Call Mama Doctor

Chapter 6. Dresser Ndogo's Tragic End

By Louise Jilek-Aall, M.D.

The so-called “dressers” of the medical service in Tanganyika were typical products of the colonial system. Not given enough training to be medical doctors, but having learned more about the use of medicines than the nurses, they were equipped for the purpose of helping doctors in rural areas. In colonial times medical doctors were mostly non-Africans and since there were never enough doctors to fill the needs of the medical centers, dressers often found themselves having to take responsibility far above the level they had been trained for. There they were, these young African men, working alone in small, badly equipped dispensaries out in the bush. Always in dire want of essential equipment, with only limited drug supplies and without a hospital within reach to send patients to, they had to treat even the most gravely ill patients and therefore worked under severe stress.

I greatly admired the dressers who worked for months on end without outside help, always watched with suspicion by their desperate clientele lest they keep the best medicines for their own family and friends and readily accused of malicious intent and witchcraft when treatment failed or patients died.

Their workday never ended; day and night their services were in demand. Few dared to take time off for their private lives, sometimes not even for sleep. Now and then a medical doctor or some government health inspector would bring in new supplies and stay for a while. The dressers would view these inspections with mixed feelings. Knowing little about the daily toil of the men in the field, the foreign doctor might criticize any lack of hygiene and orderliness in the dispensary; not familiar with the fact that few instruments and insufficient remedies were available, he would often make useless recommendations which the dresser was too polite to dispute, but had to discard for practical reasons. This would leave the dresser frustrated and insecure. Dressers working for the mission had an easier life. The Fathers would help them and back them up in difficult situations. The missions were also better equipped due to the many donations from physicians in Europe. Sensing the dresser's guarded feelings when I arrived at the scene, I used to think it over carefully before I suggested any changes to improve his work habits or treatment methods. The dresser was the insider who had accumulated experience and knowledge about the diseases common in his area and the best way of treating them with the few medicines available. I, as the physician, was the outsider who came with new ideas but with little knowledge of the complicated situations which develop when demand is greater than supply. Again and again I wondered how these anonymous heroes kept their spirits high. They always seemed to be ready to laugh and joke in spite of their hardships.

Dresser Ndogo was not like the others. He hardly ever smiled and his somber expression made me feel uneasy in his presence. I also noticed that his patients were afraid of him. But he seemed to know how to handle them and he kept his dispensary clean and in good order. Dresser Ndogo was a puny little man in his mid-twenties. He suffered from ill health and his big eyes had the air-hungry expression of an asthmatic. The first time I came into his crowded dispensary he stepped aside without a word and simply made me take over. I could hear his heavy wheezing as he stood there, looking with apparent interest at the way I worked. Having become used to his silence, I was startled when he finally spoke. There was something indefinable in his low, halting voice, but his questions were intelligent and much to the point.

There was something about him that made one hesitate to ask personal questions, but the Father in charge of the mission station told me that dresser Ndogo had suffered from asthma since he was a boy. At the mission school he was an exceptionally bright pupil and the Father had taken a special interest in him. Since both parents seemed to dislike their sickly son, the boy came to look upon the priest as his fatherly friend. The Father remembered how the boy had tried hard to please his parents, and that the mother had been especially rejecting, causing the boy much sorrow. The situation improved some when the boy earned money and sent her regular monthly payments. Soon after the boy had finished his training as a dresser, the Father was transferred to another outpost. But no dresser wanted to work there because the Wangindo tribesmen were known for their use of witchcraft and poisons. Not only did they employ cardiac toxins to kill game, their medicine men were renowned for their knowledge of all kinds of poisonous decoctions. It was said that they knew ways of making a person go insane, or of causing internal bleeding or other afflictions which would slowly kill the victim. Dresser Ndogo had been very upset when hearing that his friend the Father had to work among the Wangindo people and one day he turned up to share life at the remote mission station with him. Dresser Ndogo lived in a small hut by himself and nobody knew what he did in his spare time. He hardly made any friends and rarely ventured out among the people. But since he was a conscientious dresser who knew his trade well, people flocked to his dispensary and, although he was a stranger, he commanded a certain prestige among the tribesmen.

In the days that followed I found out that it was interesting to work with dresser Ndogo. In contrast to most of the others, he stayed with me the whole time when I treated patients. In his quiet way, he made me aware of many things I had not yet been able to pick up due to my scanty understanding of the language and customs, and he even allowed himself to smile at my blunders. I remember once getting angry with a young mother for bringing her sick infant in in a deplorably neglected condition. “Your child will die if you don't take better care of it,” I said. A commotion arose among the patients, and the young mother picked up her baby and left without letting me touch it. Later dresser Ndogo explained, “You must never say to a mother that her child will die. People can't understand your reasons for saying that. They think you want to punish the mother and that instead of curing the child you will kill it.”

