Call Mama Doctor

Chapter 3. Becoming Mama Mganga

By Louise Jilek-Aall, M.D.

It was the first morning in my new room. I woke up from a restful sleep such as I had not enjoyed for a long time. It was indeed nice and cool here, compared with the sweltering climate of the coast. I had gone to sleep wondering about the swarm of hungry mosquitos hovering outside the net around my bed. There seemed to be thousands of them, and the buzz of their wings blended into a high-pitched monotonous song which helped me fall asleep. Now, looking through the window beside the bed, I could see where they had come from; there was neither glass nor protective screen and the fresh morning air gently stroked my cheeks. From the bed I could see the two towers of the church across the yard. “A--e--i--o--u, ma--me--mi--ma--mu”; it was a chorus of children's voices. I sat up in bed and looked outside. Beside the church was a small school house, or rather an open shed. I could see the curly-haired heads of the little children sitting in rows and facing the teacher, who was standing with his back to me, swinging his arms like a conductor. The sweet voices of the children taking their first English lessons were to wake me every weekday morning as long as I stayed in Ifakara.

My room was tiny; there was hardly any space between the bed, a table and chair and the old clothes cupboard. A small veranda gave me more freedom to move, but during the daytime it was too hot out there and at night the mosquitos made it impossible to sit anywhere but under the mosquito net. Downstairs was the dining room. Food was provided by the convent of which this old house was a part. The mission was in the process of building a new wing onto the convent, so the old house was allowed to dilapidate--and dilapidate it did! Every night bats and crows fought endless battles under the roof. With blood-curdling shrieks and loud scratching of claws and wings they rumbled above my head, sending down dung and dust from the ceiling. A layer of it covered everything in the room and had to be cleaned off every morning. I used to hold my breath when scooping up the mess; the awful stench of the bat manure made me retch. I do not think anybody knew the dreadful condition the room was in; it had been unoccupied for a long time, and nobody ever visited me there. Most of the day I spent in the hospital anyway, so I did not make a fuss about it.

On the first day, I began to unpack my equipment and to install myself in the research institute. But very soon my good intentions gave way to paralyzing frustration. I was simply unable to work. The unfamiliar environment, the many new faces, the language problem and the fact that the hospital staff was too busy to take time to explain things to me, made me feel like I was in a daze. How foolish one appears when unable to speak the language! I caught myself hiding in my lab, too embarrassed to venture through the hospital for fear of having to respond to questions. It was a shattering experience to find out that the Swahili I had taught myself on the ship was of so little value in real life.

The hospital complex, consisting of one-storey brick buildings, was spread out over a large area, each wing connected by a roofed walkway. The wards were always overcrowded and sometimes patients shared their beds with family members. Others slept on mats on the floor between the beds.

I could not make out who were the patients and who were the relatives or visitors. In the evenings people were sitting around small fires everywhere on the hospital grounds, cooking food for themselves and for their sick. The people would watch me with curiosity and laugh at my clumsy attempts to communicate with them. In my desperation I went to see the head nurse, an old nun who had worked at the hospital since it was founded some thirty years ago. Everybody in trouble turned to her, I was told. She listened patiently to my problems and at once had a plan ready. “Forget about your research for a while,” she said. “First learn about the people and their illnesses and acquire enough knowledge of Swahili to handle the patients.” She suggested that I start off by working in the hospital laboratory; the technicians spoke some English and could teach me Swahili whilst I worked with them. Moreover she invited me to spend the first morning hours with her as she conducted the out-patient clinic.

Sitting there beside her under the protection of the great prestige and respect she enjoyed, I finally felt at ease and began to grasp what was going on around me. Every patient coming to the hospital had to be screened at the outpatient clinic. Sitting at a long table with all kinds of medicines in front of her, the nurse examined each patient and decided what had to be done. With a score of helpers she was able to handle hundreds of patients everyday. Some received their routine medication, others were sent to the laboratory for tests, again others were referred to the dressers for injections or wound treatment or for fitting of casts. Those who appeared seriously ill might be sent for X-rays or other investigations and only a few had to be directed to the waiting room of the hospital's only physician. There they might wait for hours until the busy doctor could find time to examine them between operations and inpatient visits.

