by Robyn Scott
Dad went to Rra Maoto’s funeral, which was sooner than customary after the death. Because so many people came from so far for funerals, time was usually given to make travel arrangements. But the undertakers, who were just starting to feel the industry boom and had yet to expand their capacity, were booked out solidly on every other possible later date – with the young, thin, and mysteriously, suddenly dead.
♦
In Botswana then, in the early 1990s, death in old age was still an expectation.
There were no famines, no wars. Health care, education, and sanitation had improved dramatically since independence. In the late 1980s the health department, in conjunction with the World Health Organisation, had undertaken a blitz on STDs, the big outstanding health issue. Because of the difficulty of monitoring patients in the rural areas, every patient with an STD was routinely given a cocktail of the strongest antibiotics available. It had been a great success. Syphilis, gonorrhea, chancroid – the once-rife diseases that had shocked Dad in the first year of his clinics – virtually disappeared.
In 1990, life expectancy in Botswana was in the mid-sixties, one of the highest in Africa. Over the next fifteen years, it would plunge by around three decades. AIDS – in 1990, already common amongst his patients – wasn’t, however, what Dad generally talked about, and was not, in the early days, what we knew his clinics for. After he’d said it once, there was not much to say: he treated the associated complications as best he could, and then he sent people home to die. With the early AIDS drugs prohibitively expensive, and the government not even talking about the lions, there was little prospect of a solution.
So mostly, when Dad held us riveted with his dinnertime stories, he stuck to the absurd, and to the people who were going to live. Or, occasionally, to those who died happily, in old age, waved farewell by their families as they departed lor the realm of the ancestors: an already familiar world, closely and powerfully intertwined with the lives and fortunes of the living.
The badinw, or ancestors, are fundamental to the religious beliefs of most Batswana. Nor is theirs a passive role, and their goodwill must be nurtured assiduously. Losing it can have consequences ranging from a poor rainy season, infertility, or an unhappy life to daily misfortunes: failing an exam, losing a job, catching a cold, the death of a cow. Even to the many Christian Batswana, the badimo often remain important.
If the ancestors are not behind a misfortune, witchcraft may be to blame, perhaps at the behest of an angry or jealous colleague or neighbour. Like the displeasure of the badimo, this is at odds with the Batswana’s belief in all-important harmony between people, their ancestors, their environment, and their god, Modimo.
All of which means that when a Western doctor tackles a disease, his patient may be seeing the problem through an altogether different lens and, even if the doctor successfully treats the illness, may resort to traditional healers to deal with the ‘cause’. It also means that if a patient dies – perhaps the greatest mark of failure in the West – the death may be considered entirely beyond the responsibility of the doctor.
And because the dead live on, nearby and forever, if you die when you are old and ready to die, no one protests your relocation to the world of ancestral spirits.
Like the very old, white-haired man who walked into Dad’s waiting room, coughing noisily. Despite being frail, he walked unaided, and his leathery face remained in a persistent grin as Dad examined him. Dad diagnosed pneumonia. The man was over ninety, several decades too old for AIDS to be the likely underlying cause. Dad gave him an antibiotic, in addition to the usual four-pronged regime – injection, liquid, tablets, and ointment – and with a nod and a toothless smile of thanks the man shuffled outside again.
Hall an hour later, Dad was called to the waiting room. Maria pointed to a corner, where the ancient man was sitting quietly, his head lolling back against the wall. The room was full, and the patients either side of him chatted loudly.
“That old man is dead,” said Maria, matter-of-factly. “He was waiting for his lift.”
Walking over, Dad checked to see if he was breathing, felt for his pulse, and examined his pupils. He was dead.
“Can we take him somewhere?” Dad asked Maria. “To his family?”
Maria spoke to one of the women sitting beside the dead man. After a rapid conversation in Setswana, she turned back to Dad. “Don’t move him,” she said. “His son will be here soon.”
“All right. Tell me when he comes,” said Dad, returning to his current patient and trying not to think about the prospect of confronting the son of a man who had died in his waiting room, after being treated.
