Call Mama Doctor

Chapter 9. The Epidemic


By Louise Jilek-Aall, M.D.

Like so many natural phenomena, the rainy season in tropical Africa is dramatic and full of exciting events. Towards the end of the dry season after unusually hot days when a merciless sun forces people to linger in the shadows, clouds begin to gather and before nightfall there is a cataclysm of lightning, rain and thunder. After having endured the dusty dry weather with its scorching heat, everybody enjoys the cool rainwater running down face and body. The people smile and laugh as they watch the little children running naked out of the huts to splash and dance in the streaming rain.

Traveling then became a special adventure, but I liked the challenge of coping with all the unpredictable obstacles on the way: dashing through shallow streams that flooded the road and hoping our landrover would make it through, enduring the laughter of the onlookers when it got stuck, watching eager helpers pulling the vehicle out and waiting in the sun until the motor was dry again. At other times, we would glide quietly among the trees over the flooded fields in a dug-out canoe, observing the teeming life in the water, half afraid a turbulent current, a tree trunk, or the back of a hippopotamus might overturn the fragile craft.

From Ifakara the road to the distant mission outpost of Taweta had to cross the many tributaries of the Ulanga River Mission stations were close enough so that one could travel from one to the other within a day, even during the rainy season.

One evening after a rainy day on that road I arrived at Iragua where one Father managed a small station alone. In his solitude he was always happy to receive guests and felt especially relieved when the visitor was a nurse or a doctor. He was eager to show me some of the seriously ill patients whom he had tried to help as best he could. I had hardly time to get out of the car before he took me to his little dispensary to see two small children. Their mothers had brought them to the mission after an exhausting march through the bush. They told the Father that some evil spirit had befallen their village and caused illness among the children. The people were in great fear because their medicine man had been unable to find the cause of this calamity and was unable to treat the afflicted children. Most parents did not dare to take their sick children on the long arduous journey through the bush, but these two mothers had braved the rain and brought their sick babies to the mission for help. As soon as I saw the skin rash of the children and their sore eyes and heard their rattling cough I knew that they had measles. For the malaria-infested and poorly nourished youngsters in the African bush an epidemic of measles was disastrous. The physically weak children quickly succumbed to pneumonia, a frequent complication of the disease. One single shot of penicillin, however, would often suffice to clear up the lungs and save the child's life. This was the case with the two little ones I thus treated at the mission, and the mother showed profound gratitude when I visited the children again the following morning. We discussed what to do about the epidemic and estimated that there were about fifty families with small children in the village the women had come from. We decided to take a trip to the village and to see what we could do. Since it was the rainy season and the bush was full of mosquitoes, tse-tse flies and all sorts of snakes and other dangerous creatures, we did not dare to stay out overnight. If we took the motor bike and started out before dawn, we would have time to spend a few hours in the village and still return to the mission before dark. I got the instruments ready, gathered up all the penicillin I could find in the little dispensary, and with that we set out early next morning.

There is something unforgettably beautiful about the early morning hours in tropical Africa. The threatening darkness of the night gradually recedes as a pale stripe of light appears on the horizon. An intense silence accompanies the dawn; the air is still and crisp with no wind rustling through the trees and the grass is cool and wet. Gradually the sky takes on an intense red and yellow coloring and suddenly there is the sun in all its glory, spreading warmth and light over the land, caressing the chilled skin with its warming rays. The new day is born as the jubilant birds break the silence with their songs, announcing their mere joy of being alive, knowing nothing of the sorrow and suffering the day might bring.

We too were filled with happiness at taking part in the great overture of the awakening day as we drove along the narrow path up and down the hills through the forest. We felt good there in the morning sun, knowing that we were on a mission to help suffering children. The small motor bike was not heavy and could easily be carried when shallow floods from the last night's rain blocked our way. Where the swollen rivers had washed away fragile bridges, friendly Africans ferried us across in their canoes. They laughed merrily while balancing the motor bike in the tiny dug-outs and were amused about my fear lest the medical supplies should get wet.

