and grandchild left with the completed admission form and the signed operation form the consulting room for the orthopaedic children’s ward. Both did not turn their heads back to me. I felt very much sorry for the girl in my heart when grandmother pushed the swing door open to pass through and were followed by the stunned grandchild with the big tears in her eyes. The tragic blows had hit heavily the family: the mother was sick and had to care for smaller brothers and sisters, the father was torn in pieces by a landmine and the ten-year-old girl with her beautiful face and the tears in her eyes was on the way for an amputation of her right arm. I knew that the girl would never smile again as she had done in the afternoon of the previous day when she came alone and trusted the doctor that he would do something good on her.
It was lunchtime and Nestor asked me at the dining table for my opinion about the comment of the matron when she proposed that the superintendent should contact Swapo to explain the danger of the shootings for the hospital and its patients. I supported her proposal and recommended that the superintendent has not to lose time to do so, if the hospital should be kept running. Nestor replied that he will think about it. He was a Swapo-member since 1974 what he did confess some years later. Nestor told with a face of great concern that the military authority watched with eagle’s eyes the hospital and keeps up the suspicion that Swapo-fighters were hiding on this premises. He mentioned in this regard that the ‘Sekretaris’ had given him a ‘friendly’ warning. “It is shilly-shallying that one side mistrusts the other side”, Nestor said and looked on his plate. I thought of the tight-rope walk when I asked him, if he had spoken to the medical director. “He cannot help and advised me to handle the matter cautiously, since he does not trust the military and the ‘Sekretaris’ as well”, Nestor said pensively.
We spoke of the injured of the previous night. Nestor expressed his horror of the war causing these mutilations. I said it were his black brothers who shot the shell from a Soviet cannon. It was not only a critical, but rather a dangerous situation with the hanging position between the chairs when the chairs were moving permanently that the hospital hung on a thread that could tear every moment. However, efforts from the hospital administration were needed to come out from the hanging postion to make the lives of the patients and of the working staff saver. Aware of the implications of the decision that had to be met, Nestor repeated his sentence of hope that the madness will come soon to an end.
There were other big problems that the rural hospitals in the north, some had more than hundred beds, were run by nurses who treated the patients with TB, malaria and other common infectious diseases. They did small surgical procedures as well and saw huge numbers of outpatients on a daily basis. The nursing staff had serious problems to cope with the heavy burden of work that they asked urgently for a doctor. “We must help the nurses, though we are only a few doctors”, the superintendent said. He suggested that one of the black colleagues should join the hard-working nurses in those hospitals once per week, since they speak the language of the people and were familiar with their tradition and culture. I understood the point and offered my help spontaneously. It was rejected by the superintendent who said that I was needed most as a surgeon at the Oshakati hospital. We left the dining room and parted in front of the door of the secretary’s office.
I passed the waiting hall of the outpatient department with the fully packed benches and entered consulting room 4. The first patients who came for follow-up wore casts on their arms or legs. I reviewed the X-rays in comparison with the previous ones and removed the forearm cast on an old woman and repaired a short leg cast on a young man by putting on some new plaster layers. I came back from the plaster room when the Philippine colleague showed the X-ray of an old man on whom one hip did not show a joint cavity. The colleague asked what can be done knowing that a hip prosthesis was not available for these patients with the ‘empty hands’ and that the technical facilities did not exist at Oshakati hospital. I answered that only a stiffening operation [arthrodesis] can be done which could take away the hip pain from the patient.
The old man said in his language what the nurse translated, he will think about it. He grasped his long stick with both hands and pulled himself awkwardly up from the chair. He stood in his frailty, while his hands held tensely the stick in the height of his chin as he were something to say. He kept quiet and accepted his status of poverty, because it was his life. So he left in a limping gait the consulting room. The colleague gave the well-thumbed and creased health passport with the prescribed pain killers and some anti-inflammatory drugs to the son who followed the poor old man who was his father.
“It is a disgrace that we cannot help this old man ”, I thought when I saw how difficult the man was walking. Patients came every day to the hospital with joint pain with or without effusion [hydarthrosis] due to the degenerative alterations with the advanced signs of wear. It were the old people who have worked so hard through their lives of privation. It was a hard message given to them after the X-rays were seen that they have to live with their worn joints by taking drugs against the pain. It was the discrepancy between the rich and the poor that for the poors the adequate treatment was not available, while the rich had the better life without pain. This gave me many times a headache. The old man with the painful hip disorder of restricted mobility walked with great difficulties with his thin and worked-up hands on the long stick in front. He had understood the situation as most of the old people did. It was the wisdom of his age and of his life in poverty and privation that the old man did not argue or complain except from pain. He should think and ask himself about the advantage of getting stiffened his hip joint.
A younger woman took the seat on the chair. She could not move the right elbow after she was beaten by her husband. The X-ray showed a dislocation of the joint with a fracture of the radial head. I put her on the couch in the plaster room and gave the injection for a short-time anaesthesia and pulled the forearm in flexed arm position back into the elbow joint and immobilized the joint with a cast in the flexed position. The next patient was a woman who had torn the right index finger and dislocated the middle joint of the middle finger when she had collected branches for firewood. I took the patient to the casualty theatre and put her on the old operating table. After the pain injection to the second and third fingers, I cleaned, debrided and sutured the laceration on the index and reduced the middle joint on the middle finger.
The patients for further treatment from the Finnish-Lutheran mission hospital in Engela, one kilometre south of the Angolan border, were brought in an old and shaky ambulance over the distance of hundred-twenty kilometres. Some of them had to be admitted. This ambulance was packed with patients with or without new or renewed casts for the trip back. It started not later than five o’clock due to the curfew restriction in the war zone from sunset to sunrise. If there was an engine or any other technical problem on the outdated ambulance that it could not leave Oshakati in time, the patients had to overnight with the other patients and family members on the concrete floor of the passage in front of the outpatient reception.
After the last patient had been seen and treated, the two doctors left the consulting room and the outpatient department. I made the short evening round through the wards to look after the operated patients of the day. The small girl after separation of the long fingers of the right hand [syndactyly] smiled and put up her arm with the fist bandage. The fourteen-year-old boy after the corrective osteotomy was happy about the shape of his leg. The old woman on whom the malignant skin lesion were removed from the right forearm and the skin defect were covered with a skin graft taken from the right thigh, thanked for the work done. The sincerity how the old woman thanked was above each dictionary.
I looked after the patients in the intensive care unit where the three injured after the emergency operations showed progress in terms of stabilization of their physical conditions. The two wound drains on the patient after laparotomy with bowel resection and anastomoses did produce small portions of blood-stained fluid. The bandaged limb stumps on the second patient who lost his right forearm and left leg, were dry. Dressing and head bandage of the third patient after plastic-reconstructive surgery because of the extensible face lacerations with the piece of metal in the left eye’s vitreous
