The day had been long and the journey full of stressful events. With a sigh of relief, I at last caught sight of the mission at a turn of the road--it signaled a chance for rest and recovery. The mission station we were arriving at turned out to be a real outpost, recently established by a Swiss priest and his African helpers, and the living quarters were not much more than a cluster of mud huts. I happened to cast a glance into the dark smelly cove of a kitchen built on to one of the huts and when I put my head inside, a horde of cockroaches scurried in all directions, but I tried to forget about them when the friendly cook served the evening meal.
A mug of Tembo beer helped us overcome our apprehension, and soon the visiting Father and his host were eagerly discussing theology and their missionary activity. Most people in the Kilwa region were Moslems, the priest told us, and it was not easy to gain converts to Christianity. People viewed the newly established mission with suspicion, but they were thankful for the services offered: education and medical help for anyone who wanted it regardless of religion. However, the missionary, who had been trained as a teacher, soon found that it was mainly treatment for the sick the people wanted. He had therefore sent for me so that I could help him find a practical solution to his problem.
After we finished eating, we went outside to sit for a while in garden chairs and cool off in the evening air. The moon shone silvery through the branches of a small palm tree in front of the hut as the Fathers talked of their school days together in a Swiss seminary. The mission priest was speaking rapidly and working himself up into that excited state which in Africa is called “bush-happy. ” It occurs when one hits upon a sympathetic audience after having been alone in the bush for a long time. I knew it well myself. It starts slowly as a deep excitement, an inner quiver and increasing feeling of unreality. It is as if one part of oneself is standing outside looking at the self and trying to make it calm down and shut up before the situation gets too embarrassing. But pent up emotions and tension, accumulated through many frustrating experiences of everyday living with nobody to share them, surge to the surface and boil over in a stream of words which cannot be controlled. Those who have gone through this recognize it at once in others and feel obliged to listen patiently until the intensity of the experience wears off.
The moon went silently on its way among the stars and as I sat there, my limbs heavy from tiredness, the peaceful noises of the night mingled with the exalted voice of the lonely priest and I forgot to listen.... At long last the priest came to himself and jumped to his feet, suggesting that it was time to go to bed. Picking up the kerosene lamp from the doorway he turned to me with an embarrassed smile and asked me to follow him. We went across the yard to a small hut which stood alone in a clearing. “This is our humble guest house,” the Father said somewhat apologetically, “You'll have to accept the modest comfort the mission can offer.” I was too tired to notice even the small basin and the jug of water placed on a chair; I stumbled into bed and fell asleep.
It was pitch dark when I was startled awake. My heart was pounding and I lay stiff, listening in the dark. What had awakened me? What was I hearing? There it was again; a peculiar noise outside. I tried to figure out what it was, but could not place the sound--like something boiling or like the rumbling of distant thunder. But it was close by and seemed to be moving around just outside the thin walls of my hut. Unable to identify the noise, I became increasingly alarmed. Maybe what I heard were the sinister doings of a witch doctor intent on scaring me away! In vain I strained my ears, but my own loud heart beats interfered with whatever I was hearing and I did not dare to get up and look outside. Then came the long drawn out howl of a hyena, a sound I knew well. It had the effect of interrupting the strange noise. I listened for a long time but could hear nothing unusual any more. It took me a while to fall asleep again. It was hot in the room and the bed was narrow and uncomfortable. It squeaked and I hardly dared to move lest somebody outside should know I was awake and listening. What a place to live in! I felt admiration for the priest who could stick it out here alone in the wilderness. I recalled him telling us that he would rid himself of his frustration and anger by throwing up, instead of getting angry at the people. Judging from his emaciated appearance, he must have had many opportunities to do so.
