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

by Warren Durrant

  ‘Please can you tell me the way to Belingwe?’

  ‘Sit down,’ invited Jock. ‘I can tell you all about Belingwe.’

  He ordered the man a drink, and did so. The man had something else on his mind.

  ‘I have just come from Ghana,’ he said, rather breathlessly. ‘I had to put down at Lagos airport, and you’ll never guess what happened to me there. I asked to go to the transit lounge. I told them I was on my way to Zimbabwe. And do you know, they sent me to the arrivals lounge, and when I tried to get back, they said I didn’t have a stamp in my passport. I told them I wanted the transit lounge: I was going to Zimbabwe, but they wouldn’t believe me. They threatened me with the police. In the end, I had to pay fifty pound to get back into the transit lounge.’

  I glanced at Jock, who knew the story of Terry’s and my adventure. ‘You were lucky it wasn’t Christmas,’ I said to the man, and told him my tale.

  I had only one difference with Jock, and that was happily resolved. I report it to show the flip side of his admirably independent spirit.

  As I have said, we took week-ends in turn, which included a Saturday morning ward round, when we saw all the patients, including the other doctor’s. (This was before the arrival of Stephan and Charles, though we continued the practice with them.) I suspected meningitis in a baby Jock had admitted the day before. Meningitis is difficult to detect in babies, and the signs would not have been so pronounced at that time. I performed a lumbar puncture and got cloudy fluid. A British student, Sam, was with me at the time. I ordered treatment. The practised nurses were better at getting a drip into the tiny veins of a baby than I was.

  On Monday, out of interest, I looked at the baby again, to discover to my horror that Jock had discontinued treament. I accosted him in the corridor.

  ‘I didn’t think that baby had typhoid,’ said Jock The baby was on chloramphenicol, used in both diseases.

  ‘Typhoid!’ I exclaimed. ‘Didn’t you read my notes?’ (Evidently not.) ‘Jock, that baby has meningitis.’

  ‘O, I didn’t think so.’

  ‘You should have seen it on Saturday. Anyway, I did a lumbar puncture and got cloudy fluid.’

  ‘Was it really cloudy, or just misty?’

  ‘Jock, normal spinal fluid looks like tap water.’

  ‘O, I don’t know. Sometimes it can look a bit misty.’

  ‘Ask Sam. He was with me.’

  ‘I’m not going to ask a medical student,’ replied Jock, indignantly.

  ‘Anyway, the lab reported pus cells and haemophilus bacteria.’

  ‘O, I wouldn’t go by the lab report.’ (Which was produced by mere assistants.)

  This was terrible. Egoism is an occupational disease in country doctors in Africa, almost a necessary evil: but this was sheer pig-headedness.

  ‘Look, Jock,’ I challenged him. ‘If I am wrong, it does not matter. If you are wrong, the kid will die.’

  This seemed to get through to him. He gave me an indulgent smile - the cheeky blighter!

  ‘All right, Warren,’ he condescended. ‘I’ll do it for you.’

  He resumed treatment. I had the cheek myself to make sure, and the baby made a good recovery.

  The best side of Jock (in which he was backed up by Joyce) was his almost embarrassing charity to lame ducks. He had two children of his own, but found time to adopt at least two others: an African girl who became a matron in UK; another, a Coloured girl, he ‘found on a rubbish dump’ in Bulawayo. ‘Where’s your mother?’ ‘She doesn’t want me.’ Jock took her to her home and found it was true. ‘You can have her!’

  In the time I knew him, he gave house-room to a demobbed young white soldier, who seemed a bit lost in his mind, with nowhere to go, before he settled him somewhere; and likewise a schizophrenic white girl, who became quite cheeky because Jock wouldn’t play the piano to her - a thing, as I have said, he never did for anyone, as a rule. ‘You’re supposed to be entertaining me!’ He managed to dispose of her after a week or two.

  All in all, there’s not much more you can do for your fellow creatures than share your home with them.

