The early afternoon sun was blinding as we stepped out from the Medical, Dental and Allied Professions Council office in Zimbabwe’s capitol, Harare. My wife Robin and I were elated.
I was brandishing an elegantly calligraphed, temporary medical license. The last hurdle between me and my fantasies of being another Albert Schweitzer – and taking up the offer from The Association of Church Related Hospitals who had told us the need for a replacement for a doctor who wanted time off from St Luke’s Hospital in the hamlet of Lupane in the northwest of the country.
This was on a trip celebrating my completion of a medical residency program in New York. I had to do two years of “purgatory” as a pre-requisite for moving to, and practicing in the US - despite having been working as a doctor for 13 years already in England .
We had spent 4 months journeying from Europe, through Egypt and down through east Africa, and it was a red-letter day when we were finally on the train from Livingston, in Zambia, to Harare, over the famous Vic’ Falls Bridge, high above the Zambezi River, and just upstream from the “the smoke that thunders” created by the 5,000 foot cascade of Victoria Falls – a spectacle that somewhat dwarfs Niagara dare I say it.
We were following the footsteps of my mother’s rebellious brother Guy, who had been imprisoned then deported by the Smith regimen from Rhodesia (as it was then), for running a multiracial farm where whites and blacks worked together and were paid the same - in contravention to the apartheid regulations.
He had been seen as an ally by President Mugabe after independence, and is the only white man buried in Hero’s Acre in Harare - though I fancy he would be turning in that grave if he could see what had become of Mugabe and the freedom fighters.
It was a bit early for a beer, as we walked down Harvey Brown Avenue, so to celebrate we opted for the inviting shady terrace of the Spring Fever Café, taking a table next to a couple of classic white colonial Zimbabweans, he in khaki shorts and bush shirt smoking Everest cigarettes. She in a ‘50s style floral dress.
Overhearing that we were obviously visitors, they struck up conversation, and we went through the usual “where are you people from?” They then asked us about our plans. I proudly showed them my license and told them our plan to be medical missionaries and work at St. Luke’s in Lupane.
They looked dubious.
“Lupane?” they confirmed.
“Yes. It’s some place on the road from Bulawayo to Vic’ Falls.”
“Yes, yes,” the man said. “But you know that’s in Matabeleland?”
“Matabeleland?” I repeated. “No, this is in Zimbabwe,” I said, thinking these were a couple of burned-out colonials, probably too fond of the G&T.
“How long are you going to be there?”
“A couple of months or more,” I told them.
They looked even more dubious. He stubbed out his cigarette. She smoothed the hem of her dress.
“Matabeleland is the tribal lands of the Ndebele,” the wife told us. “There’s still a lot of fighting,” she said, looking at Robin, who was playing with her napkin in an anxious way.
“Fighting?” we asked. We were aware there had been a lot of fighting during the War of Independence, but independence had been won ten years ago.
“Really? There’s still fighting going on in Zimbabwe?” I followed up.
Seeming like anxious parents they explained how Mugabe and the governing Zimbabwe African National Union - Peoples Front (ZANU-PF) are all from the Shona tribe and the area of the country around Harare, and included the vicious, North Korea-trained, 5th Brigade. But Bulawayo and Matabeleland are the domain of the Ndebele tribe, and opposition leader Joshua Nkomo, with the Zimbabwe African People’s Union (ZAPU).
“Just recently there were six tourists abducted. Taken as hostages by insurgents on the Bulawayo Vic’ Falls Road while on a safari,” they continued. “They were all killed in an attempted rescue.”
“I’d give it a miss if I were you,” the man told us, as they rose to go.
Foolhardy or otherwise, we swallowed our misgivings, and found ourselves on the night train to Bulawayo – and took comfort in the old-fashioned rolling stock reminiscent of my childhood in England, and tea served on linen tablecloths.
It was like the school kids we’d seen in blazers and straw boaters. All “more British than the British” – like I’d seen in India, Burma and Kenya.
