and scribbled some lines on a piece of paper. I felt the satisfaction that I could improve the aesthetics of the hand shape and gave this hand a function and the girl a better quality of life. The mother was happy. She told that she will send her daughter to school what was impossible with the hand monster that had to be carried by her left hand. Doctor, patient and mother had a smile of relief and gratitude on their faces and the date for the next follow-up were noted in the health passport.
A man of around fifty years of age took the seat on the chair and held the leg prosthesis with his right hand. The bone stump was prominent and had thinned and inflamed the soft tissue coat. A revision with shortening of the bone shaft was needed that I admitted the patient and put his name on the preliminary operating list. An old woman supported by another woman walked with difficulty to the chair. She stood by holding the right hand on the backrest and pulled up with her left hand the long-hanging dress over her left knee. The old woman kept her head bowed and indicated with her left index finger the swollen knee which she could not bend. I helped the old woman for a seat on the chair and cleaned the skin over the knee with the disinfectant solution and put a needle into her joint. An amber-coloured fluid of a big amount ran through the needle into the kidney bowl. I had removed the needle when the old woman felt the relief and flexed the knee. She was one of the many old people who came to the hospital with advanced alterations [arthrosis] of the knee joint for release of the effusion. An artificial joint could help a number of patients, but this was not affordable for the poor people in the north and also not feasible at Oshakati hospital. I explained to the old woman that only a stiffening of the knee could take away her pain, but she rejected this kind of help. She said that she needed her knees. I prescribed the anti-inflammatory drug in her health passport. The old woman left accompanied by the younger woman the consulting room for the dispensary in the waiting hall to receive the small yellow plastic bag with the pre-packed tabs for no longer than one month or only two weeks, if a drug shortage was in sight.
A child with a broken right forearm sat on the knees of the mother. I went with mother and child to the plaster room and reduced the fracture in a short-lasting anaesthesia and immobilized the arm with a long cast in flexed position of the elbow. A young man had dislocated his left thumb. It were reduced in local anaesthesia and immobilized on a splint. The next patient was a woman who had cut off the tips of her left index, middle and ring finger with a panga. I put the patient on the operating table in the casualty theatre and anaesthetized the fingers and covered the defects over the stumps with flaps in V-Y-shapes. The nurse gave the anti-tetanus injection. A boy entered accompanied by the father the consulting room. He limped with the left foot wrapped in a rag. The boy had stepped in pieces of glass and had cut his toes. The father carried the son to the small theatre room and put him on the operating table. I cleaned the toes and the forefoot and gave the anaesthetics to the toes affected and removed some splinters and sutured the wounds. Dressings and bandage were applied and the nurse gave the booster injection against tetanus. A mother brought her baby on whom the sixth finger on both hands and the sixth toe on both feet were ligated to separate them from the blood supply. The surplus fingers and toes had fallen off that the hexadactyly [six fingers] were brought back to the normal pentadactyly [five fingers] with five fingers and five toes. Lunchtime had started thirty minutes ago when I left the consulting room. Three of the seven waiting benches were cleared up.
The kitchen man filled the plate with rice and put a lobe of meat and the two pumpkin halves on the plate and spread with a big kitchen spoon the sharp chilli sauce over the rice. Dr Nestor and the paediatrician sat at one table that I took the next table. The friendly kitchen man with the dark spots on the white kitchen clothes cleaned the table from the used plates, cups and cutlery. I ate the rice and the half of the meat and the flesh of the pumpkin. The ten-year-old girl was in my mind, I had cut off her right arm.
The paediatrician left the dining room and Nestor came to the table and took a seat. He saw the sadness in my eyes and asked for the reason. I told him the story: The father was torn in pieces by a landmine a few weeks ago and the mother was sick who had to look after the girl’s younger brothers and sisters. I had cut off the right arm on the ten-years-old girl because of a bone malignancy in the upper arm. Nestor got a serious face from one second to the other. He put his right arm on my left shoulder and looked at me with sad eyes. After a minute of a thoughtful silence he said that we as medical doctors have to do our work which is to help our patients. “More than saving the girl’s life, you cannot do”, he added and changed the subject knowing that nobody could give the poor girl the right arm back.
He asked in connection with the text of the advertisement in the German ‘Ärzteblatt’ for my opinion, particularly if German doctors would be interested to come to Oshakati. A small advertisement was commissioned for what Dr Witthuhn as the medical director was ready to pay from the small and restricted hospital budget. I was concerned, if the small size could catch the eyes of the readers, but I answered the question positively and said that a glut of doctors exists in West Germany that goes parallel with a reduction of the medical and nursing staff according to the reduction of the bed capacity in the hospitals together with the closings of small community or privately run hospitals.
Africa is the continent where the sun triggers off the reflex of the exotic with the great distances, the width of the deserts, the clear night sky and the pristine habitats of the wild animals. Dr Nestor laughed and his fist knocked the hope for more doctors on the table. He got attracted by his imagination that the German doctors would respond, since from South Africa there was nothing to expect after it has withdrawn its doctors from the hospital. “The military does force us on our knees, but we will not give up”, Nestor said with an undertone of bitterness. I agreed and said that the few doctors left will stand as a unit with straightened knees. “We will pass the critical time and keep the hospital running and if we work sore our fingers.” It was a strong saying of an unconditional motivation when we left the dining room.
On his longer round in the children’s ward, I looked after the ten-year-old girl whom I hopefully did save her life, but took certainly away from her the quality of a normal and a cheerful life. The girl lay in bed with a tear-stained face. Her eyes were red which looked hopelessly. I gave a smile of deep sympathy and understanding what however remained unresponded. The girl kept the great sadness on her face that I was unable to ease. There was no point of light. I stroke her hair as her grandmother has done in the consulting room. The girl took it with running tears. She started weeping bitterly that my eyes got moist as well. It was the sad lesson that I couldn’t comfort the girl in her despair. I left her and left the children’s ward.
Outside the ward I wiped off the tears and went to the outpatient department to continue the work in consulting room 4. The Philippine colleague was busy in the plaster room to reduce a lower leg fracture on a child and to put on a long leg cast. I took the seat at the table, while a mother put her three-year-old girl on the knee and held up the girl’s right lower leg which had the clubfoot deformity. I explained the operation to the mother who agreed and gave the consent for the operation that I admitted the girl and wrote her name on the preliminary operating list. An old man who was accompanied by his son entered the consulting room and took the seat. The man had a spotted grey cataract and was blind. He showed his right hand which had a bayonet deformity on the wrist. The son told that the father had fallen. I took father and son to the plaster room where I put the father on the examination couch and gave the pain injection into the fracture gap. The son held the thin upper arm of the father and I pulled with one hand the old man’s thumb and pushed with his other hand the radial knot into place. I put on a forearm cast, while the son held the father’s hand up by pulling his thumb.
“Is that all?”, the old man asked his son and the son asked the doctor. I removed the plaster spots from his hands and made some notes and prescribed the pain killer in the health passport and gave the passport to the son who helped his father to sit up. The father thanked for the work and that it was painlessly done and left the plaster room guided by his son. A young woman sat on the chair. She put the tip of her right index finger on her right thigh where a needle was inside. I palpated the resistance and removed the needle in local anaesthesia