The technicians in the laboratory at first did not know how to deal with me and it took quite some time before they overcame their initial apprehension. I had to explain to them over and over again why I was there, how life had been in Europe and why I had come to Africa. As they later admitted it was only after I had passed their secret tests, such as sharing some food with them, helping them work overtime and laughing at their jokes, that they accepted me on an equal footing. Once that was achieved, they rivaled one another in teaching me Swahili and in telling me about their life in the bush. I could never thank the old nun enough for having guided me so well during this first month of my stay in Africa. Not only did I become versed in diagnosing the different kinds of bacteria, worm ova and parasites we daily discovered under the microscope, I also learned much about the people, their beliefs and customs from the three technicians. But that was not all; the head nurse took me along to assist her on the maternity ward where she attended to her favorite call--midwifery. With enormous experience, skill, and firm hands she delivered babies and trained young mothers to take care of their newborn.

I soon developed confidence in delivering babies and assisting her with complicated cases and she arranged for a small room at the entrance to the maternity ward where I began to see patients she sent me from the out-patient clinic with the non-infectious diseases I was to treat in my research project. At the same time I could keep a watchful eye on the expectant mothers. I liked it so well there that instead of returning to my bat-dung infested room in the convent I stayed on in the hospital until late at night. Since I was not part of the regular hospital staff and could set my own pace, I never discouraged visitors. People soon discovered this and liked to drop in, even if it was just to sit on the floor and watch me work. Sometimes one of the boys from the laboratory would join me there after work, helping me to translate what people said or telling me what was going on in the hospital. My room on the ward eventually became a meeting place in the evenings after the hospital staff had left. Only African personnel worked on the wards during the night. One European nurse was on duty and stayed in a house close enough to the hospital to be quickly at hand if called.

Amazing how the whole atmosphere in the hospital changed at nighttime! It was like two different worlds: the rational, highly organized world of the European physician and nurses dominating the scene and instilling confidence during the day, and the mystical, anxiety-charged world of the African bush taking hold of the people during the night. When the European staff left, dangerous spirits and the power of magic filled the darkness. People huddled together and discussed the events of the day. They thought of anesthesia as “making a person nearly dead” and the surgeon who could operate on the patient and make him come back to life again was a great magician charged with astounding powers. The people loved and feared him at the same time. If a patient did not recover as quickly as they expected, fear and suspicion would flare up. The relatives would anxiously go over what the doctor had said or done. Had the doctor smiled at the patient or frowned at him? Was he displeased in any way? Why did the patient not improve? Surely somebody must be responsible. Messengers were sent back to the village telling the medicine man about the patient's condition and asking for advice. Worried people taking refuge in my room whispered about poisoning and witchcraft. Maybe the neighbor who never came to visit was using black magic against the patient. Or perhaps the evil influence came from the patient in the next bed who was of a different tribe. Even though I did not understand everything too well, I felt the constant emotional stress the people lived under. It opened my eyes to a world of anxiety and I always remembered that part of the lives of the people whom I later was to treat in the bush.

Sometimes the medicine man would advise the family that the patient could only recover if taken home. Then the people would become extremely agitated and after debating for hours might pack up and sneak the patient out of the hospital in the dark. The same could happen if the patient felt he was going to die. People were afraid of dying in the hospital, I was told. They wanted to be at home where the proper death rituals could be performed. Much to the physician's dismay, it happened that a seriously ill patient under intensive care had disappeared by the time of the morning rounds. Silence would meet the upset doctor; nobody dared to tell him that the family had taken the patient home to the village because they were convinced that he was going to die.

I had been completely absorbed in my work at the hospital for a few weeks when one day my friend the Capuchin truck driver asked to see me. He waited at the hospital entrance with a bicycle. “I think it is a pity that you bury yourself in the hospital,” he said. “Why don't you look around a bit? Here, take my bike and go on trips sometimes,” and with a broad smile he handed the bicycle to me. A warm feeling of gratitude filled me when I was riding along seeing people live and laugh in the villages. He was right; I had forgotten life was going on outside the hospital walls. With joy I saw that some people recognized me. They shouted, “Jambo, Mama Mganga--How are you, Mama Doctor?” By now I knew how to answer, “Mzuri, asante sana--Very well, many thanks,” as I passed them on the bike. Mama Mganga was the name I became known by in Tanganyika. As a matter of fact I never heard my personal name for years.

