Call Mama Doctor

Chapter 5. Looking Fear in the Face

By Louise Jilek-Aall, M.D.

Once having experienced that I could manage on my own, I felt restless in Ifakara. It was quite lonely in the hospital in spite of all the activities there. I also discovered that one of the diseases I was to investigate was rare in the Ifakara region. Writing to several other places and inquiring about this condition, I received a positive reply from Igota, a mission a few hours drive away. The Father wrote that his schoolboys were indeed severely infested with parasites causing that particular disease and he would be grateful for any help I could offer. I could use the laboratory of the mission's dispensary. This would imply helping with the out-patients who were usually cared for by two young dressers trained in Ifakara.

I liked the proposal and discussed it with the nurse who visited there twice a month. She suggested I come along on her next trip. She would introduce me to the patients and let me take over for as long as I intended to stay there. I concluded my research project in Ifakara, and since I planned to be away for at least one month, I took all my belongings. I left Ifakara lightheartedly, not knowing then that apart from a few short visits I was never going to live there again. The research work I had set out to do in Africa was completed within the first year and from then on I became a traveling physician, the Mama Mganga who turned up and helped out wherever there was an urgent need for medical services. Once I had started this traveling consultation service, demands steadily increased and before I knew it, I was caught up in the immense task of providing medical services for the large area of the Ulanga district. My stay in Africa turned into a venture lasting much longer than I had planned, and for years I was going to live out of my suitcase. I became used to staying overnight wherever I had a chance, whether I had a bed or not. The mission stations always provided a roof over my head although it sometimes happened that I had to sleep on a mattress in the church or the sacristy where I would again encounter my friends the bats! Sometimes on safaris I slept in the open, protected by a mosquito net fastened to branches and guarded by African scouts. When we heard lions roar in the dark, they would seize their bushknives and look around, assuring me that they knew well how to protect me against any wild animals. The scouts also used to spread ashes from the fire around the legs of my field bed, to prevent ants from crawling up during the night and I always made sure this job was well done for I feared nothing in the bush more than the siafu, reddish-brown ants with powerful mandibles which bite fiercely and burrow into the victim's skin.

But I never ceased to love the safaris. They opened up a new dimension of human existence, the long-forgotten life of the nomad which my forefathers had also known when in ancient times they roamed the forests of Northern Europe.

At the small mission where I was to treat the schoolboys I was cordially received and I liked the place right away. My room was large and overlooked the plains. The howling of the hyenas and grunting of the hippos in the nearby river reminded me at night that now I was indeed in the middle of the African bush. Every morning I could hear the chatting and laughing of people waiting outside the dispensary. When I returned from breakfast, the two dressers had already begun their work and had prepared everything for me. Now it was my turn to head an out-patient clinic like the old nurse in Ifakara, examining and treating the sick and ordering tests. I was amazed how much the two young dressers were able to do in their small laboratory. With a microscope, a centrifuge and a few reagents they were able to diagnose the different types of malaria and most parasitic diseases. Patients were usually able to return home after having received their medicine but a few would be kept overnight in a small room adjacent to the dispensary. The seriously ill were taken to Ifakara hospital. My two assistants were easy-going, good-humored young men, thankful for every opportunity to learn and eager to discuss the problems we met with when working together. We were usually able to finish seeing patients in the afternoon. This gave me time for my research project, although I was often interrupted by late arrivals from distant villages.

The school was built on a hill close to the mission. It was an intermediate school for grades five to nine, and those who wanted further education had to go to secondary school at some bigger center. The boys, ranging in age from nine to fifteen, slept in two dormitories, about sixty in each. When I asked for volunteers for my project some hundred eager boys crowded the dispensary. Only forty boys were selected, but even that was more than enough candidates. The headmaster, a local man, accompanied the boys on their first day of treatment. He seemed to be somewhat apprehensive and asked for detailed information about the research and the treatment I intended to give his students. Reserved as he was, there was an air of authority and efficiency about him. I felt rather intimidated by him and could not figure out what he thought of my project. The boys showed great respect for their headmaster and whenever he appeared their otherwise unruly behavior became exemplary.