Arriving at Bulawayo, we were tired and disheveled and met by Thomas, the hospital’s gofer, sent to drive us to St Luke’s in the hospital’s rather decrepit Austin van. A trip along pot-holed roads through an arid, red dirt landscape dotted with scrubby thorn trees and what looked like shanty towns of houses with cinder block walls and roofs made of beaten-out oil cans, but which Thomas assured us were middle-class dwellings.
It was late afternoon when we turned in through the heavy iron gate to the hospital’s walled compound. The staff were in a screened gazebo – grandly called “The Summer House” - having tea.
This implied a degree of civilization I thought.
We were welcomed as conquering heroes by the staff, but especially by Dr. Johanna Davies, who had founded the place in 1947, following her imperative as expressed in her autobiography “to practice for the poor, following the call of Christ,” and who, slightly stooped in her white coat, looked care-worn and older than her 66 years. She was surrounded by nurses, and nuns from The Sisters of the Precious Blood - an order founded in Switzerland that vowed that not one drop of Jesus’ precious blood “would be spilled in vain.”
We were given the royal tour, round a collection of whitewashed buildings that housed chaotic wards, segregated only by gender, rather than, as in the “civilized” world, by pathology. Beds with two patients head-to-toe. Others under the beds – who had to be coaxed out, like a hermit crab from its shell, to be examined.
More camped out on the cloistered walkway and on the scrubby lawn by day – making the patch of ground outside the obstetrics ward, with colorful dashiki’s and sheets drying in the sun, look like a refugee ship.
This was how a hospital built to house 250 patients, regularly accommodating nearly twice as many. “How can we turn anybody away?” Dr. Davies asked plaintively.
Then every patient needed a friend or relative as attendant - often seen bent over the fire pit, worrying a mess of steaming Sadza (the local version of a mush made from maize/corn flour) in a blackened saucepan – often with a baby strapped to their back.
Dr. Davies saw us looking at a photograph of an elderly white lady hanging on the wall of the entranceway.
“Dr. Johanna Francesca Decker” she told us wistfully – and explained she was another German woman mission doctor, but who had been shot and killed when the hospital she ran was attacked by insurgents and burned down. And who Dr. Davie’s says she wants to be buried beside.
Finally, tired, and anxious, we were shown to the guest bedroom of Bernard – the youngish German surgeon who we would be standing in for. But not without being introduced to their ferocious pet monkey, Mozart, who we would be baby-sitting, and who was quick to bite anyone too slow with the next peanut.
We lay on the bed, listening to the unfamiliar sounds of the night, discussing just what kind of a mess we had got ourselves in to. My diary entry of that day noted Robin being “in a suicidal depression.” And complaining of landing in a community of “dried up old cunt-heads” – as she put it with her acerbic, Jewish, New York way.
Next day, we found each part of the day punctuated by the ringing of a “gong” made of a piece of truck propeller-shaft. This mostly meant meals - morning tea, lunch, afternoon tea, then supper.
Though we felt a certain discomfort at all this eating, when we learned the government forces were using starvation against the locals, and we saw pot-bellied kids with stick like limbs being admitted to the hospital to be fed.
My entire training and orientation took place the next day with Bernard – seeing 160 in-patients on the wards on “rounds” – but which often times was nothing more than a passing nod, like to the elderly guy with leprosy, camped out for years, with his bed on one of the covered walkways.
He showed me to two elderly women, sitting side-by-side, with massively protuberant stomachs, looking like pregnant twins - but for their age and their sallow complexions.
“They have what in Germany we call ‘aszites,’” Bernard told us. “I don’t know in English”
“Ascites?” I volunteer, “from cirrhosis?”
“Ah, yes. Is cirrhosis.” He exchanged a few comments with the nurse, who translated to the women, who held their abdomens and looked pained.
Later I got to do a “paracentesis” on each – drawing off several liters of straw-colored turbid fluid - with a none-too-sharp and probably non-too sterile, large bore needle, a giant syringe and old newspaper for what should be sterile drapes. A procedure that would normally be done in a super-sterile OR or radiology department, because of the grave risk of contaminating the culture-medium like fluid, and causing catastrophic peritonitis.
