Call Mama Doctor

Chapter 7. The Children of Ngombe

By Louise Jilek-Aall, M.D.

The dry season was nearing its end. On the slope of the Mahenge mountains where the Ruaha mission stood, the thick tropical forest held enough moisture to keep the trees and plants lush and green. But on the plains below, the leaves were withered and the grass turned brown. Fire swept through the dry grass, blackening the bush and leaving the plain naked and even drier than before. Frightened by the smoke and uncomfortable without the shelter of the thick bush and high grass, the wild animals roamed restlessly over wide areas, gathering towards the evenings at the few remaining water holes. There small, floating plants covered the surface and helped to conserve the dwindling water. The ponds were teeming with life; frogs croaked among the leaves and thousands of insects were humming over the green carpet, while lions and hyenas waited for their thirsty prey in the bushes at the edges. Now and then the motionless surface was disrupted by a snorting head of a hippopotamus; it seemed to warn of the many dangers lurking in the deep below.

The people living on the plain were hard put for water themselves, but feared the supernatural power they thought was hovering over the water holes. They preferred the foul-smelling liquid they could still draw from their own wells but they suffered from thirst and dirt. During this time an increasing number of sick people came to the mission of Ruaha and the Fathers asked for my help.

Upon my arrival at the mission, a big crowd of small children gathered around our landrover. They clung to each other like a frightened herd of deer and looked at me with alarm and curiosity. I learned that they were children from the far-off village of Ngombe. With their teacher, they had come to the mission to ask for the treatment of bilharzia, a parasitic disease from which they all suffered. Children playing around in the murky waters are especially prone to contract this disease, for larvae of the bilharzia parasite penetrate the skin of those who wade into the water. They lodge in the wall of the bladder and cause pain and considerable blood loss. I looked at the crowd of thin and undernourished children and hesitated to take them on. They seemed such a bunch of wild kids and they spoke a language quite different from the Swahili I knew. The treatment would strain them and would last for a week. How would I be able to keep track of these unruly children besides all the other work I had to do? Noting my hesitation the teacher shouted something and the children ran off into the bush. I could hear them whimper while they were urinating. Soon they returned with tears of pain still on their cheeks, and with thin arms each held up a bottle, showing me the blood-stained urine. How could I send them back to their village as sick as they were? The mission offered full cooperation and was to provide food and lodging. The teacher would act as guard and interpreter and help me with the children. Finally, with much worry I consented to treat the children.

The first day of treatment was a nightmare. Everything at the mission station was new and frightening to these children of the wilderness and they were already pretty scared when they lined up for their first injection. The children's eyes widened as they watched me prepare the syringes. It took the teacher much persuasion before the first child dared to bend down for the needle. The scream of pain which followed nearly scared the others out of their wits. But since they wanted to get well, they mustered all their courage and most of them went through with the treatment. In the evening I went over to their quarters. I thought it would be best to get acquainted with them in a more pleasant way and hoped they would then have less fear. At first they were quite timid, but gradually curiosity took over and they came close. Cautiously they began to touch me. They burst out laughing when I wiggled my white toes in my sandals; they wanted to know whether I was white all over my body. When dusk fell and we had eaten a simple meal together, they became more confident and some started to sing. When they saw that it pleased me, the others soon joined in. A strangely beautiful scene: the small flame of the lamp flickering under their breath was reflected in the eager, lively eyes of the children and made their teeth shine as they opened their mouth and sang with all their might.

The following afternoon the children smiled when they saw me, and the whole procedure went much faster. The funny little rascals! Those who had already gone through the ordeal would gather beside me and look with glee at the others still standing in line. With mounting anxiety the waiting children would step from one foot to the other. Some cried out, “Mama wee...” while others whistled to get rid of the tension, but when their turn came they all courageously bared their behinds. Everybody was laughing heartily when the poor kids hopped around crying and pressing their hands on the place of the injection.

On the fourth day the urine was clear, but the children felt sick and weary. The medicine caused them to vomit. The teacher comforted the children as much as he could since I was too busy with other patients to give them much attention during the day. When I visited them in the evening, there were no happy singing children any more. They sat around hanging their heads and only wanted to lie down. I felt worried and decided to let them have a day of rest before they received their last shot. The teacher was instructed to give them plenty to drink and to keep them out of the sun on the following day.

