by Damien Brown
In reality, Tim can’t get the Administrator to meet with him. The town’s new hospital was built a year ago by Namibian contractors but still sits empty, with no water supply, beds, or medical equipment. We’ve offered to complete it for them—the log team will do it for free, no strings attached—but we get no answer. We’ve also offered to donate a three-month supply of drugs and move our own staff and equipment there, but again, no answer. Tim meanwhile struggles in the middle of all this, caught between being necessarily diplomatic yet appropriately pushy, and dealing as well with our team’s growing frustration. We’ve asked MSF coordination to push for action at a higher level, but for the moment dozens of emails just fly backwards and forwards within the organisation, CCed to everyone who’s remotely involved with Angola. Seems that being strictly apolitical can be a highly political process in itself.
‘What else did she say?’ asks Tim.
‘Just that she’s tired of guys passing—’
‘Stop! I can’t believe this. You are single. She is single. You are both staying together—end of story!’
‘And tell me this,’ says Pascal, with an air of contemplation, as he dips bread into the can of lukewarm cheese. ‘What are you going to do with all those condoms they gave you in the briefing? That entire box, Novo Doctor—what will you do with them?’
I excuse myself after dinner to check on a patient in Intensivo. I cross the yard and step into the assessment room, stopping suddenly. The scene is frightening. A clinico is standing beside the bed, swaggering as he tries to guide a syringe into the buttock of a young child lying prone. The brown plaid shirt is unmistakeable.
‘Manuel?’
He swings around unsteadily. ‘Ohhhh! Boa noite!’ he slurs. ‘You are back? Eh, I did not think you were back!’
‘What are you doing?’
‘Just treating this child, Novo Doctor.’
To a near-death experience, perhaps. I can’t believe it. The real cause of his increasing ineptitude and fidgety demeanour is now revealed to me, the evidently un-astute doctor and supervisor. Manuel’s an alcoholic.
‘Put that syringe down, Manuel.’
‘Yes. I will just give the injection,’ he says, pivoting to face the child again, his arm arcing wildly.
I step closer. His breath is thick with alcohol fumes. He looks over and relaxes his arm, averts his eyes in resignation. A heavy silence follows.
‘Go home,’ I tell him.
He can explain, he says. ‘I had the day off. Okay, yes, I had a few drinks, but I was not working for hours, you see—’
I take the syringe from his hand and guide him out the door. The patient’s family watch. I ask the guard to please find another clinico to do the night shift, but Manuel won’t leave the gate. He stands. Begs. Holds my arm and cries, says that he’s the only wage-earner in his entire family and he’s never done this before, and I think, What a pitiful sight: a fifty-year-old survivor of war with no other job prospects, being reprimanded by a privileged white man half his age who’s threatening to leave him unemployed.
I tell him to return in the morning. I’m not sure what we’ll do. Tim will be obliged to fire him if he knows the extent of this, so maybe we can bend the story a little, play down the drinking and make it more of a competence issue. There’s simply no way we can allow him to treat patients; maybe we can keep him on the payroll as an attendant with no clinical duties, and I’ll insist that we deal with his alcohol abuse.
Was it really only this morning that I landed back here?
I head home, help finish the cheese and climb into bed. But how does one fall asleep after all this . . .?
Surprisingly easily. I refuse to keep going in circles. For months my mood has ebbed and flowed according to our failures or successes, but not anymore. I can’t keep wondering whether what we do makes any difference, whether any of this is actually worth it, so I don’t. I light a candle. I grab a book, tuck my mosquito net in and ignore the termites, and remind myself of our successes—and there are many.
The reality is that work here is boring at times, although it’s taken me a while to work out why: most of what we do is easy, and most of the health workers do it well. While I’m distracted by the minority of cases with serious conditions—the Kidjes with encephalitis, the Josés with burns—the clinicos quietly manage the majority of in-patients, and almost all of the two to three thousand outpatients, each month. Cases of malaria that are treated in time, cured with three days of tablets; children with mild coughs who are given antibiotics, long before they become the three o’clock night call with pneumonia; and many hundreds with simple gastro, brought into the hospital hours after it begins, and managed adequately with advice and a few cheap sachets of oral solution.