The illness which I was to investigate and treat was schistosomiasis, one of the most common parasitic diseases of tropical Africa affecting liver, kidneys and bladder. In order to prevent further infestation with the schistosoma parasites, I suggested that all students come to the laboratory for a lecture on prevention. The headmaster arranged for one class at a time to come for the lecture. He himself was present but never made any comment. It was a lecture the boys were not to forget, and it was amusing to observe their reactions when they looked into the microscope. Seeing the enlarged larvae racing around in the drop of urine, some boys jumped from their seats expecting to see these beasts crawling everywhere. Others uttered a cry of fear and did not dare to look again, and some did not dare to look at all. “Witchcraft!” they whispered. It took quite some explanation and persuasion before they overcame their apprehension. I had hoped my demonstration would please the headmaster, but he remained as reserved as before.

Many of the boys would hang around the dispensary all day long. Trying to get my attention with petty complaints and questions, they became a nuisance when I had to treat other patients. Finally we made a deal--if they would leave me alone while I worked, I promised to take time off every afternoon to be with them just for the fun of it. This was readily accepted but hardly respected, and since some of the boys on my project felt sick at times, I could not be too strict with the complainers. We had lots of fun after work, however. I could not help admiring the tireless enthusiasm of these children! They had an insatiable craving for knowledge. Many more boys than the school could accommodate wanted to enrol. I was told that boys who did not make it in the entrance exam cried for days and would persist in trying again. They would hang around the other students and try to learn as much as they could just listening to them. The mission staff always had a group of curious boys on their heels, eagerly observing and picking up anything they could learn. They investigated every car which happened to pass through and built exact car models of bamboo wood and other materials. On the school ground they laid out in an ingenious way a relief map of Tanganyika, constructing roads, bridges, towns, villages, mountains, streams, and now and then adding something new and building on to it. Observing all my moves they offered to do all kinds of services and run errands.

On sports days when villagers came to watch the games the boys would arrange festivities with singing, dancing and drama performances. Playing thieves and police, soldiers and officers in little sketches, they made the school yard resound with the laughter of the onlookers. It was difficult to say who enjoyed it more, the young actors themselves or their audience. They eagerly took up every game I suggested. Especially popular was our shooting competition with bow and arrow. The best marksman of the day received a prize which I had to come up with, and the boys always looked forward to seeing a new trophy. Once I brought a small ice-cube from the mission's fridge. The boys had never seen ice before and at first they dropped it with a cry of “Oh, it burns!” With big eyes they saw the cube disappear as it melted into water in their warm hands. Once they had overcome their fear, this prize became very popular, especially when fruit juice was mixed in.

As my treatment of the schoolboys was nearing its completion, the strain of it began to show. Any remedy aimed at killing parasites acts as a poison at the same time. The toxic substances of the dead and dissolving parasites enter the system and make the patient feel nauseated and generally sick so I monitored each patient carefully and varied the amount of medicine given according to his tolerance. Generally the boys were tolerating the treatment well and I began to breathe easier. Actually I was enjoying myself more than I had since I left Europe. Then suddenly everything began to change into a nightmare.
It started with a frightening experience and a dramatic change in the weather. The long dry season was interrupted by a short rainy period. Every evening for a few days, we saw dark clouds gathering over the mountains. Sheet lightning flashed over the night sky and we heard the rumbling of distant thunder. One day when I opened my medicine chest a green viper disappeared among the bottles. I pulled out my hand with a shriek, and unable to control a sudden panic, I jumped up on the table. People were startled. They must have thought I had gone crazy as I pointed to the cupboard, shouting words they could not understand. Someone ran to fetch the priest and when the people finally understood what was the matter they too became excited. They sent for a famous snake-killer, a man who brought a forked branch sharpened at the ends. Carefully and slowly he made his way between the bottles; I nearly fainted from fear as I watched. The boys later told me I had become as white as chalk. With a quick movement the man pinned the snake in the fork and triumphantly held up the still writhing reptile. It was indeed an extremely poisonous viper. I did not come down from the table until I was sure the snake was dead, and it took me a long time before I got over this shock.

