I had been working in Ifakara for about a month when the first call for medical services outside the hospital reached me. It came from a small outpost a day's journey away from Ifakara. The priest there sent the message through his driver who arrived by landrover to fetch fresh supplies and, if possible, take me back with him. I was keen on adventure and immediately agreed to go, although I had no idea what such services would imply. I arranged for one of the nurses at the hospital to look after my patients during the week that I would be absent so that my research would not be interrupted.
We started out before dawn, and it again struck me how beautiful the early morning hours are in the tropics. It always gave me a joyful feeling--the crispness and fragrance of the air, refreshing like a cool bath--and the memory of this pleasure helped me to endure the heat of the day. The soil on the unpaved road took on a deep red in the first rays of the sun; I could see it glow between the green trees on the mountain slope ahead. When we reached the summit we saw the distant blue mountain range of Iringa rising over the morning mist on the Ulanga plains. The mission we planned to reach by evening was called Merera and was situated at the end of the road in the foothills. The driver told me that the best part of the road had been built by the Germans during the first World War and after they left, the Catholic mission kept the road open and expanded it as new outposts were founded in the region. The forests and plains were thinly populated, but when the road was improved, people came from far away to settle alongside it. In their own interest, the newcomers now helped with the upkeep of the road. I could see recently established villages as we drove along, newly built mudhuts with patches of barely cultivated fields among the trees. We came upon crews of men with spades and hoes working on the road. They jumped aside and greeted us with laughter and cheers from the roadside as we passed them in a cloud of dust.
When a new village reached a certain size, an Asian merchant would move in, building his little duka shop at a strategic location alongside the road or in the village square. These East Indians were amazing pioneers; in the middle of nowhere their duka would hold an incredible variety of merchandise. Built on to the store were the closed-off living quarters of the large family where mother, grandmother, sisters and daughters attended a large flock of children and ran a traditional Asian household while father, grandfather, uncles and grownup sons worked in the business. The stranger who happened to pass by would be invited into the duka where a youngster served the thirsty traveler a cooling drink. The merchant, friendly and busy, would display some articles and surprise the stranger with all kinds of luxury wares, unexpected that far away from civilization. If the traveler should happen to ask for some goods not in store, the shopowner would be most distressed and the customer would be sure to find them there the next time he came around.
On that first safari we stopped at a duka around noon, in the worst heat of the day. While the men were discussing different business matters, a sari-clad lady beckoned me to come with her. She took me to the cool living quarters and with a charming smile invited me to rest upon her own bed.
She brought tea and Indian cookies. From the whitewashed walls numerous portraits of family members looked down with dignity. In a corner, framed by flowers, was the large photograph of the Ismaili's beloved Aga Khan. The houses of the duka owners that I was to see on my travels through the East-African bush, all looked alike. Sparsely furnished with a few oriental carpets, incense burners, cushions and couches, and perhaps an old fashioned ice-chest, they lacked most commodities. I could not help wondering how the delicate ladies in fine saris preserved their good spirits, living as they did out in the bush, far away from other compatriots and friends, sometimes for years on end. As far as I was able to find out they did not have close ties with the Africans living around them. They employed a few, but seemed to keep that same reserved distance as they displayed towards me, which precludes intimate friendship. I suppose they were satisfied with their self-created culture islands, working incessantly for their large families, looking at the pictures on the walls and thinking about a son studying in London or a daughter well married in India, thanks to the money the parents had saved.
Struggling to keep their business going, the men transported goods from Dar-es-Salaam to the interior. They were their own drivers and mechanics. Whoever got stuck on the road would be assured of help if a duka truck happened to pass by. Friendly and polite, the Indian would offer his services, even if it meant a long trip to town for spare parts or hours of sweaty work on the car there on the sun-baked road. In the rainy season, when everybody else had given up driving, the Indian merchants with their old trucks would still make it. Daringly they dashed through swelling rivers and skidded along the muddy roads, miraculously getting through the most impossible sections, providing their dukas with goods and their antiquated pumps with gasoline. No one who has traveled in the African bush and endured hardship there can think of these Asian traders without a feeling of appreciation and respect.
Refreshed from our stay at the duka we continued our safari. We were now on the plains, and the driver told me to look out for wild animals. Lions, buffaloes, waterbucks, zebras, antelopes and elephants were abundant in this part of the country. I got a thrill out of watching the white birds walking up and down the backs of the brown buffaloes, peacefully picking flies and other insects off their skin. The huge buffaloes would lift their heads and watch the car as we passed, their broad horns showing clearly against the sky. The waters were crowded with crocodiles and hippopotamuses and I thought of them with a nervous feeling in my stomach as we were ferried across a river. The small float hardly offered room for us to stand beside the car. I searched the-murky water as the waves leaped over the edges wetting our feet and I hoped we would not encounter such beasts. Half a dozen men stood at one end and with long poles they pushed the vehicle across. They looked at me with curiosity and exchanged remarks which I could not understand, but from their glances and laughter I guessed that they found me rather funny looking. That was nothing, however, compared to the stir which I caused among the people waiting at the mission when we arrived towards evening.