The dead man sat on the waiting room chair for another hour.
When the dead man’s son finally arrived, he greeted Dad with a warm handshake and smile. He spoke good English and nodded understandingly as Dad explained that his father was very old and weak and had died painlessly. Then he thanked Dad for his attention to the old man, thanked him again for helping to carry the body outside to the bakkie, and waved him good-bye as he trundled away down the dirt road.
♦
Dealing with healthy patients, for a doctor, could often be the hardest of all, and it was one such patient who, three years after Dad started practising, drove him to break one of his most non-negotiable self-imposed codes of conduct – rules for what he considered the reasonable adaptation of general medicine in rural, traditional settings.
“My patients have won,” he announced one evening at dinner. He leaned back in his chair and surveyed four curious faces. “I took a patient’s blood today.”
Ever since he’d started his clinics, Dad had refused to draw blood except for diagnostic reasons. “I will never encourage that ridiculous belief,” he’d said many times before. Even facing defecting patients who complained that Dr. Meyer had taken their blood, Dad had told them they could go elsewhere.
Lulu, Damien, and I gaped at Dad. We gaped not about the blood, but because Dad had changed his mind. When Dad made a decision, he never changed his mind. It was the most frustrating, reassuring, and reliable thing about him.
Mum said, “You said you’d never do that, Keith.”
“How come, Dad?”
But Dad was looking at Mum. Mum took another mouthful. She chewed slowly, glaring at her plate. Dad said, “Lin, hear me out at least.”
“Fine,” said Mum. “I’m just incredibly disappointed.”
Dad said, “I made that promise before I understood this place.”
“Keith,” spluttered Mum, “how the hell can understanding a place ever make you think it’s okay to perpetuate such dangerous ignorance?” Her knife and fork clattered to her plate. “Quite frankly, I’m shocked.”
Doubly stunned, Lulu, Damien, and I looked at the table. Mum never got disappointed and never shouted as reliably as Dad never changed his mind.
“Willyou hear me out, Lin?”
“Whatever you want,” said Mum coldly.
Three weeks earlier, an elderly man had visited Dad at his Tonota clinic. He had an infected arm, at the site of an IV that had been left in too long. Dad cleaned and dressed the open part of the infection and prescribed him antibiotics and painkillers. On his instruction, Maria explained to the patient that the pain would go and the infection should clear up in a few days.
The man replied in agitated Setswana.
“He wants you to take dirty blood from his arm.”
“You know I don’t take blood,” said Dad. “Tell him.”
“I’ve told him,” said Maria. “He says he has dirty blood.”
“Tell him again.”
Maria translated and turned back to Dad. “He says he won’t get better until you take blood.”
“He will get better,” said Dad. He gave the man a reassuring smile. “Tdamaya jentle, rra.” He turned to Maria. “Now give him his medicines and bring in the next patient.”
The following Wednesday, the man came back. The ‘wound looked much better. The man lo
oked worse. He gasped in pain as he told Dad, via Maria, how his arm was in even greater agony.
“He wants you to take blood.”
“Tell him that I won’t. And if he’s not happy with me, he can go back to the hospital.”
After another exchange, Maria said, “He says the hospital gave him dirty blood.”
Dad looked at the patient’s card. His village was Matsitama. “Where’s that, Maria?”
“Ah, far away,” said Maria. “On the road to Orapa.”
Dad stared in amazement at the man who had twice travelled two hundred kilometres to see him. He gave him stronger painkillers. “Tell him this is the best I can do. And tell him he will get better. And tell him if he goes to a private doctor again he’ll just be wasting his money.”
The man, looking dismayed, left with his new batch of painkillers. The following Wednesday, he came back. The wound had almost healed; the pain, according to the patient, was even worse.
“He wants you to take out the dirty blood,” said Maria. “To stop the pain.”
Dad said, “Maria, please tell me what I have to say to convince him that his blood is not the problem.”
