Helmut Lauschke

For Justice, Understanding and Humanity

Efforts and the lack of response and support

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Inhaltsverzeichnis

Titel

Preparations for the future and the withdrawal of the army doctors

The telephone rang on a Saturday morning

Dr Nestor became the first black superintendent in the history of the hospital

Humane psychology versus war psychology

To cut off the girl’s arm

The triangle conversation

The problem of getting milk for the patients. The siren wailed in three waves over the village

The dream of a girl in labour who laid out the torn cloth

The small church bell rang for the Sunday service

Starvation versus rich and regular meals

Before the landing manoeuvre

The transitional period

The helicopter safari over the Kaokoland and the farewell of a great doctor

Power change and the aftermaths

The royal visit

“Attention! Her Majesty The Queen of the United Kingdom”

Willingness, commitment and competence

One who knew and skived

The stage of disrespect and disobedience

The subcommittee’s work for the establishment of a medical faculty at UNAM

Preparation of the international workshop

The missing contribution

How the workshop took place

Visit to the university and to the two hospitals of the Windhoek hospital complex

The outcome of the workshop

There was still something to see

Harlequin with violin without sounding board [as a conclusion]

Impressum neobooks

Preparations for the future and the withdrawal of the army doctors

Efforts and the lack of response and support

Namibia – The Years of Learning and Reconciliation:

Efforts regarding Medical Improvement

With true humbleness, honesty and respect to the disabled and the poor in particular, and hard work in consistency, we shall strive to achieve understanding, reconciliation, trust and truth on a high ethical level which should be the fundament of freedom, peace, uprightness with mutual responsibility and helpfulness, and justice.

Reference:

1) On The Path To Freedom, Macmillan Education Namibia Publishers 2012

2) Dr Omidhi, For Freedom, Equality and Justice, 1st Volume: Namibia – The Years of Decisions, Life and Medical Challenges, Publisher: Worldwide Books and Art PTY Ltd 2016

3) Namibia – The difficult Years – The most critical time, epubli 2017

A Number of Villagers left Oshakati

The cocks crowed six o’clock when I left the flat for the hospital. I showed the permit to the guard at the checkpoint. Though it was compulsory to check the permit, the guards followed the order often sloppily and did not look on the permit when I was accompanied by the young colleague in uniform as a lieutenant of the SADF. Military vehicles drove frequently out in respect of the fear of the whites regarding the increase of insecurity. These vehicles had driven deep ruts and big potholes into the gravel roads.

Quite a number of villagers had left Oshakati with their families for the south what was Windhoek or one of the coastal towns, or for South Africa to get out of the danger of war and to enjoy the better life with quiet and restful nights and to start some kind of profitable businesses. They preferred to bypass the last rigours of war by joining people who lived without disturbances and fears, and in the prosperity of the white ‘peace’ and to observe the further development of the last, but decisive battle from a distance of the personal safety. The distance did depend on the prosperity they had achieved in the north. The higher the prosperity was with the hidden wealth, the bigger became the distance, but some hundred kilometres in general.

As ‘people from the front’, they held themselves important when they discussed the ongoing war in the north and the consequences with the business people and friends and some drinks what could be expected for the country. They discussed these topics also in length with the stool neighbour at the bar counter what led by the regular repetitions to remarkable and advantageous business deals. Some houses in the village became vacant. The situation was used by the Filipinos who worked as teachers and motor mechanics when they moved from smaller houses into bigger houses which were better maintained and had a bigger garden in the front and in the back.

I passed the hospital gate. The gatekeeper behind the right post was busy with peeling his egg. He threw the shells on the ground and stuffed a big part of the egg into his mouth that he could not reply my morning greeting. Fresh ruts of the Casspirs rough treads with curves were pressed in the sand on the square. Some ruts branched off to the gravelled ring road inside the premises with its huge potholes. I started the round in the intensive care unit. The patient after relaparotomy to stop the intraabdominal bleeder was in a stable condition. The drain produced only little amounts of blood. The blood pressure and pulse rate were reasonable. A bag of blood was connected. I made my notes. The other patients were in stable conditions to be transferred to the general wards. The two bedrooms that the superintendent and doctor for his private patients had occupied were full. In one room were the mothers after their recent deliveries.