One evening after work I again set out on the bike. I had been told of a bush fire burning somewhere in the vicinity and I wanted to have a look at it. I knew my way through Ifakara, but then the road turned off into the bush and became quite narrow. Without hesitation I kept up speed, enjoying the head-wind I created. Soon the sun was setting behind the trees, and the fire was still far away out on the plains. Should I dare go on? Perhaps a little further on I would have a good view of the fire. Suddenly I heard the rumble of many galloping animals; it seemed to come right in my direction. I jumped off the bike and looked around for somewhere to hide. But there was no time. A large gnu-antelope broke out of the bush right in front of me, followed by a horde of others. I stood frozen as the animals rushed towards me. There was a ditch at the roadside; the first animal cleared it with an elegant leap and all the others followed. One after the other they threw their heads back and jumped, their horns nearly touching their backs. They flew through the air, landing with ease on the other side, and continued their fleeting gallop without the slightest change in speed. What a sight! The strong smell of warm animal bodies increased the impression of power and speed. As I stood there dumbfounded I heard the stampeding of more animals. They were fleeing from the approaching bushfire. What if there were elephants among them ? It suddenly dawned upon me that I was in danger. I turned the bicycle and fled in the same direction as the animals, away from the fire.

There was a fork in the road which I had not seen on my way out. But there was no time to choose, I just hoped I took the right path. It was getting dark fast and I was alone in the bush with running animals all around me. I could see pairs of eyes flashing in the reflection of my dynamo light. It nearly scared me out of my mind, but I did not dare to stop because then the bicycle lamp would go off and I would be completely in the dark. I worked the pedals as fast as I could, holding on to the bike and desperately hoping I would soon reach a village. I must have taken the wrong way because the road seemed to lead nowhere. I began to feel exhausted; how long could I keep up the wild speed? But the sound of the fleeing animals drove me on and I pedaled with pounding heart and burning eyes. Just as I thought I could not make it any further I saw light through the trees. The road made a turn and ended in a court yard. A man was standing in front of a house looking out in the direction of the fire. He got a scare as I came racing into his yard and half fell off the bike, shaking and panting, unable to utter a word.

“Good gracious, young lady, what's the matter? What are you doing out here at night?” It was asked in English. “I. . .I wanted. . .to see. . .the fire,” I stuttered, still out of breath. “But alone and on a bike? Where on earth did you come from?” I was safe--here was a house and somebody who spoke English. My fears vanished and I could not help laughing; the situation seemed too funny now. “Would you like to come in for a cup of tea?” God Bless the English! It sounded like a formal invitation. All of a sudden I felt weak, and my bike rolled away and crashed into a fence as I sank to the ground. The gentleman, greatly concerned, helped me up and led me into the house. While I recovered in a deep armchair, he put on water for the tea. He left for a while, and when he returned he had changed from his work clothes to the obligatory British shorts and white knee stockings. Now it was my turn to be embarrassed. Covered with sweat and dirt and with my clothes and hair disheveled, I certainly did not look like a presentable lady. Gallantly he offered me his facilities and waited while I took a shower and refreshed myself; then we sat down for the tea party.

It turned out that he was an agronomist, living alone and experimenting with different methods of farming. Since he appeared ill at ease I did not ask why he was living alone far away out in the bush. His terribly formal manners made one feel that he was not used to company and he was probably wondering what to do about this female intrusion into his privacy. Therefore, as soon as I felt strong enough, I thanked him for the tea and asked him to drive me to the mission; I would not dare to go there alone on my bike. He was visibly relieved and brought out his landrover which had room for both me and my bike. Recovering his composure, he offered to drive me close to the bush fire since that was what I had set out to see. Again there were glowing eyes in the dark, but sitting in a landrover beside the man with his rifle, I was not frightened anymore.

