Poverty abounded in Mtwara. This was very much evident in the hospital and clinics. Ligula Hospital was built in 1964, and it probably had not changed a great deal from when it first opened. The CTC shared space with the regular outpatient clinic and only opened on Wednesday and Thursday. HIV patients mingled with the regular patients and were not singled out. The waiting rooms were always crowded with patients sitting on benches or lying on the floor, waiting patiently. Flies swarmed around open wounds, settled on the eyes and lips of the patients. During the rainy season, the ceiling leaked onto the floor, and patients waded through ankle-deep water to see their doctors.
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One morning Dr. Mdoe and I took a long walk along a corridor crowded with many waiting relatives, almost all women, to make rounds in the hospital. He pointed out a rotunda in the hospital compound where the women cooked. The hospital did not provide food for the patients; relatives cooked for them and provided ninety percent of the nursing care. The ward was a long building lined on both sides with wrought-iron beds with peeling white paint, placed only a few feet apart from each other. Blue or hunter green mosquito nets, tied up for the day, hung from the ceiling. The patients brought in their own sheets, and when all of the beds were full, two patients shared a bed, their heads resting at different ends.
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Tanzania
Into Africa, Out of Academia
A Doctor's Memoir
Dr. Mdoe took Christine and me to the “Frelimo,” the maternity ward used to house exiled Mozambicans who formed Frelimo or the Mozambique Liberation Front in 1962 seeking to overthrow the Portuguese colonial rule in their country to gain independence. At the reception, a very pregnant woman lay on a bed covered with a dirty brown sheet. This room opened into a ward with three beds, each equipped with a pair of large, bloodstained canvas stirrups. A pregnant woman occupied a soiled vinyl bed with no sheet, and another arrived on her own two feet, alone and unescorted; she was led to an empty vinyl bed. Off to one side was the delivery room with three beds equipped with rusty steel stirrups, lending an air of austerity and reminiscent of the butchery of medieval times. Delivery beds purportedly scrubbed clean looked ominously blood stained. Beside one of the delivery beds, a wooden tray lined with a bloodstained rubber sheet, a giant bulb syringe lying forlornly near it, was ready to receive an innocent newborn into the world. The old bloodstains from numerous previous deliveries had set permanently into the rubber sheet; no amount of washing could ever remove them. There were three other wards: one for women post C-section, a second for women after vaginal delivery, and a third holding women in labor. The hallway led to a small room for premature babies, with three bassinets each holding up to four preemies, covered with mosquito netting. Naked light bulbs hung low over each bassinet giving out feeble heat. There were no intravenous lines or respirators. Nine preemies snuggled against each other, no nurses around, only a lone mother hovering over her baby.
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Tanzania
Into Africa, Out of Academia
A Doctor's Memoir
South Africa
One could not visit Cape Town without paying a visit to District Six, which used to be a vibrant inner city of mixed residential areas located in the bowl of Cape Town and linked to its port. Its residents were mainly black: Cape Malays, black Xhosa, Indians with some Afrikaans, and whites. In 1966, the government declared District Six as a whites only area using the Group Areas Act, and over 60,000 residents were forcibly removed by the apartheid regime. The old houses were bulldozed, and the displaced people were relocated to the barren, outlying, sandy area of the city now famously known as the Cape Flats. I spent an afternoon in one of the townships in Cape Flats, a mixture of one story-homes, two to three story-flats, tin sheds, and rows of communal outhouses lining it periphery. Newcomers squatted on the sidelines in lean-to sheds. One big living space filled the inside of the smaller homes, beds rolled up during the day to make space for eating and cooking; sleeping took place in the same tight quarters. Clothes fluttered from the common courtyards with scattered outhouses. Children ran around barefoot and stayed out of the hot container homes.
The District Museum in District Six portrayed the history of apartheid and its effects on the ordinary people through an intimate look at their personal stories, belongings, and interiors of their homes. On the ground floor was a large map where residents could leave their comments. There were old street signs, the bench with its “Whites Only” plaque, and countless memories, moving stories retold by the people who had their lives torn apart.