To me the venomous snake seemed like a bad omen and together with the darkening of the sky and the heavy thunder clouds, it gave me an oppressive feeling of anxiety. Something seemed to be wrong with the boys too. In increasing numbers they came to the dispensary complaining of kichefuchefu, which meant nausea and headache. They looked worried and said they felt tired and had “pain all over.” Suddenly the land showed me a new and threatening face. The clouds grew even more menacing and one evening tore away from the mountains to come upon us with all their vehemence. We could see and hear the tempest approach us: a dark wall of rain and a roar like a waterfall. The wind swept across the dry land; a cataclysm of thunder and lightning broke loose. Everybody ran for shelter and I stood dazed and looked at the drama. But it was not only the weather that frightened me; the condition of the boys burdened my mind and heightened my anxiety. Some of them were seriously ill now. Examining them again I noticed that their livers were enlarged and tender. Many of the boys had fever and abdominal pains. Looking carefully at their eyes I found what I had suspected; the white of the eyes had taken on a yellowish color. There was no doubt the school had been struck by an epidemic of infectious hepatitis. This illness is endemic in the tropics and tends to flare up during changes of the seasons. Malnourished and feeble children are the hardest hit. Thanks to one of the Fathers who was a skillful hunter, the schoolchildren were provided with fresh meat most of the year. The students were therefore well fed and usually such an epidemic would end after a few weeks without any of the students becoming seriously affected. But the boys just recovering from the stressful treatment of their parasitic infestation could not well tolerate another disease on top of it. Their violent reaction frightened the other boys and made them more sick than they would otherwise have been.

Obviously my research work could not be blamed for the epidemic of hepatitis since many other boys were ill as well, but I still felt responsible. I could not help thinking that the headmaster also blamed me for what was happening. Sinister clouds and the flash of lightning surrounded me when I visited the boys in their dormitories. All the joy was gone from their faces. Like broken flowers they hung their heads and pressed their hands against aching stomachs. Over and over again I repeated to myself that it was not my fault, yet I felt shaky and guilty. I had to pull myself together and muster all my courage to call the teachers together for a meeting to discuss what to do. Was there reproach in the eyes of the headmaster? Nobody said anything which could be interpreted as criticism and all listened anxiously to my advice. As long as the boys complained of kichefuchefu and showed high temperatures and jaundice, they were to stay in bed. I would come to the dormitories twice a day with medicine and their diet. An adult person would have to stay with them all day, refuse visitors and watch that the patients did not eat anything or get out of bed. If any of the boys became worse I was to be called right away. Since the school had to be closed, the headmaster delegated the teachers to stay with the sick boys. Everybody went around in a gloomy, depressed and anxious mood.

In the days that followed I was barely able to work at the dispensary. My thoughts were constantly with the sick boys. Twice a day I went over to the school, distributing sugar-water and reconstituted milk with vitamins. It had been raining for days and with the rain came cool temperatures and gusty winds. The boys were shivering with cold and fever. Seeing the long rows of boys lying on their beds, wrapped up tightly in grey woolen blankets which also covered their heads, I thought with a shudder that they looked like corpses already. It was like a nightmare and I went around as if in a bad dream, startled out of it from time to time by the glaring lightning and the ear-splitting thunder which drowned the moaning of the sick. Never had I experienced such terrifying thunderstorms. Once I counted more than sixty flashes of lightning in one minute. People walking barefoot through rain and mud became afflicted with sores and wounds; they suffered from colds and coughs and many of them, especially small children, quickly developed pneumonia. Our facilities were overcrowded with patients and there was more work to do than ever before.

Even as the boys began to recover, I could not relax. Somehow I had lost my self-confidence. I caught myself trying to avoid the headmaster. He seemed to personify my feelings of guilt and inadequacy. I believed I could see disapproval and hostility on his face. The boys too had difficulties regaining their good spirits. Clinging anxiously to me as if I was their mother, they regressed to the behavior of small helpless children. They appeared particularly fearful at night and whispered into my ear about evil spirits haunting the dormitories in the dark. I did not understand them well, but when I asked the teachers about it they looked aside without answering and seemed scared themselves. Had the boys become emotionally disturbed? Another reason for anxiety. On Sunday at church I wanted to speak to the priest about my fears, but noticing that the headmaster had approached us and was overhearing what I said, I felt embarrassed and changed the topic.