Two other women sat with plaster castes on the forearm, and on Bernard’s prompting demonstrated how they got injured, holding their arms over their heads, as if warding off blows.
“It is the Fifth Brigade trying to get villagers to tell where the insurgents are” Bernard told us “or it’s the insurgents trying to make them not.”
Then on to a cement block room, with the charm and comfort of a bus shelter, that was the clinic building, with a few metal chairs for the patients and, and a desk for the doctor.
My big anxiety in taking on this job of “muzungu” doctor (“muzungu” being the Bantu term used to for whites – which literally means “someone who wanders aimlessly”) was of seeing patients with things like Kalar-Azar, Bilharzia, Tsutsugamushi fever, schistosomiasis - tropical diseases and parasitic infestations we had to learn about in medical school – and promptly forgotten immediately after graduation.
My fears were never realized – instead there was trauma – albeit sometimes exotic. Like the man who was bitten by a crocodile. Or the guy who spent two days on the bus getting to the hospital, after an argument with his neighbor who had stuck him through his axilla with a spear. The hole in his chest wall put him in imminent danger of having his lung collapse.
But he was the beneficiary of some ingenious “bush medicine.” Rather than a chest tube and an under-water seal, which the hospital didn’t have, he was patched with duct tape to stop any leak.
Similarly, in another ingenious thinking-outside-the-box episode, confronted with a 7-year-old girl with bad burns from falling in the cooking fire that needed debriding - a painful process normally done under general anesthetic. But no proper anesthetic was available. What was available was a bottle of cough medicine – that contained codeine. With a carefully calculated dose, she dozed peacefully in her mother’s arms while her burns were debrided and dressed. And she never coughed once.
I was amused by one four-year-old with a nasty abscess that needed draining. As the attendant held him in a firm embrace, and I incised the abscess, together with his screams and protests, he threatened, according to the translation by the attendant, “I will tell my grandfather.”
Then in addition to these injuries I was impressed with how much of the illnesses we saw was tied to procreation.
Women with complications of pregnancy. Or women with a form of psychosomatic abdominal pain from not being ableto get pregnant. Men - often scary soldiers in battle fatigues with automatic rifles – complaining of “the drip drip.”
Not a sinus infection I found out. Rather, a lurid name for the urethral discharge of gonorrhea – caught while trying to procreate.
Probably commonest of all illnesses was people of both sexes and all ages with dizziness, aching, cough or vomiting – a combination considered a sin-a-qua-non of malaria. They were admitted and dosed with antimalarials – but I loved the brevity. The admission “history and physical” was a scrap of paper on which I would write “Malaria, chloroquine.”
An all-too-common scene was a variation on malaria. One of the large red and yellow local buses that would drop boluses of patients at the hospital gate at odd times bringing some mother with a lethargic or comatose child – a sure sign of cerebral malaria.
Though Sister Anna – Dr Davie’s sister, who had been a nurse in Germany and had also answered the call to “do the bidding of Jesus” – was often to be seen apoplectic with rage, at the cot-side. Angry with the mother for taking the child to a n’anga first.
These native healers would give the kids “muti” – their home made medicine, that Sister Anna claimed was poison.
I was interested to find out more about these supposed healers – though the claim was they could also caste harmful spells. The locals had a distinct respect, if not fear of them.
When Thomas was going into Lupane market, we asked if he would take us to meet one.
Though usually resourceful, for some reason Thomas was never able to find one for us to meet. As a second best, he took us to a muti shop – a kind of demonic pharmacy.
There were scary carved wooden masks on the walls. Strings overhead with mummified carcasses of unidentified rodents and toads that got entangled in our hair. The back wall was lined with jars that looked like they should be full of candy or bath salts, but instead held sinister looking fungi, seed pods, and more animal carcasses. It all seeming to reinforce Sister Anna’s claim that “all muti is poison.”