We reached the village towards noon and were greeted by the high-pitched trills the women sound when announcing a happy event. As usual, everybody received us with absorbing curiosity. The women laughed at their children screaming with fear at seeing the white strangers. They soon made room for the elders who greeted us ceremoniously while their wives arranged for us a meal of rice and chicken under a big tree. While we were eating the chief spoke about the mysterious disease. He told us that some children had already died and he thanked the Father for bringing Mama Mganga to treat the afflicted children. III at ease, I noticed a growing crowd of women with sad-looking youngsters hanging in slings on their backs. Seeing how the flock increased by the minute, I knew there would be more than enough work to do, and while the Father was still talking with the men, I spread out my instruments on a clean sheet I had brought along. I asked some of the women to make a small fire and to keep the water boiling which was needed continuously to sterilize the few injection needles I had. Since there were no tables or chairs in the whole village, treatment had to be given right there on the ground so the women knelt down around me. Each was eager to have her child treated first and they all got in my way as I tried to hold the terrified children. I called the Father to help me, but he was not at all fit for the role of a nurse. He held the children most awkwardly, turning his face away with a pitiful grimace when the injection was given. A few times the needle nearly broke in a child's behind because the Father jerked and dropped the child when it let out a howl. The poor Father was more a hindrance than a help and I became impatient with him, which of course made matters worse.

I noted the miserable condition of the children. Most of them showed shallow respiration with flapping nostrils and many coughed up bloody froth, a sign of acute pneumonia. It was not even necessary to use the stethoscope; my hand placed flat on the child's burning chest could feel the roughness of breathing inside. Although one shot of penicillin could work wonders, I realized that some of the little ones were already beyond remedy. More and more people arrived and for each child treated there seemed to be two more coming. Finally I had to face the fact that there was not enough penicillin for all of them. I felt hot and cold; we were surrounded by moaning, crying and coughing children. What a miserable situation! I was inclined to withhold treatment from the dying ones and to give the precious medication to those who had a better chance to survive. But how could I explain that to their mothers? Impossible!

I began to mix distilled water with the penicillin and to give sufficient doses to only some of the children. I felt like a criminal, and my tension mounted as the penicillin supply diminished. The mothers sensed my uneasiness and anxiously pushed forward. At last the Father stood up and declared we had to leave. A storm of protest arose. Why should some of the children get help and others not? Could we not see that the little ones would die if they did not receive the injection? The women closed the circle around us, sobbed and begged, clutching their crying, coughing children, holding them up to our faces. I looked around in amazement. Where had all the people come from? The mothers must have run for miles through the bush with their sick children. There was no way that I could treat them all. Clouds were gathering in the sky and the rumbling of thunder came closer. We would have to leave. But they did not let us. The mothers threw themselves down in front of us: Mama Mganga, you cannot leave us now, please don't let my child die, help my child, it is such a good baby, can't you see how sweet it is? Why did my neighbor's child get help and you refuse my baby? What have I done wrong? Why don't you like my baby? Please give an injection to my child, just a little one and it will not die! They grabbed our arms, blocked our way, seized the motor bike. The children howled and coughed, cried and moaned. Big drops of rain started to fall and soon we were soaking wet. The whole scene had turned into an ugly nightmare.

I had no more penicillin, but I had to do something to appease the desperate crowd. Knowing that to the mothers it was the syringe and not its contents which had the magic to save their children, I filled the empty penicillin bottles with sterile water. But the rain had extinguished the fire and the boiled water was mixed with water from above. Is rainwater clean? I wondered as I injected the thin penicillin water into the little behinds of the shivering children. The cool rain splashed the febrile naked bodies of the sick children making the skin damp like that of horses after a race. I worked in a fury as one child after the other was held before me. The mothers thanked me and their smiles burned my heart. The emotional strain, embarrassment and fatigue blurred my senses and made me confused. I vaguely remember how the lightning dazzled me and reflected on the wet bodies and that needles and bottles were washed away in the downpour. But we had to carry on to the bitter end until the last child had received its shot. Then we picked up our instruments and ran away, leaving behind a few latecomers and other sick people who had hoped to get some help.

We stumbled along in the rain full of pity for the many children we knew we had not helped, burning with shame about what we had done. With shaky hands we started the bike far away from the village. What a miserable failure, what a mockery of medicine! Tears mingled with raindrops on my face as we drove off amidst thunder and lightning. It served us right that we skidded off the road and fell into the mud. It did not matter that we lost all our equipment in the raging streams. It was good that darkness hid our faces from which the rain could not wash away the shame. I do not remember when we finally reached the mission. I only know that it was pitch dark, that we had fought our way mostly on foot and that the motor bike had been something cold to hold on to in the turbulence of rain and water and mud.


Copyright 1979 Louise Jilek-Aall
Reprinted with permission

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