I went to the surgical male ward and looked after the old man after the exploratory laparotomy with the inoperable colon cancer. The patient had opened his eyes in which I read the fear of uncertainty and death. The word which should comfort him took the patient without a word. I went from the male ward to the female ward. The old woman after amputation of her left leg due to the malignant bone tumour looked at me without any complaint. She impressed by showing her strong will to recover from the operation that she could leave the hospital as soon as possible to support her daughter in the upbringing of the two small children. ‘High life’ was in the children’s ward. Children who were not bedridden, ran and crawled half or fully naked through the corridor and bedrooms. Some of them had spots of excrements on their grey hospital dresses. There were small urine lakes and piles on the floor what had to be cleared up.

The few nurses did a marvellous work in cleaning the children and replacing the dirty linen by clean linen. They fed them and put them on the bedpan. I admired their commitment and patience. One of these nurses, I called her the angel of the children’s ward, was busy in changing dressings on children with burns. She did it in a professional manner with a mask over her mouth and sterile gloves and made the dressings wet with sterile saline solution before she removed the dressings from the wound. This particular nurse with the true human face was lean and did her work extremely gently to avoid any unnecessary hurt. It were the sick children who were in her mind when she did her work without looking at the small watch on her left wrist. I followed her doing with great attention and respect. It was the close connection between brain and heart what made her work outstandingly valuable. I praised her commitment as a wonder of humanity in this terrible time of war.

It was time for the morning meeting that I left the children’s ward. The office of the superintendent was filled. I took a seat next to Dr Ruth. Dr Nestor came later and took a seat next to US. The matrons and the pharmacist couple sat already on their chairs opposite to the desk of the superintendent and looked straight at his pale face. Dr Lizette and some Philippine doctors arrived and occupied the last empty chairs, Lizette took an upholstered chair at the window front. The superintendent in his white linen jacket left his chair and crossed the room and switched on the air conditioner which started rattling. The short black paediatrician entered the room as the last with the right hand deep in his trouser pocket. He stalked like a star with a face of great importance from the door to the window front and took a seat right of Dr Lizette. He crossed the right leg over the left and looked at the ceiling. Nestor closed the door and the superintendent opened the meeting.

He announced what was already known that at the end of the month what was in five days, the colleagues from the army would leave the hospital. He thanked these doctors for their commitment which he called exemplary, and added that he didn’t know how the work without them could have been handled by the few remaining doctors. The young army doctors made their big eyes when the superintendent put it in the following words: “The hospital had depended on the military doctors. You have rendered a great service by your work on the patients for what I like to thank you in the name of the hospital administration and the rest of the colleagues.” ‘If that doesn’t go wrong’, I thought of the hypocritical manner how the superintendent did express his thanks and had in mind the disrespectful behaviour of the paediatrician on the day before when he introduced the new specialist surgeon to me. It was this negative-remarkable event when I realized that the future had already started. I saw in my imagination the rising tips of the black masts of the new vessel with the black crew which would take over soon the power in this country.

There was silence in the room after the sentence of thanks had been addressed by the superintendent. The black paediatrician had anger on his face whose eyes focused something at the ceiling. The other faces on the window side looked seriously without any motion. The young colleague and talented story writer took the word on behalf of his other young colleagues in uniform. He thanked for the opportunity that they could work at Oshakati hospital where they have learnt so much in the recent months. He himself has collected experiences that were extensive to an extent he couldn’t think of before. When the young colleague mentioned my name to thank for all my guidance and support in teaching him the medical basics and some operative techniques, it has opened him the eyes. The paediatrician looked critically at me as I did not deserve these words of thanks in this wonderful humane way. I took the averse eye expression relaxed, but remembered the furious looks of the ‘lieutenant of the devil’ who was the arrogant, selfish and scheming Dr Hutman. However, I took the paediatrician’s response as a token regarding the future when the new power vessel with the black crew has docked and the power change gets in full swing from white to black. It was the sincere gesture of a friend when Dr Nestor nudged gently my arm and whispered ‘excellent’.

The superintendent made a note on a paper and folded and stuffed it to the other papers in his left pocket of the linen jacket and started talking about the precarious security situation. The wording of the topic was worn and blunt, since it was the same what he had used the previous weeks. He mentioned some new thefts which have occurred in the main kitchen where big amounts of meat were taken from the freezer and barrels with diesel fuel for the power generator were taken from the generator hall, and the engine and four new tyres were stolen from the carport. He reiterated the disappointment of the acting shirt-sleeved medical director in respect of the recent criminal activities. He expressed his concern that crime would continue as long as the culprits were not identified and punished. “These activities affect severely the hospital. What can the patients eat, how can the generator run in cases of the power cuts and how can the ambulance get ready to function, if meat, fuel, engine and tyres are missing?”, the superintendent questioned.