Dresser Ndogo accompanied me every time I was asked to visit patients in their huts, even when it meant marching for hours through the bush after work. On these trips he hardly spoke a word and I could never figure out whether he came along of his own free will or because the Father requested it. His silence was probably due to his asthma which made it hard for him to keep up with me, but whenever I stopped to let him get his breath or offered to treat his asthma he turned hostile and sullen. One morning, however, I found him suffering from such a severe attack that he could neither move nor speak. I quickly prepared an injection and without first asking, gave him the shot. The prompt relief from the spasm that followed surprised him greatly and from then on he gratefully accepted my treatment. Gradually we developed a kind of friendship based upon respect and the task we had in common. Sometimes on our long journeys, especially if we were alone and his asthma did not bother him too much, he would ask questions about the world outside. He was greatly interested to hear how patients in Europe were treated. I remember he was very amused when I told him that asthma was not uncommon among white people.

In the region where we traveled I noticed that people appeared exceptionally scared when meeting me in the bush. Mothers would pick up their terrified children, two or three at a time, and dash off into the thicket yelling “Wachinjichinji.” When I asked dresser Ndogo what this meant, he became very embarrassed and it took a long time before he would explain: “People in this remote area have only vague ideas about the rest of the world. A few of them have been to a hospital. They return with weird stories about white people keeping human blood in glass bottles. Having had blood samples drawn for laboratory testing, they imagine that the whites use their blood for all kinds of sinister purposes. They believe that the ‘European birds,’ the airplanes, can only fly when given human blood as fuel. Fantastic stories are circulated about how the whites get the blood they need. People say African children in the bush are lured by Europeans with gifts; they are caught, blindfolded, strung up on trees, their blood vessels opened and the blood collected in glass bottles. Chinja means ‘cutting the throat--slaughter.’” I was quite shocked. How then did the sick dare to take my treatment and swallow my medicines? “The more dangerous a doctor the more effective his remedies.” explained Ndogo, the dresser.

Several months had passed when I was again asked to stay for a while at the same remote mission. I found dresser Ndogo looking more sinister than ever. In some ways he had changed and appeared suspicious and depressed. When he laughed, which I had not heard him do before, it sounded uncanny and cold. A heavy wheezing indicated that his asthma was getting worse. The Father told me that dresser Ndogo had planned to buy a bike so he could travel home for a visit. Since he wanted to go before the rainy season set in and made the road impassable, he had to save up his money quickly and had therefore neglected to send the usual amount home to his mother. One day an angry letter from her arrived which made him extremely upset. He carried the letter around not knowing what to do and finally showed it to the Father. “It would have been better if you had never been born,” wrote his mother, and dresser Ndogo shed many tears over that.

Around this time a young girl who had fallen in love with dresser Ndogo used to hang around the dispensary. Feeling more lonely and rejected than ever, he had finally invited her to come to him one evening but had apparently been unable to make love to her. This was considered a great disgrace for a young woman and the girl had left him in anger. Dresser Ndogo now began to feel people were laughing at him behind his back. He believed he heard somebody call him “the child,” which painfully indicated to him that his mishap was being talked about. He lost his usual grip on the patients and withdrew more than ever into solitude, hardly eating anything for fear that the food might be poisoned by the girl's family as an act of revenge. I felt very sorry for him and tried to boost his shattered pride by praising him and asking for his advice in front of the patients. This seemed to help and soon dresser Ndogo was almost his old self again.

