most African systems, the MAs see all the patients first, screening out
the more serious cases for the attention of the doctor. I was surprised Amos
did not know this.

I asked him the name of the complainant,
but Amos would not tell me.

Well, I could work things out, just as
Amos could, even if my system was no doubt not as highly developed as his. On
the day in question, there had only been one European patient. The managers sat
in their own waiting room, where he would have seen Sackey in the doctor's
room. His name was Bill Cartwright. He had malaria, and I put him off sick.

The managers enjoyed home visits, which
were performed by Jenny, as well as myself. At my request, she attended on Bill
next day.

I asked her how she got on, and took the
opportunity to tell her of Bill's offence.

Jenny's face fell. 'My word! I've put my
foot in it!'

Jenny had entered the sick-room and
placed a thermometer in Bill's mouth, as Bill's wife stood by. While Bill sat
up in bed in his best pyjamas, cooking the thermometer, a self-conscious
silence descended, which affected everyone in the room except Jenny, who stood
with arms folded, regarding Bill with a clinical eye. Seeking to fill the gap,
Joan Cartwright opened a social conversation with the words:

'And how are things at the hospital,
matron?'

She got more than she bargained for.

Jenny had heard of the complaint, but
did not know the identity of the complainant.

'Things at the hospital,' she thundered
'would be a braw sight better if some of the folks in Samreboi would learn tae
mind their ain business!'

She recounted the story of the mystery
European manager.

'Ah doan't know who he is, but ah shall,
and when ah do, ah'll tear him apart!'

One of the main planks in Jenny's
campaign of reform was the eradication of public spitting. The African
peasantry shared with British footballers an immovable belief in the poisonous
properties of their oral secretions, which must be removed at regular
intervals, regardless of locality. Although Jenny put up notices and made the
most terrifying examples, the offenders never seemed to connect these
activities of the strange white woman with the matter in question.

One morning, Jenny stood outside her
office, contemplating her domain, her thoughts upon the same. Her eye fell abstractedly
on a small black girl in a body cloth, sitting with her back to her on the edge
of the gangway. The almost physical pressure of this powerful gaze seemed to
affect the girl, who turned her head and rolled the whites of her eyes at
Jenny. As one blinded by the sun, she looked ahead again, but now froze like a
small animal under observation. After a minute, she turned her head again, but
the sun was still glaring. Once again she looked ahead, but this time, feeling
that something was expected of her, filled her mouth with spit. When it was
good and ripe, she hoicked it on to the ground a yard in front of her.

Until that moment, the girl had lain
unregistered on Jenny's retina. Now she became only too visible. Jenny rose a
foot in the air with a loud bang, or rather series of bangs, representing the
names of Miss Lemaire, Mr Sackey, and sundry other persons, including even the
disgraced Mr Mills (perhaps to examine the sputum under his microscope).

A European manager, who had been
standing by observing this little comedy, now pulled his pipe out of his mouth
and began laughing: 'Ha! Ha! Ha!', until Jenny rounded on him, and he managed
to save his life by timeously converting it to 'Ah-tishoo!'