Across the Wide Zambezi: A Doctor's Life in Africa (49 page)

     Beside this, about every quarter we
got catalogues from the same large-minded source - six copies of each;
addressed to the ‘Head of Surgery, Zvishavane Hospital’, ‘Head of Paediatric’,
etc, innocently unaware that these titles belonged to the same person. I did
pass the ‘Head of Pathology’s’ copy to the lab assistant, telling him not to
get any big ideas. And the ‘Head of Anesthesiology’s’ copy raised a few laughs
in the theatre, where we saw an anaesthetic machine illustrated, that delivered
half-a-dozen gases we had never heard of and none that we had, monitored all
vital signs and measured blood gases; and, I told them, played
Ishe
Komberera Afrika
at the end of the operation.

Then one night, a bus went over a bridge
and into a river: a burst tyre, an accident becoming commoner as the country
got poorer and imports fell. Not much water in the river, but a big enough fall
to kill ten on the spot and produce fifty casualties, twenty of them serious.
Most of these were compound fractures: the sort of thing we could have dealt
with in twos or threes; but twenty would have taken us a week, without going to
bed - quite impossible. It was a good exercise in triage.

     I called out all doctors and staff.
We moved patients from the beds in the first bays, and went to work on the
serious cases as they came in, with drips, dressings, antibiotics, and
morphine. We secured an open lorry from the district administrator, and loaded
most of the bad cases into the back, with blankets, as it was a cold night. We
put some more in the ambulance, and sent all to Bulawayo, after warning them to
stand by. The ambulance turned back, after one old man, who had lost the top of
his head, died on the way, and whose body would have had to be expensively
recovered by his relatives; before setting out again. That left five
dislocations of hips and shoulders, we doctors dealt with between us, and many
more cuts and bruises, the nurses dealt with. All done between 10pm and three
the next morning. Not bad for a small hospital!

More other cases return to mind than the
unrecorded cases of Sherlock Holmes - ‘for which the world is not yet
prepared’.

     A man bitten on the hand by a puff
adder. His arm crackled with gas gangrene to the shoulder. A surgeon had told
me you could deal with these cases by debriding and packing, like gunshot
wounds. I laid open the black flesh to its full extent and did my best, but the
man died within two hours of the operation. I should have taken the arm off at
the shoulder right away, but he was probably too far gone with toxaemia anyway.

     A little boy with a fractured elbow
- the commonest fracture we saw in little boys. But this had a tiny break in
the skin - technically compound. Another surgeon told me you could safely suture
such tiny cuts. Two days later, this arm was also crackling. This time, I took
it off at the shoulder, without hesitation. Nor did I close the wound, but
packed it open. After three days on penicillin, I inspected it. The black flesh
was spreading. I debrided further (reluctantly removing the head of the
humerus, which is usually left to preserve the contour of the shoulder), and
re-packed. In another three days, the wound was clean. I closed it and the lad
lived. Never again did I fail to do a full operation on a fracture with the
smallest break in the skin.

     A little boy with an abscess of the
scalp. When I opened it, a litre of pus came out. I put my hand into the
child’s head, and felt - nothing! In alarm, I placed a drain, and sent the lad
to Bulawayo. He returned in a few days, after no further surgical intervention,
his brain re-expanded and the wound healing. Epidural abscess, caused by
osteomyelitis of the skull, caused by head injury. He recovered on antibiotics.

     A young woman with pelvic sepsis
and peritonitis. We had more and more of these, which I treated by removing the
tubal abscesses and washing out. It dawned on me that this was the onset of the
Aids epidemic. But when I opened this abdomen, the pelvis was solid - ‘frozen
pelvis’, the sort of thing caused in Europe by cancer (in my student days, at
that). I suspected Tb, made a biopsy, closed the abdomen, and started Tb
treatment. The biopsy was positive. The young woman was cured (
unless
it was Aids-related (not tested
))
but would
never bear another child.