On our trips through the bush, friendly people often offered us a drink of pombe. This nutritious home-brewed beer, made out of fermented rice, is contamination safe because of its alcohol content. Since one cannot drink untreated water in the tropics I was always happy to accept this refreshing drink. One day when passing a compound of huts we were invited in for the usual drink. Dresser Ndogo had just emptied his bowl and I stretched out my hands to receive mine when suddenly an old man snatched the bowl from me, took a sip and then politely returned it to me. From a dark corner rang the laugh of a young girl. Looking at her, dresser Ndogo turned ash gray. Gasping for breath and with a wild look in his eyes, he dashed out of the hut and ran down the path. Very much alarmed I followed him as quickly as I could. It was already getting dark when I nearly stumbled over his crouching body as I hurried towards the mission. He seemed to be scared out of his mind and was wheezing and struggling for air. It took a long time to make sense out of his mumbling. “I am lost! They finally got me! I am dying, there was poison in the pombe.” Cold fear gripped me but for his sake I tried to suppress it. I shook his shoulder, “Listen, I drank from the pombe too and I don't feel anything.” Dresser Ndogo wrung his hands. “No, no,” he moaned between his gasps. Had I not noticed how the old man drank from the beer first before offering it to me? This was the custom to demonstrate to guests that the drink was not poisoned. But nobody had tasted the drink they gave to him! He became aware of it when he noticed the girl in the corner. That girl wished him no good and now he was going to die. His eyes widened with fear and he trembled all over. I tried in vain to calm him down. We had both drunk from the same source, I said, and the old man would not have taken a sip of the brew had it been poisoned. But dresser Ndogo was inconsolable. His teeth chattered as he explained: “I have been told these people have a very strong poison which they can conceal under the thumb nail. Filling the bowl to the very brim when handing the drink to the person they want to kill, they inconspicuously dip the thumb into the brew. By drinking first, the old man wanted to show that he was not out to harm Mama Mganga, only the man who had disgraced his daughter.”

Dresser Ndogo was beside himself but I had to find a way to get him home. Making myself appear angry I said that was enough of this nonsense. It was all no more true than the wachinji-chinji stories; he should feel ashamed to let himself be scared like this. We were doctors ourselves and would show these people who had the stronger medicine. If he did not pull himself together, the asthma would kill him, if nothing else. I finally got him up and holding on to each other, we slowly proceeded through the dark. We were both badly shaken. My heart was pounding and besides fearing that a leopard or other wild animal would leap at us from the dark, I seemed to see strange shadows of witch-doctors lurking behind the trees. As soon as we reached the mission we woke up the Father and told him the whole story. He too tried in vain to calm the dresser, but nothing could take away dresser Ndogo's conviction that he was doomed. I finally gave him a sedative and we asked a mission teacher to stay with him through the night.

The next morning dresser Ndogo did not appear for work and fearing the worst the Father and I hurried down to his place. We found him standing in the middle of the room, holding on to the teacher with all his might. “He won't let go of me,” said the embarrassed teacher. “He won't let go of me,” repeated dresser Ndogo in a high-pitched voice. “What's the matter with you?” asked the Father. “What's the matter with you?” echoed the dresser. Whatever we said, he repeated it; whenever we made a gesture, he did the same. He seemed scared out of his wits, and as a bronchial spasm nearly choked him in his agitated state and did not disappear even with medication, we decided that he had to be taken to Ifakara hospital some hundred miles away. The teacher and the Father would go with him while I stayed to treat the patients who already waited at the dispensary. Just before the car left, dresser Ndogo came to his senses. He hung his head sadly and muttered, “You too want to get rid of me--I know you are sending me away, but I have done no wrong. Please don't leave me alone.” For a moment I hesitated. I thought it was better for him to leave this place for many reasons; he looked too sick, and I did not dare to treat him at this outpost. He turned away with a hurt but also suspicious look in his eyes, and I knew he felt rejected again.

In the days that followed I found it hard to keep my mind on the daily work at the dispensary. Everybody around me was upset and was discussing endlessly what had happened to dresser Ndogo. I could not understand much of what people said, but I could sense apprehension and fear in their behavior and agitated talk. On his return the Father reported that dresser Ndogo had been quiet during the long journey to the hospital. When people asked him where he was going, he replied passively, “I don't know where they are taking me.” But when he was handed over to the hospital staff, dresser Ndogo reacted with panic. He pushed aside doctor and nurses and ran through the corridors, fighting off anybody who tried to restrain him. He cried and shouted at invisible enemies until the whole hospital was in an uproar. There are few things the people feared more than a mentally deranged person. It was not physical violence but mysterious powers they were afraid of. Believing that the evil spirits which possessed dresser Ndogo could be dangerous for others, visitors started to leave the hospital, carrying away their sick relatives. The commotion was such that the hospital administration refused to admit and treat dresser Ndogo. His relatives were called in, and knowing that mentally deranged patients could be sent to the mental hospital, a fate which the Africans dreaded more than death, they decided to take dresser Ndogo home with them. They skillfully subdued the raving man, swiftly tying his hands and feet to a pole which they placed along his back. To avoid chafing the skin they placed cloth under the ropes. Feeling that he was immobilized, dresser Ndogo gave up the fight and again passively endured whatever happened. The relatives lifted him up by the pole, placed him upon a simple stretcher and carried him off to his brother's place, far away from the hospital. “Who knows what will happen to our friend now,” the Father ended his sad report.