We stopped on a hill overlooking the burning plains. The wind which had fanned the flames before had died down and in front of us was a carpet of glowing embers. From time to time our faces were lit up when the flames engulfed a tree or a dry shrub; then we could hear the distant crackling. But the bush fire had obviously spent itself. The agronomist told me the villagers had set the fire to burn the high grass on the plains. This was done not only because of the danger of wild animals hiding in it, but also because lightning would often kindle the dry grass and such a fire could burn out of control. Sweeping fast in the parched bush it could easily destroy villages, and burning quickly along the roads it might trap the people trying to flee. When setting a fire themselves the villagers skillfully used wind and water to guide its direction They would light the fire on an evening when the wind was weak and when rain might fall to help extinguish it after a while.

As we drove to the mission the Englishman told me about his own battles with fire and with wild animals. He had constantly to cut grass all over his plantation. To keep elephants and buffaloes from devastating his crop, he had to patrol his fields every night, chasing the beasts off and shooting those who persisted in coming back. By the time we arrived at the mission he had warmed up a bit and in a friendly manner invited me to visit him another time. Then he would show me his experimental plantation.

After this frightening experience I did not dare to venture far on my bike for some time. I spent more time in Ifakara where I was completely safe, even at night. I had become a familiar sight to the people and it was heartening to notice how they encouraged me to speak Swahili. I was told that when approaching a hut or people sitting in the yard, it was the custom to call out “Hodi,” meaning “May I enter?” Unless the people replied, “Karibu--Please come,” it would be bad manners and sometimes even dangerous to approach any further. When I passed the huts it happened that women would smilingly call “Karibu!” thereby inviting me to stay for a while. I would sit with them in the yard, looking on as they cooked their ugali, a porridge made of maize or rice, and watched their small children at the same time. A few chickens and dogs also belonged to the household. The women laughed at my curiosity and let me peep into their huts which were without windows and therefore quite cool even in the midday heat. They had hardly any furniture, only a few straw mats and perhaps a handmade bed in one corner. A small fire glowed in the middle of the floor; often an old grandmother would sit there tending the flames. Every morning when I went to the hospital children, who now were used to me, came running. They laughed and played around, trying to catch my attention. Mothers, on the way to the hospital would reprimand them requesting that they behave properly.

Usually people were friendly, and I began to feel at ease with them. Not so, however, when encountering Masai tribesmen. They belonged to a nomadic tribe roaming the steppes around Kilimanjaro. To me, they seemed to be a personification of Africa: enigmatic and beautiful. These pastoral people with their large herds of cattle often suffered from bovine tuberculosis and tape worms and would walk hundreds of miles to Ifakara to get the best treatment then available. Tall and slender, the men had a proud bearing and looked at any woman with daring eyes. They had a strange way of walking, as if constantly wading through high grass. They moved along slowly and graciously, raising their heads haughtily and holding their long spears with a firm grip. It was said that a Masai boy was not allowed to marry before he had killed a lion with his spear. The much smaller local people kept out of their way. They disliked and were afraid of the Masai and did not permit them to put up their tents in the villages. The Masai women were never seen unaccompanied by their men. They were very different from the local girls and were heavily laden with copper ornaments. Numerous thin copper rings were added together to make broad bands of metal, tightened around arms, legs and neck. Once in place, these rings could never be taken off again, and used to create a big headache for the technician at the hospital when he had to take chest x-rays of the tuberculosis-affected women. At least one helper had his hands full trying to lift up all the copper rings in such a way that they would not obscure the pictures of the patients' cavernous lungs.

When these proud people came to the out-patient clinic, tension was stirred up among the local patients. Towering above all the others, the Masai never waited his turn but walked right up beside the old nurse and without a word stretched out his hand with the clinic card. At first, only seeing the hand, she called out annoyed--“Await your turn!”--but when the hand did not disappear she looked up and met the challenging eyes of the Masai. “O.K., here is your medicine,” she said, lowering her voice to avoid a confrontation. She knew from experience that if a Masai felt insulted or provoked, he would swell like a turkey cock and suddenly tear apart his clothes to expose his male attributes--the Masai gesture of aggression towards women.

When Masai passed under my window in the morning on their trek to the hospital, I could hear the copper bangles of their women clanking with every step, as if they were prisoners walking in chains. Were they not? I often wondered.

Copyright © 1979 Louise Jilek-Aall
Reprinted with permission

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