     A young soldier from Mozambique,
with a fractured femur. I inserted a Küntscher nail: an easy operation, which
took me twenty minutes. But after three days, this one was pouring pus:
something that had never happened to me before. I suspected Aids, and the test
report came back positive. Meanwhile, I removed the nail, and the fracture
healed on traction.

     (Like all surgeons, I got dozens of
needle-sticks, many surely from Aids patients. I just carried on: I didn’t even
think of squeezing my finger. A surgical needle is less dangerous than a hollow
needle. When I got back to UK, I tested negative.)

     A young man was brought in,
unconscious. I tested his urine, which was loaded with sugar and ketone. I
diagnosed diabetic coma, but two things were wrong. His pupils were
constricted, and he was sweating: the opposite of diabetic coma. As I did not
understand these signs, I ordered diabetic treatment. The lad died within the
hour. Never ignore the anomalous sign. The anomalous sign is the significant
sign: one ignores it at one’s peril - and the patient’s.

     Soon after, came a carbon copy of
this case. I was about to repeat my folly. Fortunately for the patient, I was
due to depart for the annual bush doctors’ refresher course at Bulawayo. (This
was while Jock was still at Belingwe.) I was reluctant to leave the patient
with the nurses, so ordered him to Bulawayo, where the correct diagnosis was
made, and the case successfully treated. Organophosphorus poisoning from
insecticides.

     I had more cases which I
successfully managed myself. But no one had then reported the ketone in the
urine (
I later heard that these cases had lain semi-conscious in huts
for some days and had evidently developed acidosis
)
. I wrote a letter to the
Central African Journal of Medicine,
and
got an inquiry from as far away as East Germany about it. In the ensuing
correspondence, someone added a ‘Van der Merwe’ touch
(as the racialist
black humour of South Africa is known) by suggesting that farmers use posts,
instead of Africans, when marking out crops for aerial spraying.

     A young girl, with all the signs of
perforated typhoid ulcer. By now, I was having good results with these cases. I
opened up her abdomen, and found the bowels all stuck together - plastic
peritonitis. I explored and got a gallon of pus from the left side. Next thing,
I found my exploring hand high up in her chest - empyema. Same thing on the
other side. Good wash-outs throughout and bilateral chest drains secured a
cure.

     An ectopic pregnancy. The old books
used to say, never forget to look at the other tube. I always looked, and this
time, found a bilateral case, and had to resect both tubes. No more children,
but a life saved, which could have been carelessly lost.

     Not only black
Africans are
tough (if that is the word in this case). A white corporal dislocated his
elbow, carried on - God knows how - to the end of his tour of duty in the bush,
and came in after three weeks. After an enormous struggle, we reduced it, but
the poor fellow would have trouble for life.

     A black man, blown up by a land
mine. His arm was jellified, and his urine loaded with protein. I took the arm
off at the shoulder, but he died, probably of shock. Should have sent him to
Bulawayo, but he may have died on the way.

     Then, at last, a case of locked
twins: the thing I had expected at my first caesar. But a case with a
difference. I did a vaginal examination, and could not believe my hand. I found
the legs of a breech with a head between them. How had the baby done this
circus trick? I did a caesar and got two live babies, the head of the second
between the legs of the first, or vice versa: take your pick!

     A girl with two upper front teeth
knocked out by her boy friend. I cleaned them with saline and replaced them.
She looked like Dracula. Wrong way round! I changed them, and after a week, she
was her pretty self again. And achieved, in my ignorance, without splinting!

     A young white cop, who drank a
bottle of ouzo, straight off, in the police club, for a bet, and immediately
collapsed. This was before independence, and he was admitted to the white ward,
where the sister passed a stomach tube, and the place stank of aniseed. We
dripped him, and when he came round, wondering where he was, he was greeted
with the same riotous laugh such cases always received on white or black wards.