Maria said, “Ga ke itse.”
Dad said, “Get me a needle and a syringe.”
He cleaned a patch of skin just beside the site of the infection, slid in the needle, and after slowly withdrawing 10 cc’s of blood, held up the syringe for inspection. The old man beamed. “Keitu-metde. Thankyou, Ngaka. Ee, that blood, it is too dirty!”
Dad sighed and helped himself to some more salad.
Mum, still sounding cross, said, “It would have got better anyway.”
“Yes, it probably would have,” said Dad. “But I couldn’t bear to see him again. And it’s a one-off.”
The following Wednesday night, Dad said, “I’ve changed my mind. I’ll take blood from anyone who wants.”
When he’d arrived at his clinic early that morning, a young woman had intercepted him on his way into the building. She said hello and in good English apologised for interrupting him. “It’s my father,” she explained, pointing to a bakku parked under a nearby tree. “He wants to thank you.”
They walked together towards the bakkie, and stopped outside the passenger door. The old man with the infected arm grinned up at Dad. “Dunula, Doctor,” he said. He held out his arm. The antibiotics had done their job. The wound was completely healed, and any sign of swelling had gone.
“Dumela, Rra,” said Dad. “Le tjoga jang?”
“Re tsoga sentle,” said the man, smiling. He spoke to his daughter in Setswana.
“Dr. Scott,” said the woman, “my father says thank you for taking his dirty blood. He has no pain. You have cured him.”
And with that she got back in the car and drove her father a hundred kilometres home to their village.
And from then on, Dad took blood from every adult patient who requested it – which was most, including his nurses, who, when pushed, acknowledged that it didn’t work, but whenever they got sick, nevertheless wanted blood taken. Dad soon became so well prepared and so fast at taking blood that it added on just about fifteen seconds to his average consultation time, which remained, even with the new ‘treatment’, under five minutes.
♦
In the villages, where most of his patients didn’t speak English, the efficiency of Dad’s consultation system at first depended heavily on his nurses, who translated the stream of questions, instructions, and diagnoses.
But over the years, and although his ability to construct coherent sentences never significantly progressed, with the endless repetition and gesticulation, Dad gradually developed an impressive repertoire of the nouns and adjectives describing body parts and ailments. And with time, as he adorned his stories with more and more Setswana words, we, too, absorbed some of this strangely limited lexicon.
Popelo – ‘womb’, default organ of blame; women’s equivalent to the male obsession with kidneys, diphilo. But less inexplicable, for Batswana men often won’t marry a woman until she has borne a child. Once Dad hired a well-qualified junior nurse whom he told to wear a previous nurse’s old uniforms until her new ones arrived. She came to work the next day in civvies. After several repetitions of ‘Ga ke itse, ’ she sulkily admitted to Dad that she would not wear the clothes of a woman who had miscarried. Dad threatened to fire her for being ridiculous, but relented after she said she’d rather lose her job than risk her fertility and marriageability with the sullied uniform. With womb and kidney complaints, having identified the actual problem, Dad would present it as auxiliary, in no way entirely displacing the favoured troubled organ as the source of at least some of the discomfort and responsibility.
Botlboko – ‘pain’, frequently used in the context of dipbilo or popelo, as was l&iwe – ‘dirty’ – which could also be applied to madi. Madi was ‘blood’, the other oft blamed organ, which in addition to being dirty, could, in the case of a fever, be molelo, or hot. And if kidneys or wombs weren’t raised as the initial complaint, patients would usually claim ‘widespread, unspecific botlboko. Government hospital nurses – and, following suit, Dad’s nurses – recorded this as ‘general bodily pains’, abbreviated to GBP, which we all called ‘General Bidily Ponds’, after an exhausted Maria once came up with this catchy alternative. A few years after Dad started practising, GBP was replaced by GBM. When Dad quizzed Maria, she said, looking surprised, that it was ‘general bodily malaise’. How or why malaise came to replace pain, Dad never found out, but both basically meant botlboko.