I observed the paediatrician who seemed to be entertained, while his eyes walked along the ceiling. I put the question up what koevoet is doing in their night raids when they search for suspected Swapo-fighters on the premises and in the wards. They could prevent the criminal activities and protect the hospital properties. The pale looking superintendent moved his eyes, but did not say one word. The pharmacist said that things cannot simply disappear, if the vehicles were screened at the hospital gate. I picked up this point and asked, if there were vehicles which bypass the control by the gatekeeper that they pass unscreened the gate. There was silence, because everybody including the superintendent understood that it got referred to koevoet with their Casspirs. The superintendent kept his big eyes on me, while I suggested that the superintendent should think about the meaning of the nightly raids of koevoet on the hospital premises. After this point, the colleagues on duty reported on their activities and the patients who were admitted. The pharmacist woman mentioned the drugs that were not on stock, but ordered since two weeks. With this, the morning meeting had ended and the participants left the superintendent’s office with serious and vacant faces.

I was waiting for the young colleague outside the secretary’s office where I asked myself when this meeting would become meaningful. We went together to the theatre building. On the way I thanked the colleague for his kind words. The young colleague said that he had made it short to avoid wrong reactions that could be based on jealousy, though he did like to say so much more. We changed the clothes in the dressing room and entered the small tea room. Dr Tabani sat already there dwelling in his thoughts and reflections. Dr Lizette arrived. She took a seat with a cup of tea and expressed her disappointment about the poor quality of the meeting where the superintendent made big talks, but without any practical solution. Dr Tabani smiled and said that he had attended some meetings in the beginning, but when he has realized that there were only empty talks, he did not attend this nonsense any longer, since he did not like this kind of delusion and disrespect. Dr Lizette laughed and agreed and said that it is a cheek to speak always the same without anything done. Dr Tabani replied with seriousness that politics does not belong into a hospital. The young colleague kept quiet, because he felt himself as part of this politics, though he had put his uniform even temporarily on the rack in the dressing room.

Tabani sat in the tea room waiting for the anaesthetic doctor, while I and the young colleague and Lizette went to theatre 2 to fix the neck fracture on the thigh bone [femur] on the man referred from the Finnish-Lutheran mission hospital in Engela what is as far as hundred-twenty kilometres from Oshakati and only one kilometre from the Angolan border. The patient was put on the operating table and both legs were stretched by a leg extension device. The femur neck fracture were reduced and fixed by a plate on the lateral aspect of the femur shaft and three long femur head screws. The operation got monitored under the visual display of the portable X-ray machine. When the operation was finished the extension device were removed. Dr Lizette pulled out the breathing tube from the throat and put the oxygen mask on the face of the patient. A nurse removed the operating coats and the lead aprons from the surgeons who stood with huge sweaty spots on their green operating shirts. The patient were lifted from the operating table on the trolley and carried to the recovery room. The young colleague and I went to the dressing room and rubbed the sweat from the skin.

We made a short break in the tea room. The young colleague filled two cups and put them on the pen-scribbled wooden plate of the small low table. The superintendent entered the tea room with his packed side pockets of his white linen jacket and his pale face and informed me that the patient with the breast lump had given her consent for the operation. We fixed the day and made notes on separate paper sheets. The superintendent filled a cup of tea and mentioned the new colleague as a specialist surgeon who would come soon to the hospital. He said that the new colleague would be a relief for the department. Dr Lizette stood up and filled a cup of tea as well, while I sat and kept quiet, since I had met the black colleague whom the black paediatrician had introduced to me in a disrespectful manner. Lizette asked the superintendent from where the new surgeon is coming. “He is a Namibian and did his postgraduate in South Africa”, he said. Lizette expressed her surprise that Namibia had already some specialists. She leant back with a pensive feature as she saw the train of the new era passing by in her mind. She was amazed at this stage what she didn’t expect.