Another part of my duties at St Luke’s was to go to the outlaying clinics – driving over rough terrane where there often was no road, in the local health departments Land Rover. Much of this was doing well child checks – primarily weighing babies to see if they’re “falling off their growth curve.” Screaming infants, suspending in a basket under a hanging scale like a prize pumpkin.
It was hard convincing parents they hadn’t “caught” malnutrition or been cursed, and all they needed was more food. The ones that were really bad got brought back to the hospital to be admitted and fed - a brown concoction that looked like semi-formed stool, made of peanut butter, milk powder, oil, sugar, minerals, vitamins and protein - affectionately known as Plumpy-nut.
I was rather horrified to find my duties also included dentistry – dentists and doctors always being two completely divergent tracks in the “civilized world” so I had no experience of teeth.
I was introduced to Sister Regina, another nun, but designated as the dentist – maybe because of her bulk. Built like what the Australian’s would describe as “a brick shithouse.”
Behind a screen made from an old sheet, she had in an old, ragged, dental chair with a very apprehensive looking a middle-aged man in a Grateful Dead tee-shirt, ragged pants and no shoes who needed a tooth removed. She showed me how to infiltrate with local anesthetic –emphasizing its cost, and the need to use as absolutely as little as possible.
Grasping the offending tooth with dental forceps, she heaved back and forth, until surfacing with a look of triumph, and a bloody tooth. “It is very necessary to have the horsepower, doctor” she told me.
I was surprised and pleased to find that – providing the tooth didn’t disintegrate - pulling teeth was not so hard. Probably dentists play it up.
With all this, I was quite enjoying myself – being the Daktari. The bush doctors. But Robin was becoming restless - and perhaps a little resentful of my playing the hero doctor while she rolled bandages or counted pills. But when the nuns teaching the barefoot doctor’s - usually young males – at the school that was part of St Luke’s, told her about their discomfort at the next part of the curriculum they had to teach, she showed interest.
Male genitalia was the stumbling block. But Robin offered to take the job on. “Something I know about” she explained.
Seeing the starving kids and the locals with their injuries from being beaten, as well as the stories, like how one of the nuns had her front teeth knocked out with a rifle butt. Another had the electrics of her car shot up by a soldier looking for insurgents, and, of course, the picture of Dr. Johanna Decker, all reminded us we were in a war zone.
I got a little antsy when a police patrol barged its way into the hospital compound uninvited, but Thomas told me “The police are our friends. They are protecting us from the army.”
Then I got justifiably antsy when an armed personnel carrier, looking like some prehistoric animal with a carapace of steel, rumbled into the compound. This was the army.
I was having a bit of a break and taking some pictures around the hospital as mementos at the time. I took a discreet photo of this vehicle, thinking it would be an even better picture to use for bullshitting to my friends when we got back home.
At that moment I found myself confronted by a slightly wild-eyed soldier who appeared from nowhere. “You took a picture of the vehicle. That is not allowed,” he told me in a hostile way.
I had recently read Alexandra Fuller’s book Let’s Not Go to the Dogs Tonight about growing up in Rhodesia, and living through the war of independence as the rebels fought the white Rhodesians.
Her wonderful and emotive book gives a good feel for the fear of the Zimbabwean freedom fighters. She describes how heavily armed rebel soldiers would turn up at their farm, often drunk or high on marijuana and very unpredictable.
These thoughts unnerved me more. I found it impossible to judge just how much authority this guy had – or how intoxicated and violent he might be.
“No, no,” I lamely insisted. “I was just taking a picture of the hospital. . . . . Just the buildings,”
“You, give me the film,” he said, holding out a large brawny hand.
“I didn’t take a picture of the vehicle, really,” I told him. “Just the buildings.”
“Give me the film,” he repeated, looking more threatening.
It was a standoff worthy of a spaghetti western. We were glowering at each other, neither quite sure how much authority the other had.
At this point the personnel carrier started to slowly make its way toward the gate. Rather than stay behind in his attempt to force me to give him the film, to my relief, he marched off to get on board.