Even our water system quietly prevents untold cases of illness. I’d go so far as to say that by running it, Pascal and the logs save far more lives than we health workers ever have. And from what I’ve seen, this is the reality of medicine in developing countries: people die of preventable conditions that are easy to treat, or even prevent. Of the millions of children who won’t survive the year, most will succumb to one of six things: poor nutrition, pneumonia, diarrhoea, malaria, measles, or a lack of basic neonatal and maternal health care. All of these are easily managed or prevented. None of it is rocket science—or expensive. Here, the death rate in our little hospital is remarkably low (four or five of the three hundred inpatients a month), not because of the occasional operation or clever diagnosis we make, but because the clinicos plug along every day, treating easy-to-manage conditions, with cheap drugs, over and over again. A fact that I find immensely empowering, yet equally heartbreaking that such a situation exists.
And for me, this is the thing about Mavinga overall. These powerful contrasts, these glaring dichotomies, that make working and living out here what it is: a confusing, intoxicating, frustrating, heartbreaking, inspiring, disillusioning and life-affirming blend of all the best and worst things. Every day, all at once. I don’t think I’ve really started to make sense of it, but I’m not sure one could.
So for now I don’t even try. I blow out the candle, shut my eyes, and do what I do each night: try to picture something good. Like Marco, that young boy admitted with malnutrition and who’s now almost overweight, except that another image keeps appearing . . . What’s this? . . . An old man, I think, and he’s sitting on concrete steps, his deep-brown suit soaking up the morning sun as he grins a toothless grin, triumphantly waving . . . Is that—?
It is. A golden bag of pee.
Hardly the image I’d hoped for, but it’ll do nicely under the circumstances.
11. MEMORABLE LINES
Late August, and Pascal’s coaxed a small vegetable garden to life outside the bedrooms. Basil, ailing tomatoes, zucchini, and sunflowers that are yet to bloom, with cow manure for fertiliser and tap water to keep it going. He also bought a guinea fowl and set up a large enclosure for it in our yard; a beautiful but noisy addition to the family. So for now, between the roosters, cats, donkeys, soldiers, generator and this new bird, gone are any moments of silence, although the place is feeling wonderfully homely.
I get up, shoo a rooster from the veggie patch and step past to the bathroom. First order of business, to locate the spider. I hold the door open and look around. Wait for my eyes to adjust, open the door a little more, and scan the room. Got it. Back left corner, as usual. The thing’s getting bigger by the day. A small dinner plate now. A small, hairy dinner plate. I prop the door open with my foot and wash with one eye on my towel, the other on it, but it saunters towards my towel. I shift the towel. I wash quickly but it gets closer again, scuttles then disapp—
I’ll brush my teeth later.
Over to the kitchen, where Andrea’s making breakfast. She returned from holidays late last week looking like a new woman—tanned, relaxed, happy she was back (as was I, I’d had to cover Maternity for ten days)—and now carrying a black baby on her hip.
‘Yours?’ I ask,
and she flicks me a dry smile. But Dominga jiggles.
‘Mum’s the one with the high fever in Intensivo,’ she says. ‘I’m just minding her for a few hours. Isn’t she gorgeous?’
She is. We coo and dote on her, all three of us, then Dominga goes back to rubbing this morning’s meat across the uncovered wood bench—the same uncovered surface we’ve been massaging pizza dough onto these recent Sundays.
Andrea fills Dominga in on her holidays. Like me, she’d also spent them in Lubango, and Dominga likes that we saw a little more of her country. ‘É lindo, não?’ she says—It’s beautiful, no?—which we all agree on. Andrea then asks Dominga about her holiday, but Dominga laughs and casts her eyes heavenward. I stick around. I’ve heard the story before but still can’t believe it.