That evening as I was sitting alone in my room tired and utterly discouraged, there was a knock at the door. A boy brought me a letter from the headmaster. My heart began to beat faster and I hesitated to open it. In my insecure state of mind I feared some sort of reproach; perhaps a suggestion that I had better leave for good. Finally I opened the letter with shaky hands and read:

Dear Doctor, Madam, you are so busy! I am extremely glad that you are so busy, not because I would like you to get tired, but because you are becoming so useful to us and humanity. I believe your profession is akin to mine in the sense that one has to offer one's heart for human-kind. And the joy one gets out of them is too deep and sublime to be experienced by traders and the like, so carry on with brave heart.

But what did you say, Doctor? You are afraid! What are you afraid of? Is the fright in your heart due to some strong tender feelings for your patients or something else? I am sure you know what you are afraid of. Understanding the fear and its cause, only one thing remains for a brave person as you are, that is to fear that fear itself. I hope it will not take long before you are able to conquer the fear, if you practice to fear the fear. Be all courage and no fear! Lo! You are doing a lot for Africa and Africans. Why are you so anxious? Keep up your head, Doctor! I know that advices are more simply said than followed, but this does not render them being said useless. Excuse me for writing this letter. I wanted you to know that you are not alone and that I am your friend.

For a long while I sat quietly. The sincere and touching words of the headmaster were balsam to my troubled mind. I read the letter again. It was shocking to realize how I had misjudged this man. I had projected my own feelings about myself onto him, seeing him as an unfriendly person quite different from what he really was like. Could it be that nobody blamed me for what had happened? As I sat there with the heartwarming letter in my hands I began to relax. A heavy load was lifted from my shoulders. The boys were on the way to recovery, there was no reason to be anxious any more. The headmaster was right. I should fear my own fear, the tendency I had of becoming intimidated and anxious when things did not turn out the way I wanted. “Be all courage and no fear,” the headmaster wrote. Maybe that is what courage is all about: to face threatening events, do what is humanly possible and not allow oneself to be overcome by fear when things take a bad turn. The headmaster seemed to know. He also showed me that in difficult times friendship is essential and that if one feels lonely it is due to self-imposed isolation. The next day when I saw the headmaster at the school, I went up to him and thanked him for his letter. He smiled and said, “Well doctor, the boys are getting better. Soon we can start the classes and then I will look after the boys myself.”

In the evening somebody knocked at my door again. This time it was the headmaster himself. He had brought his guitar and one of the younger teachers. They were wondering if I would like some entertainment. Since there was only one chair in my room they had to sit on my bed. They looked at each other and grinned while the headmaster fumbled nervously with the strings. With shaky voices they tried out a few melodies but were continuously interrupted by their own giggles and laughter. I thought they were exceedingly charming and was again amazed how I could have misjudged the headmaster so badly. Finally the two teachers cleared their throats and began to sing. Their gentle voices blended beautifully with the delicate tones of the guitar. I had to hold back my tears; it was rare that anybody thought of cheering me up. My enthusiasm encouraged them and their songs sounded livelier. Before they left, a warm feeling of friendship had sprung up between us and I asked them please to come again another evening. They did, although sometimes after a day's work at the school they were obviously very tired, especially the younger teacher, who often could not keep his eyes open. He inevitably fell asleep upon my bed. The headmaster would continue to play for a while and then start to talk. He told me about his life when he was growing up in a small village. I believe it was the first time that he had spoken so openly to a European. Noticing my interest in traditional African medicine, he revealed to me that his grandfather was a medicine man and that he was taught in this art because the old man had hoped his grandson would take over from him. But he had been too afraid of the powerful spirits of his grandfather and decided to leave home, convert to Christianity and train as a school teacher. He could never forget what he had learned from his shaman grandfather, however. He had experienced the supernatural power of the old people and seen how this power was used or misused.