I was beginning to think it wasn’t a case of bullshitting when we got home, but if.
Not finding myself in some Zimbabwean dungeon, I plodded on, getting more comfortable about dealing with the different medical issues – and able to see a good proportion of patients, which was necessary as Dr. Davies, famous for her dithering, and indecision, and who Robin had christened “a Flatterkopf,” was painfully slow.
I got the impression that Bernard, who was a decisive surgeon type by all accounts, would see very much the lions share. The concern was, with him being away, what was going to happen if anyone needed surgery.
We’d got away with it until now – but patient Precious Ngadya changed that.
She was around 16 years old, pregnant, and arrived on her own on one of the buses. She had a note from one of the nursing outposts, “Due date, -full term, repeated bleeding vagina.”
Succinct, but enough to fear she had a placenta previa – a complication that can cause catastrophic bleeding if the woman goes into labor, and which requires a C-section.
She looked pale – but it was very common for pregnant women to be anemic due to poor diet, blood loss from intestinal parasites like hookworms. And of course, that ultimate parasite that nature has arranged to get preferential treatment over the mother for nutrients like iron.
After a tense discussion the only path seemed to be for us to section her. Dr. Davies told me she hadn’t done a C-section in years, and she insisted she would be my assistant.
I had done various very minor surgical procedures as a junior hospital doctor in England and had observed several C. Sections – but the idea of doing one myself, of cutting through this woman’s abdomen, finding her uterus, hacking that open to deliver the baby was a very different proposition.
However, I found myself standing side-by-side with Dr. Davies, scrubbing up together at the sink in the sluice, as the nurse infiltrated Precious’ ripe abdomen with what seemed a totally inadequate quantity of local anesthetic.
Taking the scalpel, I hesitantly cut a large, crescent shaped incision – being reminded that human skin is a lot tougher than you might think. Tying off the bleeders as quickly as possible with Dr. Davies’ help, I found the lower pole of the uterus.
You might think a pregnant uterus is like a ripe fruit. One nick and the baby would just pop out – like the scene in Alien. In reality, I was having to saw through the thick muscular wall – careful not to stab the baby within. Trying to get away with as small an incision as possible, but big enough to pull the baby through.
A turbid gush of amniotic fluid poured out when I penetrated the amniotic sac. Then I was fishing around trying to get a grip on some part of the baby. Finally, I got a grip on the head, and though hard to keep hold of, was able to gently winkle it out through the incision.
After checking there was no umbilical cord around the neck, I applied gentle traction, bending the head and neck first one way to get one shoulder out, then the other, extracting this thing that looked like a cross between an alien and Golem.
At this point, everyone heald their breath.
It was a boy, and he was laid on a -probably not very sterile – towel and rubbed vigorously. Seeming to realize that it was an inevitability that he has to forsake the warm, safe environment in-utero, for the big-bad world outside, he started to scream bloody murder.
And at that point, everyone else began to breathe again – then there were whoops, hugs, high-fives and ululations. The slimy, blue-black thing, covered in white cheesy vernix and meconium (fetal poop), was handed to the mother, who smothered him with kisses.
This was a bit of a grand finale, as it was time for us to stop being missionaries – which, for the two most agnostic people in the world, was a bit of a joke anyway.
We were offered a ride to Bulawayo by Dennis, a Texan mining engineer who was advising the government, who had been doing some business in Lupane. We were sad to leave, even Dr. Davies – who was effusive in her thanks. But glad to be finally moving out of this war zone.
Dennis arrived early the next morning, looking immaculate in freshly laundered bush shirt and pants – at least in comparison to our travel-weary attire. We threw our packs, and a few other assorted souvenirs, into his white Toyota Land Cruiser, and were off on another spine-jarring ride on pot-holed roads and more arid red dust landscape.
Our trip was congenial enough – until Dennis started in.
“Apartheid was the smartest thing the Rhodesians ever did,” he told us waving his hand for emphasis. “Look at what a cockup these ‘muntus’ have made of the farms they’ve taken over . . . . .It’s the same over the whole of Africa” he told us – too focused on the road to see the horrified glance that Robin and I exchanged.