It was daylight when I opened my eyes again. I sat up quickly and was just getting out of bed when a cry of surprise slipped from my lips. Something like strange plants were standing in groups in front of the bed; long brown stalks, some more than a foot high, seemed to have grown out of the earthen floor during the night. As I was staring, a pale-colored ant appeared at the top of one of the pillars, carrying a lump of earth which it cemented on to the wall of the column. Then it disappeared inside and a second ant crawled forth with another lump. I relaxed and had to laugh; the funny stalks were the work of termites building their air shafts. They must have had their colony right underneath the floor of the hut. I knocked the earthen pillars down as I walked about doing my morning toilet. The funny sight put me into good spirits and made those inexplicable noises from the night seem less frightening.
Much later, in conversation with a game warden I asked about those strange noises. To my surprise he started to laugh; he knew right away what I had heard. The rumbling sound of digestion in the intestines of elephants! These huge animals often use the quietness of night to graze around human habitation. Their soft broad soles tread so quietly that one would never suspect such giants to be around. When elephants relax, their digestion works and their intestines rumble. The noise can be heard at quite a distance. But the elephants can stop the noise at will and do so when they are startled. No wonder I had been unable to figure that out!
At that time, however, I was still concerned about the noise, and as a precaution against any adverse reactions to my arrival, I asked the missionary to send a messenger to all surrounding villages to announce to the people that Mama Mganga would like to speak to their elders and chiefs if they would do her the honor of coming to the mission for a meeting. While I was waiting for the men to arrive I checked through the modest equipment in the dispensary hut. I found the usual pots and jars with ointments, laxatives and worm remedies, as well as the ordinary drugs against malaria, colds, wound infections, indigestion, headaches and other common ailments. There was also a good supply of vitamins and iron tablets, medications which I could teach an interested and willing person how to use. The more sophisticated medicines which should be administered only by an experienced nurse or a physician I put in boxes and placed them in a corner for special use.
In the meantime the men were arriving. They greeted me with cool dignity and a certain curiosity. We sat down in a circle under a huge mango tree and I began by introducing myself and explaining why I had come to this place. The men did not look particularly friendly and I was nervous as I struggled along in Swahili telling them about my work as a doctor and wondering who might have disturbed me during the night. I looked them over carefully. I knew of certain tattoos and ornaments which would reveal the medicine man among them. Then I spotted a chain with the typical medicine man badge around the neck of one, half-hidden under his shirt. This was one of the younger men in the group and when I caught his intelligent glance I felt he knew I had recognized him for what he was. But he did not blink. When I asked the men for an interpreter, since I did not know their tribal language and wanted to make sure I would understand all the patients, they nodded in approval and silently waited for what else I had to say. As I was going to be at the mission for only a short while, I asked them to choose one person interested in helping me and in learning how to use some of the medicines the mission could offer. There was a stir. They eagerly discussed this in their tribal language, which I could not understand. I observed them closely, however, and when I felt there was a certain indecision about whom to delegate for the job, I turned to the one I thought was a medicine man and asked him if he would be my helper. There was a tense silence. Surprise and bewilderment showed on all faces. But when, after some hesitation, the man agreed, the others burst out laughing, visibly impressed by my choice. I felt I had won the battle and, quickly, before the man had time to change his mind, I took him to the priest to settle the matter. The Father, happy about the prospect of having somebody trained to assist in the care of the sick, was pleased about the plan. He did not know the man, but seemed to find him trustworthy and they quickly agreed upon a small remuneration. The Father asked the thus established helper if he would consider taking further training as a dresser at the mission hospital in town. The medicine man replied with dignity that he would think about it after having tried out the job by helping Mama Mganga at the dispensary.
Quite excited about my new helper, I went with him to the dispensary where sick people were already waiting. He had not in any way indicated that he was a medicine man, but I was sure of it and thought about how to relate to him. I did not want to appear as the all-knowing teacher who doles out wisdom to an inexperienced pupil. I was sure this man knew everybody who came to the dispensary, and that he had already treated most of them at one time or the other. I saw how the patients' eyes widened with surprise, and probably also fear, when they realized who was my helper. But they kept their thoughts to themselves and flocked to the dispensary as usual. During the first few days I was too busy to give my new helper much attention, but I noticed that he was keenly observing and listening, while translating for me. During work I therefore made it a habit to comment on what I was doing as if talking to myself, and to explain why I arrived at a diagnosis and how I used various drugs. I had the embarrassing feeling that the medicine man found my treatment methods rather unsophisticated, which was indeed true, due to the poorly equipped dispensary and the few medicines I had at my disposal.