That day was exceptionally hot and I was too busy at the dispensary to inquire about the children. It was nearly evening when I finally hurried to see them. Their quarters were empty; the children were gone. I learned that the poor little ones had felt sick and wanted their mothers, so they had sneaked away in the middle of the day and run home. I was startled to hear that the teacher had gone along without contacting me first; he had obviously not realized how sick the children were. My uneasiness about the whole undertaking had been only too well-founded. A feeling of impending disaster was weighing me down. I could visualize the children, weakened from their illness and from the incomplete treatment, running through the bush in the scorching sun, without food and water for hours. More than fifty little children--and only one irresponsible adult to take care of them. What would happen? What could I do? The food dried up in my mouth at the dinner table. “Everything is in God's hands,” said one of the Fathers, who saw my distress. I looked at him with dismay. That was no comfort for me now. Quick steps approached from outside. Somebody asked for me. All blood drained from my face; the first catastrophic news had arrived. One little girl had collapsed and died shortly after she reached the hut of her parents. The other children were scared and exhausted as they lay around prostrated in the village, said the messenger. Night was falling. There was nothing I could do.

Early next morning Father Superior arrived at my door with the deserted teacher. Their faces were somber. Another girl had died during the night and the people in the village were upset and frightened. They were convinced that all the children would die. Rumors had it that I was a witch who wanted dead children for some sinister purpose. My heart pounded and my knees started to tremble. “I must go to the village right away.” Father Superior looked at me. “It could be dangerous.” “But I have to go. I must treat the children or more of them will die,” I exclaimed. Nobody could argue this point. The Father reluctantly agreed to take me there. Hastily medical supplies and other equipment for a week's stay in the bush were packed and sent off with porters, and soon we were riding on a motorbike towards the village. There was no time to think about the situation or what was awaiting me.

The narrow path through the bush was rough and at times perilous. It must have taken the children half a day to reach their homes. The sun was already burning when we approached the first huts and there a group of people blocked our way. News of our arrival had reached Ngombe, but I don't know how, since we had come much faster by motorbike than any man could run. The people were the village elders who wanted to know what I was up to. We had to sit down with them and explain carefully all that had happened. The teacher, for obvious reasons, had kept quiet about the children's running away before the treatment had been completed. I had come here to finish it. The village elders talked among themselves and then invited us to follow them to one of the huts. In there was one of my patients, “half dead,” as they said. They wanted to see what I could do for him. Fortunately the little boy was not seriously ill, only exhausted and weak from lack of food and water. I hastily prepared some sugarwater, a remedy I had on many occasions found helpful for half-starved people in the bush. Soon the child felt better, and as everybody could see how he was recovering, we were allowed to proceed.

Close by the small school house on a parched meadow stood a half-crumbled mud hut. That was to be my quarters. The Father unloaded my things. He asked me to send one of the porters who were to arrive with my equipment to the mission whenever I wanted to be taken back there. Before I could say anything further he mounted his bike and drove off. The dry sound of the motor echoed over the plains, fading away in the distance, and soon the hot air shimmered over the grass as before. Life in the bush is tough; there is little time for sentiments. I felt kind of lost for a while, standing there alone among these strange and suspicious people, who now stared at me in silent curiosity. With a sigh I followed them into the village. They took me to an open place with a cluster of grass-thatched huts. I could hear kilio, a sing-song used when mourning the dead. The elders were taking me to the place where the girl had died during the night. I went in, hoping that this child would also be only “half dead.” There she was, lying on a mat on the floor, her fragile arms and legs stretched out, her sweet face turned upward. Her eyes were closed and there was a little froth at her mouth. Alas, her limbs were stiff and there was no warmth left in the once so lively body. I gazed at her, numbed with grief. There was silence in the hut. “I am sorry--there is nothing I can do.” As I stepped out into the light, a wild party burst forth from the bush. Disheveled women, howling and yelling, their faces painted white, poured handfuls of dirt over their heads. They threw themselves backwards on the ground, rolled around, bit the grass and tore their clothes. I knew that these were mourning relatives of the dead girl, and the impact f the scene on my already guilty conscience was overwhelming. I staggered away from the place and somehow found my way back to my miserable abode.