It made me think of Alexandra Fuller writing about how her father and his buddies talked about how you could never teach the blacks to farm properly – an idea that uncle Guy, with his multiracial farm, had demonstrated was patently untrue.
Dennis’s attitude bugged me. True we had seen evidence of some of the infrastructure degenerating, and heard people complaining about the endless tribal wars and corruption. But, apart from a veneer of 21st century like TV, and even a McDonald’s in Harare (the epitome of progress), just one or two generations ago most of Africa was in the stone age.
It took Europe a lot of time and wars to get to its current level of civilization and achievement. And the colonials didn’t exactly fall over themselves to educate, share resources, or follow policies to help the indigenous population – a great example of which we saw with maize/corn now being the staple food source. But an imperfect one being deficient in a variety of vitamins and minerals, that if not supplemented, will lead to pellagra.
We saw kids looking like Save The Children advertisements with stick like limbs and pot bellies. But they also had some of the symptoms of pellagra - typified by “the four ‘D’s” (dermatitis, diarrhea, dementia and sometimes death).
To try to reverse this, the hospital staff were showing mothers how to grow traditional crops like finger millet (known as “rapoko”), pumpkins (smushed into an orange goop called “nhopi”) and ground nuts in a Nutrition Garden, to supplement the Sadza diet.
I gather maize became so popular because it is easy to grow, and easy to store, so was an ideal food for slave ships.
From Bulawayo we journeyed on to South Africa, Australia, and across the Pacific back to the US. I finished up joining The Pratt Medical Center at the north Stafford office and settling into medical practice and the muzungu life in the “civilized” world.
It was then that some of the significance of what we had experienced really came home.
Compared with the people I was now treating, the African’s seemed to have great natural immunity – like the guy stuck with a spear or the kid with the abscess we drained who threatened us with his grandfather. They both bounced back in no time - maybe that OTT hygiene of our society with antiseptic impregnated toilet seats or wipes for the handle of your grocery cart had something to do with it?
I missed the ingenuity of “bush medicine” and marveled at the lack of common sense of the new recruits to our medical group – who have had to go through years of training, but who still seemed to end up complete idiots. Would they have had the ingenuity to prevent a collapsed lung with duct tape, or to use codeine cough medicine as an anesthetic?
There was also the satisfaction that all we did was of immediate benefit to the patient. We weren’t ordering tests for fear of malpractice suits, or fighting with insurance companies over pre-authorizations. No computerized medical records with ten-page admission notes. No HIPPA regulations. No DEA. None of the other innumerable aggravations that make medical practice in the “civilized” world so onerous.
Practicing in a completely different culture helped me broaden my empathy, communication, cultural sensitivity, and compassion – especially giving me a better understanding of the cultural influences of my African Americans patients.
I was also intrigued by the influence of the n’angas and the power of belief – which I found is also a significant factor in treating patients in America.
I was already aware of the placebo effect of medicines, but the n’anga’s themselves seemed to have a strong placebo effect – enhanced by being dressed in animal skins, tusks, horns and other “terrifying objects.”
It was Robin, whose father, like mine was a psychiatrist, who suggested “if doctors in the US, and especially psychiatrists, would only dress in skins and terrifying objects they could really enhance their placebo effect.”
As we drove off with Dennis, we had mixed feelings. But, unknown to me, we left with a memento of our time and our simple life style and boredom at St Luke’s.
In Johannesburg, Robin told me she wanted to go shopping, but didn’t say what for. “Why don’t you stay here and catch up on your diary” she suggested (my insistence on needing solitary time to compulsively record our trip had been something of a bone of contention - so this seemed a little out of character).
When she came back, she went straight to the bathroom. Then came out brandishing a test strip – very like the ones we have all become so familiar with, when testing for covid.
Instead of the red line indicating covid though, this was a pregnancy test – and it was positive.
Conceived amongst The Sisters of the Precious Blood, our first child, Tegan was on the way.
