Lying there, with her belly and her womb laid open, covered in blood and meconium,
she grunted something in the vernacular.
I asked Mr Sackey what she said. He replied in these immortal words:
'She's asking for her breakfast.'
All I could say was, she would have to wait.
I got everything stitched up, and they took her back to the ward. Ten days later she galloped off into the bush, with her new baby on her back.
I remember the names of my first big cases: my first caesar, my first hernia, my first ectopic. I remember hers. It was Veronica.
I wonder what became of her. I wonder if she returned to the hospital for her next delivery. Perhaps not, after her drastic experience with her first. Perhaps she is lying in some grave in the forest, with an unborn baby inside her.
And I wonder what became of the baby I delivered. I cannot remember if it was a boy or a girl.
3 - The Mercy Flight
It was not exactly a flight. It was mostly a train journey. It began in the labour ward.
Emilia, the midwife, informed me that she 'had a baby which she did not like the look of'. I went with her to see.
The baby had just been born. African babies are not born black: then they are only slightly duskier than white babies. They gradually turn black over the first ten days of life. This one looked decidedly grey.
I examined it carefully, including the heart sounds, which were normal. I decided to wait and see.
Two days later, the baby looked worse; and now I could hear a loud heart murmur. Obviously we had a 'blue baby' on our hands, a baby with a congenital heart defect.
I asked Emilia where we could send it for heart surgery. She thought maybe the capital, Accra.
'Then we must send the baby to Accra,' I said.
Midwives the world over are independent figures as many doctors have found to their cost. African midwives are no exception.
Emilia drew herself up to her full five feet and declared: 'Never since I am in Samreboi have we sent a baby to Accra!'
'Well, we are starting now,' I retorted.
Emilia began to harden with that adamantine hardness which I was later to discover was a peculiar property of this otherwise docile race. In the discussion that followed, I referred to the chances the baby would have in the West End of London, with other such appeals to fair dealing. Eventually, Emilia gave way.
Once she had accepted the proposition, she threw herself into it with characteristic dedication. We made plans.
First of all, we obtained oxygen for the baby. The only oxygen available came, not in the handy medical size cylinder, but a massive industrial object it took two strong men to handle. This was connected to the baby, whose colour began to improve. Now for the journey.
The mother would have to go, as all African babies are breast-fed. Father would be needed, if only for muscle power. Moreover, father's consent must first be obtained. An African peasant woman is no more placed to take an independent decision than her baby itself. And Emilia would have to go to manage the business.
Where was the father? Another difficulty. It transpired he was not a company employee but a 'house-boy'. (Those were the days before we called them male domestic workers, comrades!) The company undertook to provide unlimited transport for employees only: others would be carried to the railhead, forty miles away at Prestea. After that, they were on their own.
Now the railways of Africa universally run up-country from the coast, being originally built to garner the products of the continent rather than with any concern for the convenience of the inhabitants. That meant that while up and down journeys were no problem, to travel cross-country was not so easy. In short, our little party would first have to travel down to the coast at Takoradi, then up-country again to Kumasi, then down once more to Accra: which is like travelling from Liverpool to London via Bristol and York.
We worked out that they would need sixty cedis (which in those days was about sixty US dollars).
Where did the house-boy work? Mother did not know. She lived in the 'boy's house', in the garden of their master, but it is no part of a poor African woman's duty to know her husband's business.
Somebody said he worked for Mr Simpson.
It was four-thirty in the afternoon, when I knew Mr Simpson would be relaxing from his labours at the bar of the club. There I found him and told him the sorry story.
Mr Simpson was a dour Scot. He listened throughout with a penetrating stare, which penetrated further when I finished.
'Ye mean ye want me tae find the sixty cedis?' You've got to hand it to them for penetration!
After sundry uncharitable noises, evidently intended to disabuse the neighbouring drinkers of any idea that he was going 'soft', Mr Simpson drew a cheque and got sixty cedis from the bar.
I carried them in triumph to his house.
The father was rooted out of the boy's house. He was followed by about ten other children. The story was told again.
The father appeared even more guarded than Mr Simpson had been.
'Ah, docketa!' he exclaimed, with that sceptical glint of the eye and click of the tongue which I was also to come to know so well. 'Dis pickin never fit go for Accra!'
Newcomers to the Coast , especially ladies for some reason, swear they will never resort to 'pidgin'. After a month or two, when the limitations of the Queen's English become evident, they change their minds.
The inevitable African crowd had gathered. I played unashamedly to the gallery like a past master.
'I never savvy you be docketa, my friend!'
This drew the expected laugh.
I produced my ace card.
'Mr Simpson has given sixty cedis for the train,' I announced, drawing the notes from my breast pocket.
A small boy, who had obviously never seen such a sum in his life, gasped: 'Sixty cedis!', clapped his hand to his head and went through a theatrical fainting fit. I might add they are born actors. Sir Laurence himself could not have faulted the lad - or done better.
The ambulance took the little party, plus the massive oxygen cylinder, to the railhead. They waited all night for the train to the coast. Then, as I have indicated, up to Kumasi, and a third journey down to Accra. The group attracted considerable interest throughout, which Emilia exploited as only a midwife can, commanding strong men to 'stop staring and lend a hand' with the oxygen cylinder. Finally they emerged from the station at Accra.
It was then that the mother saw traffic for the first time in her life.
Vehicles there were at Samreboi, even some very large ones, called 'loggers', for transporting the timber, but they never added up to 'traffic'.
It was too much for the poor mother. With a scream of 'Jee-sess!', she turned tail and clutching the baby, tore back into the shelter of the station.
Leaving the husband in charge of the oxygen cylinder, Emilia tore after her.
Eventually they got into the outpatient department of the great Korle Bu Hospital. It was, like any such institution, a sea of bodies. Emilia found a big bossy sister.
'Is this an emergency?' demanded the BBS.
Emilia faced up to her like a honey badger (which is well known to be the fiercest animal in Africa) to an elephant.
'Of course it is an emergency. We have come from boosh! FROM BOOSH!!!'
In short, the baby was admitted to the ward, where it lay for three days before being seen by a doctor - in fact, by the professor on his regular ward round. He just had time to demonstrate the interesting case to the usual train of registrars, house officers, and nurses, before the little thing expired.
The truth was, I had overestimated the level of the country's technology.
Which taught me one thing: the 'demands of the ideal' (in Ibsenian phrase) have no place in Africa, where 'the best can be the enemy of the good'
4 - At the Dirty End
The scope of the country doctor in Africa embraces everything from major surgery to public health. To
day 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.
5 – Jenny
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, inse
rting 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.
Across the Wide Zambezi: A Doctor's Life in Africa Page 2