  His individualism remained unimpaired as long as I knew him. One day, he discovered one of his patients - a young girl with typhoid - had been discharged by her mother. ‘Why did you let her?’ protested Jock to the ward sister, in his petulant falsetto. It was not unheard of for patients to do this (or parents), if they did not get better in five minutes, to go to the witch-doctor.

  Here was a clear case for an appeal to the magistrate, under the Child Protection Act. Magistrates and their acts were not Jock’s style: Jock’s style was the citizen’s arrest.

  He got into his Audi and patrolled the town like a police car, until he found the runaway pair in the main street. He got out and ordered them into the back of the car, to the amusement of the afternoon drinkers on the veranda of the Nilton.

  And his gallantry. Another time, Terry and I were sitting on the balcony of the bottom house, when we saw a girl running up to the hospital, screaming and beating herself with her hands. I suspected another lunatic. I soon got a call to the hospital - to the private wards (which were still in existence), to see Dr Scott. I found Jock sitting up in bed, stripped to the waist, covered in bee-stings, which the nurses were brushing off. I ordered Phenergan and pethidine.

  Jock had been driving up to the hospital, when he saw the girl in a cloud of bees. African bees are the fiercest and most dangerous on earth. He jumped out and told the girl to get into the car. She did, and so did the bees, and soon Jock was in a worse case than the girl. How and when he got to the hospital, I do not know, but the girl, when I found her, was more comfortable than he was. He had shut the bees in the car, and the police waited till evening (when bees are calmer), before releasing them and recovering the vehicle.

  In 1985, when he was seventy, Jock retired from government service and went (if not to sweep the streets) to live with Joyce in Bulawayo. He continued to do locums, including three months at St Paul’s mission in Matabeleland, which was now haunted by disaffected bandits, who no more frightened Jock than they had in their previous metamorphosis as ‘freedom fighters’. Then came news that he had died suddenly in his own home. He was seventy-three.

  For years after he left, children on the borders of his old district would hurl the cry, ‘Scott!’ after me in my Land Rover. People change slowly in Africa. I expect the cry of ‘Durrant!’ was long being hurled after my successors.

  Terry carried a small pistol in her handbag, during the war years. In 1980, she handed this weapon over to the police, not bothering to sell it, being more averse to such toys than even I was; and got an official receipt for it. (I gave my cowboy set away to a man who, with his wife, had shown me more hospitality in my selfish bachelor years than I had ever returned. What did I give his wife? Good question!)

  Then, in 1985, Terry got a chilling notice through the post: ‘Our records show that you have a pistol, licence number 123, expired 1981.’ Obviously, the official record of the receipt had been lost. But that was not their fault! The mandatory penalty for possessing an unlicensed weapon was five years in jail. And this was a country where, even if a good lawyer got you off, you could be re-arrested on the stroke of a minister’s pen as you left the law court.

  Terry never threw anything away. (I don’t think even I would have thrown that away.) We got our files out on the bed and had an anxious fifteen minutes before we found the receipt. In that time, we felt what English people have not felt for centuries, the deadliest fear I know - the fear of the State.

  Yet another of our duties was covering the prison. We would be called there to examine the new intakes. I had a system of getting through them very quickly, without missing anything important. We also dealt with sick prisoners, either in outpatients or admitting them to the hospital. They were always accompanied by a guard, handcuffed to him in outpatients, handcuffed to the bed in hospital, while the guard sat beside it. There were also one or two women prison
ers in a separate part of the prison.

  Under the new order it was considered incorrect to allow the prisoners out to work on the roads, etc. This piece of socialist philosophy was not appreciated by the prisoners, and the prohibition was soon abandoned.

  Capital and corporal punishment existed: the latter was abolished after independence, but while it was the government’s intention to abandon the former, it was retained owing to the disturbed conditions which developed through the differences between the two main parties, which, as ever in Africa, were essentially tribal.

  Another curiosity of the country was the abolition, some twenty years before independence, of trial by jury. I am ignorant of the reasons for this, but I can imagine that if you assembled twelve good Africans and true, they would be arguing from now until Christmas over a simple parking offence, especially when they were getting paid for it, and there was no planting or harvesting to be done. For a time, both systems ran concurrently, and you had a choice. It used to be said, if you were guilty, opt for trial by jury: if you were not guilty, for God’s sake, opt for the alternative - trial by judge, sitting with two assessors.