Fortunately the two men from the mission had arrived. One would be my cook, and stay at the hut; the other was to follow me, carrying my equipment when I went around. The teacher now joined me again and tried to hold me back. The houses of the village were far apart, he argued; it would be too hot and tiresome to walk in the sun on the stony paths. He should have thought of this when he allowed the children to run home! I was far too upset to heed his words and ran from one place to the other finding the little patients prostrated in the darkest corners of the huts, half crazed from fear, hunger and thirst. Nobody had dared to go near them since they returned. Many of them were hot with fever. Malaria is endemic in the African bush and tends to flare up after physical or emotional stress, so I dispensed antimalaria drugs, heart strengthening medication and my panacea, sugar-water. I was greatly relieved to see that most of the little ones responded well, and once they had lost their fear, they got up and walked around. They were soon out of danger. As the teacher translated my instructions, I could see the expressions--fear and hope, suspicion and trust--shifting on the mothers' faces. When dusk crept over the dry land I had seen more than half of all the children, and there had been no further alarming news about the others. I dragged my feet back to my quarters and forced myself to eat some of the chicken and rice the cook had prepared. Some people had brought a few eggs. That was always a sign of good will and it made me feel better.

Night in my mudhut. The bed was a wooden frame with twisted ropes strung over it, covered with thin mats. A true paradise for bugs. Of what kind it was too tiresome to find out. They were biting anyway, and sleep would not come. The moon shone down through cracks in the roof and the tropical night was full of noises. Somewhere a child was crying. Animals seemed to crawl in the grass; a hyena was howling somewhere out there, and voices reached me from a hut across the school yard. There the little girl that died the first evening had lived. I heard a few sobs, and then, when the moon was high up in the sky, the mourning chant was sung by the fire in front of the hut. A man's voice--maybe it was the father: “Ay--ay--ay--eeee. . .ma--va--oooo. . .je--le--maooo. . .” and then heartbreaking sobs. There was a strange beauty in the song as the voice rose and fell, reaching up in melancholy towards the moon. I lay there spellbound. Hours passed and there was no end to it. Little by little the voice seemed to penetrate my body. It opened up one door of resistance after the other, allowing heavy, guilt-ridden thoughts to crowd into my mind. What was I doing in Africa? What right did I have to be here, unwittingly bringing unhappiness and death to these people whose language and customs I did not even understand? An irresistible impulse made me sit up. I wanted to walk over to the bereaved father, say something, cry with him--but I did not dare to do so. Instead I fell back into heavy thoughts. The children must have been much more afraid than I had realized. If only I had looked after them better myself!

The teacher had probably not even understood my instructions. That night cast doubt on my whole effort in Africa. I realized how dubious was the blessing of mass treatment if poorly organized. I stopped trusting Western medicine when practiced among non-Western people where many unknown factors are at work. It was a night I would never forget. Towards morning the sing-song died away and there was even some laughter. Exhausted I fell into a deep sleep.

Another arduous day--wandering through the bush; sweating in the sun; looking up the children; examining feeble patients; listening to anxious hearts; giving out medicine and reassuring apprehensive parents. The children I had treated on the previous day were recovering well and looked forward to the cherished sugar-water. The ones I had not yet seen needed help urgently. One of the last families to visit lived far away on a hill. Tired, I climbed the steep path to find the people there hostile and upset. A little girl who had also been at the mission for treatment was dying, they claimed. Inside the hut it was dark and the air was heavy from smoke and from the many people watching the girl. In the flickering light of the fire I saw the child lying on the floor, semiconscious. Convulsive jerks shook her body. Her skin was burning hot and her lips cracked and dry. I tried to give her something to drink but she grimaced and could not swallow. I asked the women to carry her outside and to place her on a mat in the shadow. They did so very reluctantly and after much arguing among themselves.