Every time his friend fell asleep on the bed, the headmaster would tell me more of the secret lore. He talked about poison which medicine men could make move by itself. The poison would slowly creep forward on the ground and “snuff out” its victim, enter him unnoticed and make him sick. “Do you know about the zombi?” the headmaster once asked, lowering his voice so as not to awaken his friend. As I indicated my ignorance, he looked at me searchingly, as if to assure himself I did not laugh at what he was telling me. I felt uncanny under his piercing glance. “Well,” he began, “some medicine men specialize in black magic. We call such a person a mchawi, a wizard. My grandfather who was a mganga, medicine man, had to know something about their sorcery to be able to fight it. He told me that when a mchawi wants a helper to carry out his evil deeds, he secretly chooses a certain young man and poisons him. The poison makes the young man fall into a deep sleep. He becomes completely rigid so that his family thinks he is dead and buries him. In the night after the funeral the mchawi sneaks to the grave and digs out the man. He carries him to a secret hut somewhere in the bush. While the man is still in his death-like sleep the mchawi cuts out his tongue so that the man will never be able to speak again. Even when the poor man wakes up from his sleep the mchawi keeps him in a trance state. The mute man, now a zombi, is completely under the influence of his master, a submissive slave who will carry out any order the mchawi gives him. In a trance state, he is sent out at night on sinister errands of evil. He will blow poison into the huts of hapless victims or poor lethal medicine into their food or even crawl into their huts and put it into a sleeping person. People are deadly afraid of the zombi. Having already died, he cannot be killed by ordinary people. There are no ways they can harm him and their only protection is the medicine man or another mchawi whose power is greater. The zombi is doomed if he shows any sign of disobedience or tries to get in contact with his family. His master will let him die completely.” The headmaster ended his gruesome account and we both fell silent. “You know,” he continued after a while, “that's why the boys have been so frightened at night. They have seen a zombi in the dark, heard him stalking around outside, seen his dead-man's hand at the window, a shadow sneaking along the walls. Somebody wanted to harm them. It was the zombi who caused the illness they have been suffering from.” I thought of the howling wind at night, the sound of branches being thrown around, the hammering of raindrops on the roof and the scary thunderstorms. It was not difficult to imagine how the culture-bound concept of the zombi could conjure up threatening fantasies in the terrified children. I did not dare ask whether the headmaster also believed in the zombi's reality.

Fortunately for us all, the weather cleared and when the sun was shining warmly during the day and the moon brightened up the night, the thoughts of spooks disappeared. The boys, recovered from their illness, took up school work as eagerly as ever before and when I had to leave for other tasks the mission was again resounding with their happy laughter. Long after I had left this mission I received the sweetest letters from boys I had treated:

Dear Mama Mganga, I am very sorry to write this letter because I have no aim; so it is better to excuse me. Thank you for having treated me so well, but I am very, very angry just because you leave me alone for a long time. This is why I am very sad. I love you very much and now I do not know what I shall do with my loveness to you. Yours thankfully, Theodos.

Hullow dear doctor. I am your friend now, and the word 'Friend' means one who has kindly feelings towards one another, or a person whom one likes very much. Remember me doctor, I am not going to forget you until I die; remember me, remember me, send me only one book or two for medicine, I want to study them, I shall do the work which you do now. Your photo, I want to see it as quickly as you can. Goodbye my friend, yours faithfully, Ali.

One of the boys had asked to borrow my bicycle so he could visit his sick father in Ifakara. Sometime later I received the following letter:

Dear mother, I can start forwarding nothing than wishing to know about your present physique. Are you well? As regards to me I am still well together with my fat stomach and means of what I possess. The bicycle is all right, but it is somehow not in good order because the sponge of the saddle is not in good order and also one of the rubber of front brakes is off and lastly the cover of the valve of the front wheel went off while I was riding. But I have replaced a blue cover instead. I am very grateful because you borrowed me your bicycle; you may tell me anything which you would like me to do, or if at all you need a help from me. Please forgive me for bad English and wasting your time. Yours truly, Samuel.

Whenever I returned to the mission, the schoolboys would come running and greet me jubilantly, jumping around in sheer excitement. They flocked around me, grasping my hands and touching me, all wanting to talk at the same time. But none of the boys who had written letters revealed themselves to me in person. I guess they feared the teasing of the other boys.

Copyright © 1979 Louise Jilek-Aall
Reprinted with permission

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