In my mind was the vessel with the black masts carrying the black crew when the siren wailed over the village with the crescendo and decrescendo of two waves. The time of the upheaval had started. This was readable on the faces of the whites who showed the signs of fear and uncertainty, as on the faces of the black people who showed the signs of hope for a better life. The superintendent had finished his cup of tea. He stood up and said that things are not as easy as he had thought. I asked, if he meant his patients. “With my patients I have no problems”, the superintendent replied standing with his bulged side pockets of the white linen jacket in the door and looked with a slit-eyed pale face over the small table with the pen-scribbled wooden plate. He laughed, turned and left the tea room.

‘This I will believe’, I thought about the superintendent’s leaving remark. Dr Tabani came from theatre 3 and asked the people in the tea room about the meaning of the wailing siren. I made a joke when I said thet the people are not falling asleep in the morning. Tabani laughed with a sneering undertone of the system hater. He said that the sleeping time is over and that the people must get awake and become alert to avoid mistakes which they may regret later. Lizette asked for the meaning of the sentence. Tabani replied: “Everybody must decide for the one or the other side before it is too late. I cannot say more.” He leant back on the worn-out upholstered chair, while the others went to theatre 2 to continue with the next operation. We washed our hands and forearms when the young colleague stated that the remark of Dr Tabani had a serious background. It corresponded well with the picture of the sinking vessels with the white echelons and the white commander-in-chief that everybody had to look for himself not to miss the right moment for jumping off to avoid drowning with the vessel like the crew in the stern.

We dried the hands in the blotting paper when I gave into consideration that only the good swimmers with the life vest have the chance to survive what will be impossible for ‘Joe Blow’ without the life vest. People with the broad short necks and the spare tyres around their bulging bellies will reach the shore. They will not lose a tear of sadness for those who have drowned. This was in respect to the saying: those who have the most, live longer than those who have little or nothing.

The second operation was an internal fixation on the upper arm bone [humerus] which had been broken in several fragments. I exposed the radial nerve crossing the proximal half of the long bone and showed the young colleague the upper and the lower course next to the nerve crossing. The colleague held the arm in flexed position of the elbow and under traction. He understood that the radial nerve could be easily damaged at this part of the course. I aligned the fragments and put the eight-hole plate on the fractured bone shaft. The fragments were temporarily held in place by bone-holding forceps and finally by the screwed-on plate. The young colleague closed the wound by suturing the muscle fascia and the skin, and I assisted him. The dressing was put on and bandaged when Dr Lizette removed the breathing tube from the patient’s throat. The patient were lifted on the trolley and carried to the recovery room, while I thanked the team for the cooperation and left with the young colleague the theatre room.

It was Friday. The academic meeting had started shortly after eleven o’clock when Dr David gave a lecture on pulmonary TB underlined by demonstrating X-rays of various stages starting from a primary focus up to the destruction of lungs with cavity formations and caseation. He mentioned as the most common disease transmission the inhalation of TB-contaminated cough particles through the branches of the respiratory tract into the air cells [alveoli]. People with a compromised nutritional and physical status are particularly exposed to the pulmonary disease because of the weakened or abolished immune system. The disease was extremely widespread in the north of the country. Dr David gave a great importance to the early detection of the disease when TB is still curable by taking the necessary drugs that there is the chance of a full recovery. If diagnosis has failed, the disease affects the whole lung causing finally the galloping phthisis. The patients lose body weight down to emaciation and skeletisation and cough themselves literally to death. It is the galopping ‘horse of death’ on which the patients are riding, if the diagnosis was not made in time and TB were not treated. Dr David went into details of the various stages when he mentioned the symptoms and complications including aspects concerning the differential diagnosis. He highlighted the rules of the pathology with a ‘second hand’ of the prognosis of the disease and the stopwatch, if life comes to an end because of the failed diagnosis and treatment. The lecture dealt with a core topic, since malnourished people and children passed away like flies due to their weakened and abolished immune system. If a bed became vacant in the male and female TB-wards, it was occupied by a new patient not later than one day, while many more patients were waiting for admission.

The presentation of the topic was brain catching. In the following discussion, the black paediatrician ‘corrected’ the lecturer that there is something different in the TB of a child compared with the TB of an adult. It was something small with what the paediatrian tried to make himself big. Dr David of the higher intelligence brought the weird position back into the clear line by a logically stronger definition showing the intellectual power when it came to the accuracy in summarizing the basic principles. Other questions from the colleagues were plain and clear and were answered in a plain and clear manner.