The child moaned. She was pale, and deep furrows were drawn around her mouth and nose. Her eyes rolled upwards. This was indeed a dying child! Kneeling down beside her I prepared a syringe for an injection to strengthen her heart. Suddenly the air seemed to be tight with danger. I looked up. A group of men with spears and bush knives stood around me, their faces sinister. My companions and most of the women had disappeared. “No more injections! My daughter has had enough,” said the girl's father in Swahili. His voice was threatening and the men closed in on me. “If the child dies, I will die too,” the thought flashed through my mind. “They will kill me, because they are afraid.” My stomach tightened; I felt weak and nauseated. There was no escape. My thoughts were racing. The child must not die! I had the same medicine in tablet form so I forced my hands to calm down and crushed a tablet in a spoon with water. With utmost care, very slowly, I poured it between the clenched teeth of the girl, who seemed to be almost dead. I remembered her well; she had been one of the wildest children in the bunch. Sweat was pouring down my back and I avoided looking up at the men.

Next I had to bring her fever down. Medicine would not do as I did not dare to let her swallow the bitter malaria tablets lest she throw up. I asked for some cloth, but as nobody made a move, I took off my shawl, dipped it in water and wrapped it around her legs. I also cooled her front with water, and as I repeatedly urged her to swallow the cardiac medicine, it appeared to me that the little girl understood my plight. She seemed to make every effort to cooperate. After a long time--it seemed like hours--her pulse slowed down and the fever receded. There were moments when I thought I was going to faint myself, but the instinct of self-preservation kept me alert as I watched every change in the patient. Towards evening she drank some sugar-water and then opened her eyes and smiled at me. Like the sun breaking through clouds, the tension around me eased. The threatening posture of the men relaxed, somebody laughed, the women lit the fires, and everybody in the yard went about doing their daily tasks. I looked at the girl's father. He too was smiling as we both watched the now peacefully sleeping child.

The teacher came back and after having assured the father that the girl would live, I picked up my belongings and made it down the hill. Waves of weakness went through my aching body and I had to stop from time to time to regain strength. “You must be awfully tired,” the teacher said shyly. My companions had to help me along the stony path in the dark and upon reaching my quarters I was too exhausted to eat. Still trembling I lay in bed anxiously listening into the night. Did I hear cries in the distance? A message that the girl had died after all? But the night was quiet. Even the people by the school did not lament. They talked together in low voices; probably they discussed the day's events. Steps outside the door. I stiffened in fear. “Listen to me,” a woman's voice called. It was friendly. “Would you like one of us to stay with you? Maybe you feel afraid alone in the hut?” I declined, saying that I was not scared, but it gave me a warming feeling. They did take me for a human being after all. I began to calm down and finally fell asleep with the vague idea that I had atoned. It had been my life for the little girl's life. She lived, so I could live--it seemed fair.

I strained my ears for mourning chants when I slowly climbed the hill the next day. Should I dare to go there? Everything remained quiet, so the girl must have lived through the night. She was sitting up when I entered the hut, eagerly awaiting my sugar-water and she drank whatever I offered her. I viewed the child with fondness and a kind of pride. That little wild kid surely wanted to live--just as much as I did!

There were no more complications with the children but I stayed on for a few days more, just to make sure, before I sent for the Father. People now came to see me for all kinds of ailments, and as much as I enjoyed their trust, it was very trying. There was no end to the work. As tired as I was, I did not dare to refuse any of the cases, lest suspicion and hostility should flare up again. They came at dawn and often did not allow me time to eat. Only nightfall ended my work since everybody understood that I needed daylight to treat the sick. Never before had I greeted evenings with such relief. When the Father arrived one afternoon he found me in the midst of a squabbling crowd. He turned pale until he realized that people were fighting among themselves to get to me for treatment. Whilst we quickly packed up, we tried to console the loudly protesting patients. We invited the people to take their sick to the mission; I would treat them there. But even when I had climbed onto the motorbike, people hung on to my clothes and begged for medicine. Again I felt the sting of bad conscience. All these people had come to me for help. Was it right to turn my back on them? This was always the dilemma facing one who dared to challenge life and death in the African bush. Wherever one arrives, some severely ill persons will survive because they get the right medicine; wherever one leaves others will die because they cannot get it. Wearily I closed my eyes as the village and its people disappeared behind me in the bush. Would I ever be able to accept the role I had to play in these people's destiny?

Copyright © 1979 Louise Jilek-Aall
Reprinted with permission

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