When the first chance turned up to visit the area of dresser Ndogo's brother, I lost no time in hiring a local villager to take me to the brother's place, hoping that I could be of some help to my unfortunate friend. The guide told me that dresser Ndogo had become increasingly disturbed. Following traditional custom his brother had consulted a local medicine man who was to find out what caused the affliction and treat it. The medicine man had listened to dresser Ndogo's suspicion of having been poisoned, performed all sorts of incantations, and burned certain plants in front of the sick man. According to the notion that ears, nose, eyes and mouth open directly to the brain, the medicine man had blown incense smoke into dresser Ndogo's nostrils and ears. However, to the family's sorrow, he had voiced little hope for the patient's recovery. Yet dresser Ndogo seemed to improve after the medicine man's treatment, until his own father turned up. As soon as dresser Ndogo saw his father, he became acutely disturbed again so that he had to be restrained. Once more, they had called for the medicine man.

I found dresser Ndogo gasping for air in one of his severe asthma attacks. He stood in the yard, hands folded behind his head so as to expand his chest, fear in his eyes. His neck was placed in the fork of a thick branched pole, held there by a cloth bound around the ends. The lower end of the pole was tied to a rope which was again fastened around a tree, allowing the patient to move around but not to run away. His hands were loosely tied together over the pole so that he could not touch his body. This clever device prevented him from harming himself, but still left him enough freedom to use his hands above the pole. Dresser Ndogo looked at me and whispered between gasps for air, “Please help me.” The brother stood by with some other relatives, not knowing what to do. Deep sorrow marked his face. With one single shot of an antiasthmatic medicine, I was able to relieve the patient's agony. Dresser Ndogo sank to the ground. He dropped his head and tears trickled down his cheeks. “I'm coming with good wishes from the Father,” I tried to cheer him up. “He says you should hurry up to get well, he needs your help with all the patients.” There was a flicker of a smile. “And you and I, we will start to work with the microscope together,” I went on, remembering that he had wanted to learn more about lab techniques. He smiled again and hope seemed to light up his sad face. But his eyes wandered around suspiciously. Suddenly he grasped my arm. “Do you see that old man?” He pointed at his father who crouched by the hut. “He is not my father, he is an evil spirit.” Hearing this the poor old man withdrew further into the shadow. Dresser Ndogo pulled me closer. “He wants to kill me,” he whispered with desperation in his voice. I tried to reassure him and promised to visit him daily. But dresser Ndogo stared out into the air as if listening. Again fear was reflected in his face. “Don't you hear the water coming?” he murmured. “The lions roar, the drums are sounding. I cannot go home--the church bells are announcing my end.” He closed his eyes and seemed to fall asleep. His father made a move. Dresser Ndogo jumped up. “Stay away!--don't move!--don't kill me!” he yelled, and ran as far as the pole and the rope allowed. His brother and another man subdued him, untied him and carried him inside the hut.

Gently they placed him on a bed. Whilst talking to him in a soothing friendly voice they secured him tightly to the bed. Apologetically they assured me that the sick man would always calm down when restrained so that he could not move at all. Dresser Ndogo looked at me with wide open eyes. “You see what they are doing to me?” he said with a somber, hostile expression. No reassuring or kind word seemed to reach his frozen mind. When the sedative I gave him took effect, he fell into a deep sleep, sweat pearling on his forehead. I left in a downcast mood, but with the impression that the relatives really cared for dresser Ndogo.

During the following days it became obvious that dresser Ndogo would not survive. He refused to eat, thinking that all food was poisoned. We persuaded his father to leave since the patient seemed to fear him the most. But as soon as the sick man found his father had left, his anxiety intensified and we had to recall the old man. Dresser Ndogo now insisted upon having his father close at his side so that he could watch him all the time and prevent him from doing evil. When asthma attacks were choking him, dresser Ndogo had lucid moments, but when they eased off he became increasingly confused and hallucinated, until his mounting anxiety again triggered off another severe asthma attack. At times he would hold my hand and calm down, but mostly he did not seem to recognize anybody except for his father whom he watched with suspicion.

The end came after one of his exhausting asthma attacks. He died quietly, like a flame slowly going out for lack of air. It was just before the rainy season, during the week in which he had planned to travel home on his new bicycle to visit his mother.

Copyright © 1979 Louise Jilek-Aall
Reprinted with permission

[Previous Chapter]     [Contents]     [Next Chapter]

to top

Internet Mental Health ( copyright © 1995-2011 by Phillip W. Long, M.D.