The mission Father came running out as soon as the landrover stopped. He nervously waved off the open-mouthed gazers and whisked me inside, closing the door firmly behind us. I was astonished at this reception, but he explained that many of the people had never seen a white woman before, and their curiosity might be a bother to me. I assured him that I did not mind the people, but when I was on the way to my new night quarters I understood his concern. It was dark before I went to my hut, but people were still waiting. Most of them were women and young girls. The atmosphere was charged with tension. As I was about to close the door, a young woman put her naked foot in the door. I did not want to hurt her, and stopped. I was immediately surrounded by the women. They talked to me in a flurry of words and laughed because I did not understand. They reached out to touch my hair, they stroked my arms, and before I knew what was happening, they had lifted up my skirt, uttering cries of “oh” and “ah” when they saw I was white all over. I could not help feeling frightened by the intensity of their curiosity when some of them even poked their fingers into my mouth, eyes and ears. Seeing that I did not get angry, people pushed forward and stretched out their hands to touch my body. A scuffle ensued and I used the confusion to slip inside and lock the door. Cries of disappointment and knocks at the door followed, but I did not dare to open again. An instant later the small window openings were packed with dark faces peeping in. I could see the reflection of my lamp in the many staring eyes. The sight gave me an eerie feeling, the like of which I had never experienced before. I felt too uncomfortable to undress, only crept under the mosquito net, blew out the light and lay motionless hoping the people would go away. I do not think they did because when I awakened in the morning a pair of eyes looked at me from the window. I heard a shout, running feet and there they were again, the laughing faces at the windows.
I washed and dressed myself with all kinds of comments from the onlookers. When I began to comb my hair the women outside went into hysterics. They pulled at the door and shouted in unison for me to open it. In daylight their behavior appeared less frightening and since they had apparently never seen long hair before, I opened the door while I continued to comb it. The women looked astounded. Some of them seemed to go into a trance. Glassy-eyed and unaware of what they were doing, they mimicked my every movement. Others, completely perplexed, moved around aimlessly and some turned upside down, literally standing on their heads! Again the vehemence of their emotional agitation scared me and I hurried across the yard and fled into the Father's house followed on my heels by the crowd of enthusiastic women. The Father had to come out and reprimand them. He told them that it was bad heshima, disrespectful, to behave so uninhibitedly towards a stranger. They finally calmed down and began to disperse, laughing as they went and discussing what they had seen.
After we had eaten and I had recovered from this initial shock, the Father took me to the dispensary, a small building quite some distance from the mission. He showed me his supply of medicines, told me about the most common diseases the people suffered from and introduced me to the patients who had already gathered there. After a while he was called away and I was left alone. Not before that moment had I fully realized what it meant to treat patients of a completely different culture, in a language I could hardly understand and speak even less. During my stay at the hospital there had always been somebody around who helped out. Most people in Ifakara spoke some English or if not, they were used to making themselves understood by Europeans. But here it was a different story and with mounting apprehension I found out how limited my knowledge of their language was. I suddenly felt very alone and frightened in the little dispensary, surrounded as I was by sick people who assumed I could understand their complaints. Suppressing my anxiety I tried to organize my thoughts and actions. I decided to listen quietly to their rapid talk and to say as little as possible so they would not notice how poorly I understood. In the meantime I would use my eyes, hands and stethoscope to examine each patient individually. It did not take me long to recognize that a good part of the people visiting the dispensary that morning were not ill and probably came out of curiosity to see me. People here suffered from malnutrition and anemia and therefore I could give them vitamin and iron pills knowing that they would be helped in some way. During my stay at Ifakara hospital I had learned how to diagnose and treat common tropical diseases, and therefore felt confident that I could detect malaria and other parasitic illnesses even without understanding much of what the patients said.
As the day progressed I began to feel more confident and to pick up more of their language. The moaning of those in pain and the shrieks of frightened children created a sombre atmosphere in the room, but I admired how readily the crowd would respond with laughter to any funny situation. There was a young man who came in with a small abscess on his abdomen. It needed an incision and the man, not knowing exactly what I was up to, calmly lay down and looked on while I prepared for the small operation. But when I approached him with the scalpel, he looked at the knife in my hand for a shocked moment. Then he leaped up and rushed out of the room knocking people aside as he ran. He must have thought that I was going to cut open his belly for he did not return and the room resounded from the laughter of the gleeful women who had watched the scene. Unfortunately such cheerful moments were rare. I was faced with the most horribly infected wounds and broken limbs, situations where I had to use all my courage for the painful manipulations necessary. I could not stop marveling at the patients' endurance of pain, as well as the fantastic healing tendency of their injuries. This type of treatment needed few words and both the patients and I were satisfied with the results.