Most patients suffered from malaria, which is easily treated with modern Western drugs and after a few days on antimalaria medication, they improved considerably. But if the medicine man was impressed with my results, he did not show it and I began to feel uneasy with his lack of response. However, this changed dramatically one day after an unexpected event. A young woman who had already been treated for malaria returned with her family. They were concerned because she still felt extremely weak. The woman was severely anemic and I decided to give her an intramuscular injection of vitamins. I told the family that she would be given a powerful medicine and looked through the boxes I had set aside. I do not know whether the vitamin ampoules had been stored away too long in the hot climate, or what was wrong with them, but as I was handling the vial it suddenly exploded in my hands, scattering glass and liquid about. Most of it hit me, but apart from soiling my clothes, did not do any harm. But the people were scared stiff. They stood stunned while I calmly cleaned up the mess. Trembling with fear, they assured me that the sick woman felt much better already and did not really need any more medicine. Hastily they left the dispensary. I glanced with embarrassment at my helper who had a big grin on his face. With admiration in his voice he said. “That was powerful medicine indeed!” The ice was boken and we began to exchange views regarding illnesses and their treatment.
Our concepts of health and disease were quite different, but the medicine man was willing to accept my therapies if he could explain their effectiveness according to his own theories. To him, most abdominal pains were due to a nyoka, a snake nesting there. People with severe malaria attacks often have abdominal pains due to swelling of the spleen. When the malaria is treated the swelling goes down and the pain disappears. To my helper, this meant that the medicine had killed that nyoka in the patient's abdomen. There were other times when I learned from the medicine man. It had been raining heavily for a few days, when finally the sun reappeared and dried up the damp ground. Towards evening that day a youngster was brought to the dispensary suffering from severe abdominal pain. The poor boy was doubled up and pressed his hands against his stomach crying in distress. Finding nothing but distended bowels, I concluded that he was seriously constipated and wanted to give him a laxative. My helper who had watched me asked the boy's friends a few questions. Then he turned to me. “Mama Mganga, this is something you probably have never heard about before,” he said apologetically. “Let me explain it to you before you give the medicine. The rainy season is the time when the termites swarm, especially after a heavy rainfall like we just had. The boys know this and watch the termite hills early in the morning. When the sun begins to warm up the ant hill a queen will come out, spread her wings and fly up into the air on her way to found a new colony. The winged termites which we call kumbikambi swarm out behind her and at the moment of taking off they are caught in bags by the children. Kumbikambi termites are one of our favorite delicacies. The women will fry the soft fat insects over the fire, shaking them well and discarding the wings which fall off. But the hungry children do not wait for the frying; they eat the kumbikambi on the spot, wings and all. Sometimes they eat too many and then the wings of the insects lump together in the belly, blocking the passage. That is what happened to this boy. Giving laxatives by mouth has never helped to move the lump of wings; one has to get at it from the other end.”
I could see he was right; the chitin of the insects' wings would lead to bowel obstruction in the lower parts of the intestines. But how could we give the lad an enema? The dispensary did not have the necessary utensils. “Just wait a minute,” said the medicine man. He took a knife and went into the bush. After a while he returned with a green bamboo shoot. It was hollow and soft. With that ingenious piece of equipment we went to work, aided by the boys and other concerned people. Everybody waited anxiously for the enema to work, knowing that it was a matter of extreme urgency for the poor boy who continued to whimper with pain. When finally a myriad of termite wings came out in a gush of water, people jumped up and down and laughed with joy and relief. They teased the embarrassed boy and made jokes until he got up and joined the others with a smile, now feeling well again. Everybody thanked my helper for the clever way he had solved the problem.