  After I had examined the new intake, the superintendent would give me a cup of tea. One of them told me a tale of Africa.

  During the Congo troubles of 1964, many Rhodesian and South African youngsters took off to grab a piece of the action and the money. One such was the super, who left home at the age of sixteen, telling his mother that he was ‘going south’ to look for work. Instead, he went north, where he lied also to Mike Hoare about his age.

  At length, he found himself in the dreaded Manyema of the Eastern Congo. ‘One day, we ran into an ambush. When we got out of it, one of our chaps had a gunshot wound of his leg. His leg was completely shattered. We knew he was going to die of gangrene, unless we did something. There was no way he was going to see a doctor: they had all cleared off, if they hadn’t been murdered by the Simbas. We didn’t even have a medic with us.

  ‘Anyway, we stopped in a clearing in the forest, and put him on the ground. One guy made a kind of knife out of a bully beef tin. We got a tourniquet on his leg, and we all held the guy down, while the other guy tried to saw his leg off with the knife. Fortunately, the poor bugger was semi-conscious by then. Anyway, we couldn’t manage it, so we just bopered his leg with our field dressings and put him back on the lorry. He died soon after that.

  ‘But what I most remembered about it was, while we were trying to cut the guy’s leg off, a jet airliner went overhead. It must have taken about ten minutes to cross the sky. I remember thinking to myself: there’s those people up there, reading their Newsweeks and eating their plastic lunches - they’re in the twentieth century, while us, down here, are in the bloody Dark Ages!’

  And the mortuary was always with us. The work here had certain spin-offs. I was able to study surgical anatomy, as I dissected - that is, anatomy in regard to operations. This I had always done: my first ectopic and my first ruptured spleen I had seen at post mortem in West Africa, and the anatomical knowledge I had gained enabled me to save lives later.

  And one day, I detected a murder.

  It was common enough to perform a post mortem on an alleged murder victim, determine cause of death, etc, but this was an unsuspected murder.

  The police brought in the body of a man, found hanging from a tree in the communal lands (as the tribal trust lands were now called). The request form for post mortem said: ‘Foul play not suspected.’

  ‘Yes, doc,’ said the policeman. ‘We think he hanged himself.’

  A wise doctor never accepts an assumption of that sort without question, and I had grown that wise long ago. I did a meticulous examination. There was a rope mark on the neck, proving that the subject was hanged alive: there was no question of a previous murder being made to look like suicide. Then, after the mortuary assistant had opened the body, I began my work. I found the expected congestion of the lungs and heart. I suppose I found Tardieu’s spots (tiny haemorrhages) on the lungs, with the eye of faith: in an African, one obviously does not find them on the face.

  Then, when we drew the scalp forward, there, over the left forehead, on the skull and under the scalp, was a small bruise. There was no fracture of the skull or evidence of damage to the brain.

  On the way out of the mortuary, I met Jock, who was still with us, and asked him, pointedly, ‘How do you get a knock on the head, when you hang yourself?’ He made some joking remark about hitting it on a bough. His joke was more serious than he knew. I later saw a case where an old woman hanged herself in her hut and banged her head in the process, producing a similar bleed. Good job a clever lawyer could not then have got that story out of me!

  It did not come to that. I voiced my doubts to the magistrate. He informed the police and they re-opened the investigation. The murderers were so surprised, they confessed. They must have thought the chiremba (myself) had been throwing the bones. They had knocked their victim unconscious with a knobkerrie, before hanging him alive to make it look like suicide. Final verdict - murder by hanging.

  The significant detail, Watson!

  Africans do commit suicide, though rather less commonly than Europeans. I wish I had made a study of their motives. Only two I remember from that point of view: a man who cut his throat after a business failure; and saddest of all, a lad of sixteen who hanged himself because his parents could no longer meet his school fees.