David thanked for the attention and the constructive questions. He received the applause, he did deserve. He took his seat on a chair and kept control of his pleasant humbleness. This doctor was a specialist of internal medicine who did his postgraduate at Wits-University in Johannesburg. He was a motivated and committed doctor and did a marvellous work on his patients at Oshakati hospital. David was always on time when he started the round through the packed wards of internal medicine. He was an excellent teacher and did once per week an academic round with his junior doctors who had praised his knowledge, experience and didacticism. Under whom, they had learnt much in terms of discipline, analytic thinking and management. This doctor kept a high ethical standard in terms of humanity who was on top compared with other colleagues, followed by Dr Tabani and Dr Ruth and the two doctors in uniform of the SADF like Dr van der Merwe and the young colleague. They were hard working doctors to the patients and dedicated with a ‘human face’ that they gave their lasting impressions to the nursing staff and the rest of the medical staff.

The young colleague said in the dining room when we took lunch that he had never heard such a lively lecture at the university. I replied that the lecture in medicine becomes more lively the closer it comes to the patients. The hard working doctor is ready to learn and be receptive for the fundaments in theory and practice which go more or less under the skin. It is because the practice-related connection exists in an overabundance at Oshakati hospital, if one only opens the door. The young colleague repeated that it was the best lecture he had heard in all his study years. He agreed that the reason was the tight connection with the practical demands at the hospital.

“Then was your time at the hospital also academically worthwhile”, I said with a smile. The young colleague replied: “It was the most instructive time in my life. I learnt a lot and have many reason to be grateful that I could work here and build up my knowledge and my first practical experiences. I wrote the Oshakati diary in which I noted the events, the impressions and experiences with the people inside and outside the hospital and the achievements in your department. I will read these notes with great attention in future, since I see them as fundamental guidelines on the way I have to go. These notes should be my lessons I have to keep in mind.” I was impressed and summarized the comment of the young colleague with the word ‘wonderful’. I mentioned the book about the forbidden love and reminded the colleague to keep me on track with the ongoing story of the young family at Pallis Bay. “I have promised this and I will keep my promise especially because you gave some constructive suggestions for the story”, the colleague confirmed.

We left the dining room and walked the passage to the outpatient department. The pale-faced superintendent saw us coming and waited outside the secretary’s office. When we were about to pass, the superintendent asked me, if the operation for removal of the axillary lymph nodes on the young woman with the breast lump could be postponed one day, since he has to attend a meeting with the medical director. I told that the operation could be done after that meeting, if it does not take too long. The superintendent said he would inform me.

We continued walking the passage to the outpatient department and passed the seven benches in the waiting hall which were packed with patients, and entered the consulting room where the Philippine colleague had started working. A helicopter turned over the roof and square when we were in full swing of work on the patients. The rotor blades whirled up the sand on the square. After the helicopter had set down a sandy cloud veiled it for some minutes. The rotor ran out and the three blades twitched to the stop when two men in uniform pulled out a man on a stretcher from the helicopter’s bulge and hurried with the stretcher to the entrance of the outpatient department. A nurse came running to the consulting room and called me to see the man who lay on the stretcher put down on the floor. The right arm of the man was torn off and lay disconnected from the blood circulation, but still connected by a small skin-muscle bridge beside the body. A strong compression bandage [as a tourniquet] was applied around the short upper arm stump to avoid the bleeding to death from the arm vessels. The injured groaned in pain. The cold sweat of death was on his face. I took a blood sample for cross-match and asked the two men in uniform the carry the stretcher with the injurd to the theatre building, while I informed the colleagues in consulting room 2 and the theatre staff of the emergency and asked Dr Lizette to give the anaesthetics.

I followed hurriedly the men with the stretcher and changed the clothes in the dressing room and helped the nurses in carrying the injured from the theatre reception to theatre room 2 where we lifted the injured from the stretcher onto the operating table. A nurse brought some bags of blood of group ‘0’ and Dr Lizette hung up the first transfusion bag and started the anaesthesia. I dried the hands in the washing passage with some blotting paper and a young nurse helped me into the operating coat and tied the laces over my back. The instrumenting nurse cleaned the skin with the brown disinfectant solution and covered the patient with sterile green sheets.