Dominga took her annual leave two weeks ago, paying for passage on the back of an old truck to take her the four hundred kilometres to Menongue, the provincial capital. The trucks rumble through here a couple of times a week in both directions, though timetables are haphazard. They come when they come. From Menongue, she’d hoped to catch a bus to the northern city of Kuito (around fifty dollars more) to meet her new grandchildren for the first time.
The first day went fine. Dominga sat on the open back as they bounced along sandy roads, but she at least had food and others to talk with.
The following morning the truck broke down. No phones and no towing service out there, so for two days the driver toyed with the engine and at nights they slept on the back of the flatbed. A minor logjam of other vehicles meanwhile built up behind them, because brave is the driver who mounts the shoulder of a rural road in these parts of Angola. (Initial mine clearance doesn’t include the road verge. Unlike the heavily time-consuming process of de-mining by hand, roads are cleared using a more rapid but less definitive technique in which metal detectors make a first sweep. A heavily weighted trailer is then towed to detonate any non-metal mines.)
By day three the truck remained stuck. Dominga realised she’d no longer make it to her family and back in time, so she began walking towards Mavinga. That took another couple of days. And where did she sleep? ‘Eh! On the road!’ she jiggles. But you wouldn’t know it to look at her this week. Her shoes have been scrubbed back to a gleaming white, no trace of the dirt that caked her when she’d walked into the compound and asked someone to please look at her foot.
Andrea’s speechless, but Dominga just shrugs. ‘Aqui é assim,’ she smiles. Here, it is like this.
She’s not as nonchalant about the food situation in town, though. We’re now well into the hunger gap, and the soils couldn’t possibly be drier. It’s a precarious state for a population that relies almost entirely on subsistence farming. Toyota says it’s as bad a season as they’ve had since the war, and that we may need to consider a general food distribution; some families are eating their seed stocks. For the moment we’re screening all under-fives who pass through Outpatients for signs of malnutrition, and hoping for rain. The weather is definitely changing—nights are sticky, the wards stifling in the afternoons and increasing tufts of clouds are lingering nearby—but September arrives, and still there’s no rain. Temperatures begin to flare. So too the tempers in staff meetings.
‘We’ll pay three months’ salary,’ says Tim, ‘and a bonus for every year of employment,’ as he explains the retrenchment packages to the staff gathered in the gazebo one afternoon.
‘But this is not enough! How will I support my whole family on this?’
‘And if we will not have jobs here,’ says one of the guards, ‘we must leave Mavinga. How are we to live in the city with this money? Will you help us in the city?’
We can’t. MSF are closing all their Angolan offices. So Tim begins running small group sessions with everyone, an orientation to the rest of the world: phone numbers and how to use them; interviewing for jobs and how to bank; what food is likely to cost; and making sense of a rough map of Luanda. He asks staff to bring in any certificates they have (UNITA ran schools and courses at certain stages) and begins typing up resumés for all staff. Some are fascinated, others frightened, but a few are plainly angry.
At around the same time, Pascal takes his leave. Toyota looks after most of the logistical issues, but Tim and I ponder the generator one evening when the guard calls us—‘It coughed then just stopped,’ he says—although it seems all is okay, just that the fuel had been siphoned from the tank. It’s part of a growing trend in theft as this closure looms, necessitating even more locks, keys, spreadsheets and vigilance to keep track of everything.
But Mavinga’s more pressing problem is at least solved one September afternoon, when the rains arrive—in dramatic fashion. Brooding anvils of clouds hurl improbable quantities of water at the town for hours on end, and every afternoon following that, and within days the town becomes green. That quickly. A stubble of grass shoots colours the earth (who knew their seeds would’ve survived such a drought?) and farmers hurry to sow crops. Soon, maize and other necessities begin their much-awaited growth towards a cloudy sky, and an impending nutrition crisis appears to have been averted. And all it took was a little rain.