The extremely hot and humid climate on the coast caused people to suffer attacks of tropical malaria with exceptionally severe fever delirium, hallucinations and mental confusion. One day a young man was brought to us in such a delirious state, which prompted the medicine man to tell me his theories in regard to mental disturbances. I had given the raving man antimalaria medicine and tranquilizers and while we were watching him slowly calm down, my helper told me in a low voice, “We used to think that madness was caused by revengeful ancestral spirits, or by a sorcerer's poison, but nowadays we know other causes. This man is deranged because he is possessed by a shetani.” The medicine man placed my hands on the patient's feet. “Do you feel how cold they are? The shetani makes the blood stop moving; that's why the patient cries out and talks nonsense. The shetani sits in his limbs and makes the body shiver.” Suppose the medicine man's concept of shetani could be equated with my concept of the malaria parasite, our etiological theories would be pretty much the same, I thought. “What do you mean by shetani?” I asked after a pause. “Shetanis are foreign Devils,” he explained, “evil spirits coming to this country with foreigners from Arabia, Asia or Europe. As many peoples now travel to the cities, they come in contact with foreigners and might pick up a shetani from them. When people return home, the shetani comes along. That's why there are more disturbed people in our villages than before. Sometimes the shetani will show itself in a dream; it talks to the possessed or speaks through his mouth. Only a medicine man is able to understand that kind of talk and to recognize what sort of shetani is plaguing the patient. Medicine men can prepare remedies out of roots, barks and herbs, which have the power to drive out the evil foreign spirit once it has been identified.”
I wondered whether my helper was going to suggest using some of his remedies on this patient, and I did not want to offend him by refusing so I said that since the patient was now soundly asleep with my medicine, we should wait a day or two before trying anything else. The medicine man agreed, and as the fever receded during the night and the patient regained the senses towards the next evening, my helper graciously admitted that my European medicine had cured the madness this time. “I guess the shetani was a European one,” he concluded with his infallible logic.
As the days passed we worked increasingly well together. I had to admire my conscientious helper, who would never undertake treatment before he felt completely confident that he understood and knew what he was doing. To my regret, however, I never could get him to pull teeth. No wonder! Even dentists in their modern offices are sometimes nervous when extracting a tooth. How much more reason for caution there in the bush with instruments so old-fashioned they would be museum pieces elsewhere and with no anesthesia except for a few aspirins. To extract a tooth under such circumstances, sometimes in a person with an inflamed jaw, extremely painful even to touch, was one of the most nerve-racking and dreaded jobs I had to perform. But people would rather go through the pains of extraction than be sent back home with their aching tooth. Locked jaws, abscesses and open sores all testified to the agony people suffered when no dental care was available. Some of the missionaries had acquired a special skill in pulling teeth and since it often required a man's strength to remove a reticent tooth, I was always relieved when there was a Father available willing to take on this unpleasant task. Since the priest of this outpost mission had no inclination to do that kind of job, I kept hoping that no patient with toothache would turn up. Sometimes penicillin and aspirin would spare both patient and myself the painful procedure. But my hopes were idle. One day a man presented himself at the dispensary and I had to admit that extraction was the only solution to his painful problem.