I separated the arm from the injured’s body by cutting through the small skin-muscle bridge and put the arm on a spread-out paper on the floor. I ligated the vessels close to the armpit and cleaned the wound by cutting off some dirty and hanging tissue shreds and shortened the arm nerves and bone stump. I smoothed the edges of the short bone stump with the bone file and covered the wound with the skin-muscle flap kept in position by some stitches. The stump were dressed and bandaged. A nurse has wrapped the cut-off arm in a big paper to an arm parcel. The operation had been finished when Dr Lizette asked, if the helicopter did land often on the square to bring injured people. It was the second time what I remembered that it was exceptional. The patient was lifted from the operating table onto the trolley and carried to the recovery room with a dripping transfusion bag to a left arm vein.

I changed the clothes in the dressing room when somebody knocked hard against the door. Without waiting a response like ‘Kom in’, a koevoet officer entered the dressing room when I stood in underpants busy to put on the shirt. The officer did not apologize for his disturbance, but said that the injured was one of his people who had crushed his arm between two vehicles. I told that he had amputated the arm. The officer was not surprised and said that he had seen already on the spot that this arm did no longer belong to the soldier. The officer asked how long the patient would be admitted at the hospital, since there was an order that military and koevoet personnel had to be transferred to the military hospital in Ondangwa as soon as possible. I closed the fly and held the ends of the belt in my hands when I said that the admission would last at least two days until the patient is in a stable condition.

The officer disagreed with the two days. He said that problems would arise in view of the military order. He did neither listen to the medical arguments nor took into account the risk of a human life after operation. He simply said that a military ambulance will take the patient in this evening when he is conscious and transport him to the military hospital. When I realized that a military order was above any medical arguments, I said: “If that is your decision then I will not argue longer. Do what you think is right. I have told you my objection from the medical point of view.” I asked the officer, if he were interested in the amputated arm. The officer agreed that I asked the nurse to bring the arm parcel and hand it over to the officer. We left the dressing room and the theatre building when the amputee with the missing right arm were carried on the trolley to the intensive care unit. The officer followed with the parcel of the cut-off and wrapped-up arm of his man lying on the trolley.

I went back to consulting room 4 in the outpatient department. The two colleagues worked hard and were busy to reduce a dislocated hip on a young man who lay on the floor. The Philippine colleague had put his right foot against the conjunction of the pubic bones [symphysis] and pulled the left leg. I assisted by pushing the greater trochanter downward when the dislocated femur head snapped with a dull sound back into the joint socket [acetabulum]. The legs were equally long and the feet were in equal position when the man were lifted from the floor onto the trolley and admitted to the orthopaedic ward. The Philippine colleague and the young colleague had beads of sweat on their foreheads. They saw and treated the last patients and finished the work shortly before six o’clock in the evening.

It was the last day of the young colleague in uniform. He said goodbye to the Philippine colleague and wished him and his family the best. The Philippine colleague had a pale face when he replied with a smile the wishes with a friendly undertone as he would miss the colleague as well. They gave each other the hand. The young colleague said goodbye to the nurses of whom some got tears in their eyes what reminded me on the farewell of the good Dr van der Merwe. Both doctors were highly appreciated as good doctors and human beings with their consistent openness to the people’s problems. The nurses thanked the young colleague for his work as they had done it to Dr van der Merwe for his work and kindness in terms of keeping up the human face as a hard working medical doctor.

The young colleague accompanied me to the wards and said goodbye to the nurses there. They took the leave of this helpful doctor with regret and dismay. The nurses had the good impression of this doctor because of his human face that the white skin and the must of wearing the uniform of the SADF did not matter much. The ‘angel’ of nurse in the children’s ward had tears in her eyes. She thanked the young colleague for his good work done and for the joy he had brought to the children and for his commitment he had shown to the staff. The nurse gave a very special pricing that the young colleague got tears in his eyes as well. He said to the nurse that he had admired her work and didn’t know, if he would meet a nurse of such humane format again. The farewell was a heart-moving one ‘chiselled’ into the memory of the people involved.

The doctors left the hospital and took the path between the rolled-out barbed wire in front of the tattered picket fence to the left and the five caravans to the right which all would become vacant by leaving of the army doctors. We stepped over the branches broken down from the old trees behind the picket fence and passed the checkpoint at the entrance of the village where the guard didn’t ask for his permit, though I held it in my hand. We parted to take the different roads. We gave each other the hand under the declining fireball when the young colleague told that he did write a farewell letter which he will bring the next day.