Mavinga changes for another reason this month, too. The deployment of over one thousand policemen takes place in the region—a costly and remarkably efficient government exercise, and one that becomes a shameless testimony to the adage Where there’s a will, there’s a way.
• • •
Sunday morning in mid-September, and the four of us stand on the airstrip. In awe. Whether we’re watching a festival, celebration, or an impending riot, I’m not yet sure.
Large numbers of police line the edges. They’ve been arriving on frequent flights these past two weeks, staying in the large sheds in the centre of town that have been hastily converted to barracks by a Namibian work crew, and here they now are: heavily armed, hot, young, and bored. And watching the gathering crowd ahead.
The crowd, so far at least, is not overly large—a couple of hundred at most, although growing quickly. Two distinct groups have formed. The first is just metres from our compound, dancing passionately, singing pro-government songs and wearing pro-government T-shirts, and waving the pro-government posters they’ve just been handed—the first things I’ve seen given to the town’s people by Administration since my arrival.
The second group is much the same size. Twenty metres to the left, they’re dancing every bit as energetically in front of the four supply aircraft parked nearby, although there’s no pro-government paraphernalia among them. Quite the opposite. The colours of the UNITA flag (red and green, with a black cockerel in the centre) adorn their banners and T-shirts, and they’re displaying them in proud protest. These are the two political parties who’d fought each other so bitterly during the war, but for now the mood seems buoyant. Plenty of women and children dance among both groups, and our staff and patients gather nearby at the compound fence. Even the King is here, watching with an entourage of elderly sobas. So it’s not the crowd that concerns me. It’s the police.
The sun climbs and the crowd continues to grow. Excitement builds. Drummers lead their respective groups in song, pounding batas made of dark wood and animal skin, while tall women blow percussively on referees’ whistles at the front, stomping and dancing feverishly as the rest of the group mirrors their movements. It’s spectacular. Bright colours and beautiful songs; deep drums, and the smell of sweat. Utterly mesmerising. We’d been told there would be a celebration—today is National Heroes Day, the birthday of Agostinho Neto, the late Angolan doctor and poet who’d led the MPLA at the time of independence—we just had no idea it would be like this.
It’s mid-morning when the third of the day’s flights, another Russian military transport, makes a low pass. It lands and taxis closer, and the crowd becomes even more frenzied as the cargo door lowers, but the excitement subdues when only police exit the plane. It’s not who we’re waiting for: the Vice-President of Angola, who, unbelievably, is said to be coming to inaugurate this l
arge police deployment. Here, on our football pitch with no goalposts.
Minutes later a fourth flight arrives. The excitement again grows. The door opens and men in sharp suits descend the air stairs, followed by a TV crew with cameras, generators, a transmission dish and dozens of rolls of cable, all unloaded onto the sand. But it’s nothing on the absurdity of what follows. As if direct from Zurich, a gleaming private jet bears down on our little town, blasting dust over the skinny kids and mud huts along the edges. Police surround it as it rolls to a stop near us; men in even sharper suits exit the jet; and now the crowd erupts. Two groups, trying to outdo each other in song and dance. MPLA supporters celebrate as UNITA supporters protest. Call and response anthems ring out, a lone voice followed by an impassioned chorus that’s harmonised perfectly, and a warm sense of nostalgia comes over me as I recall the first time I’d heard such music being sung, sitting in a primary school hall in Cape Town when a group of black children were led onto our stage. A township choir, they were the first black Africans I’d seen in the school, and they’d looked terribly uncertain about the whole idea as they took their position in front of five hundred white boys—until the moment they sang, that is, filling the hall with the most heartfelt, beautiful music in languages I knew nothing of.
Pascal nudges me. He points out a lean man draped in a UNITA flag who’s walking defiantly through the centre of the pro-government group. The singing crescendos as the man heads deeper, and I wonder if he’s about to get beaten or cause a riot, and so I forget all about township choirs and think instead of the township anti-apartheid protests I’d seen on South African TV at around the same time, many of which had turned violent, and I wonder how much, or how little, it’d take to ignite this crowd.