The awful feeling of tension in the stomach and the trembling hands which I always experienced when I had to inflict pain on a patient gripped me as I dug out the rusty old dental pliers and cleaned them in preparation for the operation. I gave the moaning patient as many aspirin tablets as I thought he could tolerate and when his toothache was dulled, sat him outside under a tree. He folded his hands on the back of a chair and anchored his feet around its legs. My helper stood behind the patient and held the man's head firmly between his hands. The sick tooth was the last lower molar and as I carefully chose the right tongs, the patient gave a big sigh, closed his eyes and courageously opened his mouth. I mustered all my strength, took a deep breath and began to pull. I could feel all the muscles in the patient's body tighten; he opened his eyes wide and sweat appeared on his forehead. “Think you are pulling out a cork from a wine bottle,” a dentist once told me while demonstrating the manipulations used for extraction. Remembering his words, I applied increasing force to the tooth. Once I started to pull, I tried not to give in until the tooth was out, as this seemed to be the least painful for the patient. But alas, this time it did not work. The bad tooth refused to budge. Bathed in sweat I had to take a break. When I made another attempt to get the tooth out, the pooman could not help letting out cries of torment. I struggled with the forceps and pulled with all my might; there was an awful noise as if I was about to crack his jaw, and the man roared with pain.
At that moment the visiting Father rushed out to see what was happening. I was out of breath and the crowd of people which had accumulated around the gruesome scene were voicing their disappointment while the poor man's tooth ached more than ever. I moistened my lips, and swallowed a few times. “Father, I think this is a job for a man,” I said and handed him the pair of tongs. “Sure, I know how to pull teeth. ” The Father looked as calm as ever. With a nonchalant gesture he took the instrument and busied himself with it. Before the patient even had time to feel the pain, the Father triumphantly held up the bloody tooth in the grip of the tongs. The people cheered and applauded. Even the patient who had been sitting in a daze finally had to smile. We gave him water to rinse his aching mouth and when he had recovered a bit, I asked him to open it again as I was concerned I might have injured his jaw with my manipulations. Wiping off the blood, I suddenly felt hot and cold. Oh no! The Father had pulled the wrong tooth! Consternation nearly made me drop to the ground as I stared at the bad tooth sitting there in the innermost corner beside the gaping wound, just as firmly as before. I did not have the heart to tell the patient; he could not possibly have endured more pain at this time. I decided to reveal nothing about my embarrassing discovery, but have the patient come again after a few days. In the meantime he was to take penicillin and other drugs to heal the wound. With mixed feelings I saw the man leaving with his friends and heard them joke about the loud cries he had produced. I felt angry at the Father, but since I had not mastered the situation myself, I did not feel I could blame him for what had happened. As the patient never returned for further treatment, I felt awfully guilty about the whole affair.
I had not quite recovered from this event when a young woman who had just given birth came down with a bad toothache. I examined her and saw to my dismay that I would have to take out the tooth. The woman looked at me with a tired expression and whispered, “Please Mama Mganga don't hurt I me. I just can't take any more pain.” I combed through all the available supplies of medicines which I had tucked away. Many of them consisted of small physician's samples distributed by pharmaceutical companies in Europe and sent on to the missions in Africa. Many were useless, either because the supply was too small, or because the illness for which they were intended did not occur in the tropics. But this time I found a small vial of an anesthetic for dental purposes. I carefully injected the precious drug into the gum, waited for a while and when I extracted the tooth the woman did not even notice that I had already pulled it out. She stared incredulously at the bloody tooth, and then she grasped my hand and thanked me profoundly. The next morning a group of people waited for me when I came out of my hut. They looked at me with eyes full of expectation. What did they want? “Mama Mganga, we all want to feel how it is to have a tooth pulled without any pain.”
I decided it was time for me to leave! When my things had been packed and the truck stood ready for departure, the medicine man, who had been such a faithful helper, and who now would have to carry on alone, stepped up to me. He looked at me and said in a confidential tone, “Mama Mganga I went to see the man who had his tooth pulled by the Father.” A smile flitted across his face when he noticed my uneasiness and he continued, “I helped him to get rid of another tooth beside the first one pulled, as it had also started to ache. It came out easily and now he has no pain any more.” I saw a twinkle in his eyes as I thanked him. We did not talk any more about the matter. I think he was satisfied by my sigh of relief as I climbed into the truck. He was surely one of the most tactful colleagues I have ever known.
Copyright © 1979 Louise Jilek-Aall
Reprinted with permission
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