The most moving story of all was the story “A Homing Pigeon’s
Into Africa, Out of Academia
A Doctor's Memoir
South Africa
Into Africa, Out of Academia
A Doctor's Memoir
View of Forced Removal,” narrated by Noor Ebrahim, one of the founders of District Six Museum. During one of the meetings of the District Six Land Restitution Case, he stood up and told his poignant story of his fifty prized homing pigeons, for which he built a loft using the wood from his home in District Six in his new home at Athlone. After a three-month stay in the new home, he felt it was time for his homing pigeons to learn to fly back to their new home. He let them fly away. In the evening, he waited apprehensively, but there was no sign of his pigeons. The next day when he drove by his old home in District Six, “I saw a sight that shook me to the core; my pigeons, all fifty of them, were congregated on the empty plot where our home had stood. Getting out of my car, I walked over to where the pigeons were. Very surprisingly, they did not fly away, but looked into my eyes as if to ask, “Where is our home?”
I, for one, was ready to go home.
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South Sudan
Andrew Walhok, a community health nurse (CHN), told me cows and girls were highly valued in Nuer and Dinka countries. Herders used spears, but often AK-47s left over from the war, to guard a few precious cows they owned. While others used pounds, Euros, USD, yen, yuan, etc., they traded in “cows.” For the Dinka, a girl brought in a highly priced dowry of a hundred cows or so, and the girl’s legs must not be seen from any direction while she was being surrounded by the “cash cows,” otherwise the dowry would be considered inadequate. The groom-to-be had to bring in more cows to cover the long legs. For the Nuer, thirty to forty cows would be enough. A girl who could read brought in more cows then one who could not. Because of the enormity of the burdensome dowry, cattle raids occurred frequently, especially in Jonglei. Only older men could afford to marry repeatedly and most often took girls as young as thirteen for a wife. Young men without the requisite number of cows would just have to pine away or marry other tribes with much lower demand of the “cash cows,” such as the tribes in the Equatorial states; they only required two cows, four goats, twenty-five chickens and two bags of termites. HOLY COWS!
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After seeing patients with diarrhea, malaria, conjunctivitis, and various aches and pains, Michael came to fetch me. He told me that the BIG MAN, the director of the Boaw Payam, Philip, would like to see me. He was the stern man we met yesterday. The first thing that came to my mind was did I do anything wrong that offended the director or the community? I was thinking in terms
Into Africa, Out of Academia
A Doctor's Memoir
South Sudan
Into Africa, Out of Academia
A Doctor's Memoir
of my running (although I checked with Johnson beforehand about dress code, running, etc.) or my interactions with the people. It was past noon, the sun was hot, and I was thankful to have my hat. During the several hundred meters of walking to the director’s hut, I felt like I was being summoned to the principal’s office or my boss’s.
Michael and I stooped down at the door to enter the thatched hut. As my eyes adjusted to the darkness inside, I saw three people: the director of the Payam behind his desk, his secretary, David, and another man. In front of them were two empty chairs. They all stood up and shook Michael’s and my hands. What amazed me was that the Payam pronounced my name correctly, told me that it was an honor to have me in his Payam, and that they would honor me with a gift. Oh no! I thought to myself, not a goat! Sure enough, almost on cue, in came a man guiding a handsome horned creature into the hut. He was white with light brown patches of hair. The man handed him over to Michael; the creature promptly sniffed at his pants and then proceeded to nuzzle my hand, looking for food. I petted him and planted a kiss on his forehead. A broad smile spread across the face of the director. My next fear was would they expect me to kill it right there and then. I had heard of such stories in which the recipient of such gift was expected to slaughter the creature in front of everyone in the village. I thanked the director the best I knew how but wished that Johnson were here to help me as to the proper way to respond, remembering the other day he told us it would be very bad to refuse water when it was offered. In my mind, I wondered whether it would be rude to return the gift to the community, which this
South Sudan
Into Africa, Out of Academia
A Doctor's Memoir
creature would serve best. I stood up and thanked him from the bottom of my heart for the goat and murmured something to the effect that I did not eat meat. Then I wondered aloud whether the community could use it. He did not take the offer but corrected me that the creature was a ram. Yes, now that I took a good look, it did have a pair of ram-like horns. He wanted to know what I would call such a creature in America. I told him that we would call it a ram. He then suggested that I take him back to America on the plane and said if I had stayed two months or longer, there would be more great gifts. I thought to myself, the CASH COWS? A marriage proposal and a dowry? I was running wild with my imagination.
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