  The most horrible occasion was the massacre of six party workers by bandits. These people were unpopular. Apart from selling party cards, as in Zambia, they would round people up to attend party rallies or political lectures. Complaints from schoolchildren, dragged away from their homework, appeared in the letters column of the newspapers. The bandits (who were the fringe of the opposition party) would take advantage of such discontents.

  But the corpses were pathetic, each killed with an axe blow in the back of the head: the youngest being a boy of fourteen. (A party of white missionaries was axed later in Matabeleland: the disaffection in that case being a land dispute with the locals.)

  The policeman told me the details. Under the guns of the bandits, the oldest man was made to axe each of his companions in turn, before being axed himself by the bandits.

  Such actions seem incredible to the white man. The fellow had the axe in his hands; why didn’t he have a go at his tormentors? He must have known he was going to die: he had nothing to lose. Quite simply, in a state of terror, people (especially simple people) act like zombies.

  The Africans were full of contradictions. No people more biddable; none more obstinate when they decided to be. None was more devoted than the African woman. We had one on the ward, blinded in one eye by her husband. I wanted to send her to the eye specialist, afraid of sympathetic disease, when the good eye can go blind as well. She signed herself out: there was no one to cook for her husband. And none more vindictive when she felt herself betrayed, as we learned another day in the mortuary.

  A village Lothario returned to his marital hut one night, stinking from his lover’s bed, and fell into a drunken sleep in his own. His wife (a sleeping African, normally barely rousable) awoke; or maybe was even waiting up for him. She had had enough, as we saw from the thousand cuts he died from - or rather, dozen axe-chops; the last, the unkindest of all, which destroyed the offending organs. ‘She meant to do it, doc!’ commented the black policeman.

  Young children were admitted to children’s ward, where we had cots only. When they were too big for cots (say four or five), they went to female ward, and older children went on male or female wards. The younger children were admitted with their mothers, who slept on mats on the floor beside the cots, and in the beds with their children on female ward - another practice Europe has learnt from Africa, which has long since displaced the cruel practice of admitting young children without their mothers, which existed when I was a houseman. Mothers in hospital contributed in the matters of feeding, etc. As for the other children at home, they were looke
d after by grandmother, as are all African children between the ages of weaning (two) and schooling (six); when Ambuya teaches them their manners and the traditions of the tribe.

  European visitors would appear in the African wards sometimes - police, mostly; sometimes a farmer bringing in a worker, or taking one home; someone visiting a favourite nanny, cook, or gardener.

  One day, a friend came in and saw a little boy with a fractured femur, in gallows traction, which means swinging both legs from a beam. The children tolerate this literal suspended animation with great cheerfulness; after the first few days, when the fracture has become painless, twisting around and twining the cords and getting into all sorts of positions, like acrobats.

  ‘What’s the matter with that kid, Warren?’ asked Fanie.

  I could not resist the temptation.

  ‘He’s been a very naughty boy.’

  I have mentioned mental cases. It used to be said, even by African psychiatrists, who should have known better, that lunacy, idiocy and genius were all rare in the African race. This seems to be a sort of wishful thinking, induced by their considerable bias towards conventionality: it is true that eccentricity, or even distinction, is viewed by them with suspicion. A man who has become very rich might be suspected of using witchcraft.

  As to mental disease and mental deficiency (and, no doubt, genius), I should say they were as common among Africans as they are with us. We rarely saw depression, and never used antidepressant drugs (which are among the commonest prescribed in Europe. A personal statement, and evidently inaccurate. I see from later statistics that the newly appointed community psychiatric nurse was treating 188 new cases of depression in 1987, in a population of 100,000 (and would be in my time) - still vastly lower than in Europe): but I suspect such cases may have gone to the witch-doctor, their condition attributed to witchcraft.

  One lad of sixteen, admitted for something else, was found to be depressed. As with the suicide reported earlier, his parents were unable to continue his school fees. Education can be a slow process in Africa (as mentioned in Part I). Interruptions occur, owing to shortage of funds, mostly, and to requirements arising in the homes of the poor. So sixteen is a more tender age than it might be in Britain: two years or more short of ‘O’ levels in many cases.