I began to enjoy my work until one day my anxiety returned when I had to see a patient and simply could not understand what was the matter. The woman was brought to me on a homemade stretcher. The family members who had come along tried to explain what was wrong with her. They appeared unusually tense and upset. The patient sat in a peculiar stiff position on the stretcher holding her head up with both hands. When I wanted to examine her, the people became acutely agitated and the woman cringed at the slightest touch. Her neck and shoulder muscles felt tight like boards. She herself said nothing, only stared out into space. I tried to ask some questions and while listening to the peoples' talk, everything in the book went through my mind, but I could not find any possible diagnosis to fit her condition. Finally I had to send for the Father. He spoke with the excited people and explained to me: “This woman tried to hang herself this morning. Her people cut her down from a tree before she choked to death and brought her here right away.” Now I understood; this woman had a broken neck, or at least one that was badly dislocated. I was quite shocked. The possibility of somebody in this wilderness trying to commit suicide had not even crossed my mind. What lay behind this tragedy the people did not tell us. Lacking proper devices, there was no way I could treat her; the slightest change in position of her neck could mean instant death. I had to tell them that I could not cure her out here in the bush; she should be taken to the small Danish mission hospital which was a day's march farther on towards Malinyi. They silently picked her up and went away. I followed the sad little troop with my eyes; the immobile woman sitting cross-legged and erect, carried on the stretcher by four young men. Who knew whether they would reach the hospital in time and whether she could ever recover, even if they succeeded in getting her there.
On the last evening, when the patients had left and I was cleaning up the dispensary, a middle-aged man entered. He was unusually formal and polite in the way he greeted me. He wanted some medicine, but for the life of me I could not find out what ailed him. I finally gave up and scribbled a message to the Father asking him to find out and send the man back with the information. For some reason the man seemed reluctant to go to the Father, but when he realized that he could not get anywhere with me, he went. After a while he returned with a note from the Father which read: “This pagan chief has several wives. He is not really ill. He has difficulties sleeping but no real sleep difficulties.” I looked at the answer for a while Was this message supposed to be a riddle? Then it dawned on me that the chief's problem was impotence. The African orderlies working with me at Ifakara hospital had told me that impotence was a major problem, aggravated by anemia among the illness-ridden men in the bush. This man too looked rather thin and worn out. How could I help him? This was not the kind of affliction I had been trained to handle. I searched through the many samples of medicines thrown together into a big box. Then I had a bright idea. Remembering that impotence can be positively influenced by means of suggestion, I grabbed a tube containing Redoxon effervescent tablets which I found in the box. I filled a glass with water and dropped the tablet of Vitamin C tablet into it. Holding the glass with the sparkling water up in front of his eyes I solemnly said “Dawa ya nguvu!--Powerful medicine!” With wide open eyes he watched the large tablet sinking to the bottom and dissolving into a myriad bubbles, as if all the strengthening power was rising to the surface like little spirits. “Here, drink it,” I said. He took a step backwards, fear in his eyes. I nodded to encourage him, but he turned ash grey as he watched the nguvu spirits continue to pop out of the drink. I held up the glass again. With a tremendous effort he reached out for it. He looked at me firmly, then closed his eyes and drank the brew in one gulp. All those little spirits tickled his throat and nose as they tried to escape. Determined to keep them inside once he had them there, he quickly pressed his lips together and pinched his nostrils tightly with his fingers. When he had to breathe he let go with a big blow. He opened his eyes and smiled. I think he felt stronger already. With a beaming face he took the colorful tube with the wonder drug. I told him to drink a glass of “power medicine” every night before going to bed and gave him other vitamin tablets to take during the day.
Happy and encouraged he thanked me and turned to the door. At that moment another man entered the room and my patient quickly concealed the medicine in his clothes. They greeted each other in a very friendly manner but both appeared slightly embarrassed. Again I understood only a few words of what the newcomer said, but his looks and manners told me that he had come on the same errand. I looked through all the supplies in the dispensary, but there were no more effervescent tablets. I provided him with the usual vitamin pills but this obviously did not satisfy him. He must have watched me and the other man through the window, because he insisted upon getting some “power medicine.” Could I not look again? I showed him that there was indeed no more dawa ya nguvu in the dispensary. The chief in the meantime had been standing at the door thoughtfully watching what was going on. Slowly he unwrapped the tube of Redoxon tablets I had given him. He counted them carefully, all the round tablets, each of them promising one night of power! He pondered over them for a long while, then separated them into two equal piles and gave one of these to his friend with a sigh. Together the two men left the dispensary. Surely that was a generous gesture by the chief, a true sign of friendship. I felt quite moved.
Copyright © 1979 Louise Jilek-Aall
Reprinted with permission
[Previous Chapter] [Contents] [Next Chapter]
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.