At least half of Dad’s patients arrived with GBP – and later GBM – on their cards, expecting Dad to figure out the real source of pain, the details of which it was not unusual for patients to withhold deliberately.
And then, of course, there were the nether regions. Like bonna for penis, and marago, for anus or buttocks.
These were the focus of Dad’s concern as he examined the young man lying supine on the examination couch, smiling pleasantly as Dad prodded and squeezed and ran his hands from head to toe. Finishing the external examination, Dad reached for a glove to perform the rectal. He did rectals on almost all male patients, partly because prostate trouble was so common, partly because patients liked exhaustive examinations. In this case, Dad did suspect prostatitis.
The glove box was empty, and Dad sent Maria to fetch a new one. While he waited for her to return, he attempted to explain the procedure in Setswana. His patient looked blank. Dad tried again, adding gesticulations to his repetition of marago and mon-wana, which meant ‘finger’. This time the man nodded with comprehension.
Maria returned with the glove box, and Dad put on a glove and then sank his finger in some lubricant. When he turned back to the examination couch, the patient was lying, as instructed, on his side in the fetal position, but with his own finger thrust up his anus.
“Tell him,” said Dad, grinning at Maria, “that he’s got the right idea. And ask him if I can have my turn now.”
Maria, without a flicker of a smile, relayed the instruction, and the examination proceeded as normal.
Whenever anyone said to me “Are you going to be a doctor like your father?” I cited rectal examinations as the principal reason not to. Next was Dad’s advice never to become a doctor, and finally my own intention to become a vet, which would complement my career as a famous show jumper. “I won’t mind sticking my finger up horses’ bums,” I’d add, if I’d managed to keep the conversation going that long.
Dad said that performing rectal examinations was the least of his concerns about being a doctor. Much worse was the repetition, which, in his opinion, was just repetition, whether it was giving rectals, or injections.
Desperate to inject variety into his long days, Dad punned endlessly as he talked to his patients. His patients invariably didn’t catch the jokes, but Dad chuckled to himself, repeating the best ones to us when he got home. He tried, however, to restrain himself from joking more directly with the patients, who he’d soon d
iscovered were usually more offended than amused.
But the woman on his couch was somewhere between patient 75 and patient 100. Dad was exhausted, and when he slid the lung X-ray from the brown paper envelope, his instincts got the better of him. Stuck to the back of the X-ray, silhouetted against the centre of the right lung, was the desiccated carcass of a huge, squashed wall spider, legs splayed as wide as a teacup.
With a flourish, Dad held the X-ray up to the light. “Mma,” he exclaimed, pointing to the spider, “there is your problem.”
No interpretation was needed. The woman shrieked and slapped her hand over her mouth. For a few seconds she stared, wide-eyed, at the alarming outline, shaking her head incredulously. Then, recovering from her stunned silence, she spluttered ‘Ee!’ several times, before descending into a fit of soft chortles.
Dad smiled back, delighted his joke had been so well received. Peeling the spider off the X-ray, he told Maria to explain to the patient that the only problem with her lung was a bit of emphysema.
But listening to Maria, the woman, whose smile had disappeared, shook her head. She retorted with a barrage of angry Setswana. Ruefully, Maria explained to Dad that his patient insisted the spider be removed from her lung.
Dad told Maria to explain that the spider was a joke. As she did so, with the spider in one hand, the X-raj’ in the other, he brought them together and parted them several times.
The woman shook her head.
Maria said, “She says you must take it out.”
“I can’t take the damn thing out,” said Dad. “It’s not in there.”
Maria shrugged. “She says you must take it out, or she won’t get better.”
The woman watched Dad expectantly, clasping her breast above the offending lung. Dad told her to lie back on the couch and reached for a pair of long forceps. As she stared at the roof and said aaah at his instruction, he inserted the forceps into her mouth and wriggled them around at the back of her throat. Withdrawing them to just above her lips, he used his other hand to quickly slip the spider between the tips, and slowly raised it to eye level with the patient.