     The old man with fifty per cent
burns. He was a proud old Matabele, and when he forgot his manners he would
complain, ‘I’ve lived so long among the Shona dogs
(Maswina)
I’ve become
a Shona dog myself’ - to the huge delight of the (mostly Shona) nurses. As a
lad he had met the great ‘Rodzi’. ‘And did you once see Shelley plain?’ asked
the nurses, or rather, ‘What did you say to Rodzi, sekuru?’ ‘I said, “Good
morning!”’ ‘And what did he say to you?’ ‘He said nothing.’ Shame on Rhodes!
Perhaps he was lost in his great thoughts, or already dying. It doesn’t sound
quite like him. Not many people can save a fifty per cent burn, and we did not
save the old man.

     Few of these cases would be seen in
Europe, or, at any rate, in those circumstances.

And at week-ends, I would get out into
the bundu - to begin with, leaving the family behind, as the children were not
yet up to fishing, and ended up boiling in the car with their tormented mother.
This situation would improve as they got older and we could all get out
together, usually with Granddad, when he came to live in the old folks’
cottages in Gweru; the children busily working with toy fishing tackle at
imaginary fish (not much more imaginary than my own, most times).

     So, in the early (post-bachelor)
days of our marriage, it was more usually with companions such as Koos; and, no
doubt, I was a selfish pig, as many ‘post-bachelors’ are.

For in my bachelor days, even during the
war, I had gone fishing with Koos, he with his FN propped against a rock, and
me with my cowboy set. Koos said (echoing D H Lawrence) that life was better on
the
qui vive,
or the
pas op,
as Koos would have said. But one
day, we were so little on the
qui vive,
engrossed in a conversation
about Mahler, that we left our artillery draped over the chairs of the
Portuguese cafe, frequented by Africans, some of them ‘freedom fighters’, no
doubt, or in touch with them; before we remembered in the street and rushed
back for it while it was still there.

     One afternoon, Koos and I were
fishing at a dam, when we heard screams from the
kopje
behind. Almost
immediately, I guessed what they meant. We dropped our rods and scrambled up
the steep stony hill, among the thorn trees, the sun baking the earth and our
sweating, panting bodies. We wandered here, we wandered there, and still the
rhythmic screams continued -
scream! scream! scream!
After a full ten
minutes, they died down and we came upon the scene of the drama - a sight men
have spent a lifetime in the bush and never seen - a python killing a buck. It
had a baby duiker in its coils. The mother stood by, poised on her little toes.

     When we appeared, the mother darted
away, the python uncoiled itself and slid into the trees, all twelve feet of
it, to return later to its meal. For by then, the little body was dead.

Then came some unpleasant business with
the sisters. I have already explained how they were the ‘officers’ of the
nursing service. The older ones had worked harmoniously with both doctors and
nurses along the traditional lines of African district practice, but after
independence, a new breed began to appear, who seemed to have derived ideas
from the West End of London. They started to object to assuming certain duties,
notably declaring persons dead on the wards and especially ‘dead on arrival’,
something the older staff had done on the principle already described - the
senior person on duty. These bright new things started calling doctors to do
it, night and day, as if they were working in Guy’s Hospital, or somewhere.

     (The famous case of a lady
‘resurrecting’ in Gweru mortuary, the first of its kind in the country’s
history, did not help matters, needless to say.)

     Of course, there was nothing more
exasperating to a doctor who had been slogging in the hospital or banging round
the landscape in a Land Rover all day, and got up to do a caesar at two in the
morning, than to be dragged out of bed at 4am to declare someone dead before
removal to the mortuary.

     I put my foot down and issued a
memorandum to the effect that this nonsense had to stop; that all should
remember they were working in a district hospital and to observe the principle
of delegation, without which our work would be impossible. And I sent a copy to
the PMO.

     The sisters retaliated by sending a
copy of this directive up their ladder to their leaders, with a covering letter
of protest. Some battle took place amongst the gods, which was never resolved,
as far as I know, though occasional rumbles and flashes came down to us,
notably a remark from some high lady about ‘standards in Western countries’,
which I had already suspected had inspired the new attitudes.