It was twilight. I reached the flat and opened thoughtfully the verandah door. I pulled off the sandals with the sweaty cork soles and entered barefoot the sun-heated sitting room. I washed my hands over the sink in the small kitchen and put the dented kettle with water on the flame of the gas stove. It was a remarkbale day. Again, a good doctor and human being said goodbye to the hospital. The new gap could hardly to be filled as the gap what Dr van der Merwe had left had not been filled. I took a seat on the step outside the verandah door and put the cup of tea to my right. I lit up a cigarette and looked into the nightfall with the stars coming up. The day gave reason to feel sad. A colleague of outstanding qualities was leaving who were needed so much at the hospital.

The first line of a Goethe’s poem said: “The human being should be noble, helpful and good”. This was the young colleague in an exemplary way. As a writer of the story about the forbidden love, he hit against the concrete wall of a system with its inhuman laws and rules. In other words, he hit on the ‘concrete’ heads because of the hopeless stubbornness with the wall rules of segregation and apartheid. This anachronistic wall had to be bulldozed down. The punishment for a human love between black and white had to vanish, this to bring life back to its given value and dignity regardless of the skin colour.

The telephone rang on a Saturday morning

It was the superintendent who asked, if the operation for the axillary lymph node removal on the young woman with the breast lump could be done at nine o’clock. He said that the patient urged to get the operation done. The malignancy apparently had affected her that she could not sleep. I agreed, though the weekend was the time for reading and writing. I put the receiver down and went under the shower when I enjoyed the silence of the morning with the colourful light of the sunrise which came through the window. A pastel-red ray touched the pile of the written papers on the verandah table as the spirit would emerge from the written words to give them the efflorescence of life. After the cup of instant coffee and the morning cigarette, I left the flat for the hospital. I took the way as a morning walk and looked at the trees and bushes and appreciated the songs of the birds and their jumps from branch to branch. There were still some cocks crowing as they had overslept. The guard at the checkpoint yawned when I said good morning and held the permit in my hand. The potholes in the gravel road were driven out to large dents. The gatekeeper at the hospital had already eaten his morning egg, while the shell pieces lay around the chair. Koevoet had done the nightly raid and had left fresh tyre ruts of the Casspirs with a bizarre pattern on the square in front of the outpatient building. Some ruts went off to the ring road inside the hospital premises.

I went straight to the theatre building. The superintendent sat already in the tea room and waited. He apologized for the inconvenience and stated for the delay that the meeting with the medical director had lasted longer in the previous afternoon. He did not say a substantial word about the meeting and I did not ask for that. It was in connection with the patient that I asked the private doctor, if the operation could be done under local anaesthesia which should be sufficient. The private doctor thought about it longer than expected. Then he said that he would prefer the general anaesthesia that the patient did not feel anything. I did avoid a discussion about the pros and cons. It was no doubt for me that the preference for a general anaesthesia was related to the higher anaesthetic fees which he would charge from the patient what obviously the private doctor had theoretically already in his pocket.

Both doctors changed the clothes in the dressing room and went to theatre 3 where the young woman lay on the operating table. When I came from the washing passage, the right arm lay extended in a right angle on an arm support. The skin of the right chest, shoulder and upper arm were cleaned and the rest of the patient was covered with green sterile sheets up to the anaesthetic frame. The private doctor held the anaesthetic mask on the patient’s face and said: “You can start”. Since the operation had a diagnostic purpose to confirm by a histological examination on the lymph nodes that the malignancy of the breast lump had reached an advanced stage, I made a small skin incision in the armpit and removed some enlarged lymph nodes as suspected metastases. The removed lymph nodes were incised and put into a small glass container half-filled with four-percent formaldehyde solution. The specimen had to be sent with the other specimens from other operations with the hospital bus the coming Tuesday to Windhoek to the lab in the Central hospital. I closed the skin and put a dressing on the wound.

The surgical intervention lasted circa ten minutes, while the patient needed further thirty minutes to get back her consciousness. The length of the anaesthetic time from induction until the state of the regained consciousness was chargeable plus the higher tariff for an operation on the weekend. The private doctor thanked for my work and wished me a relaxed weekend.

I made a short round through the wards. The old man with the inoperable colon cancer had given up his will to live. He breathed deeply toward the relief from suffering and kept his eyes closed in the haggard face when I stood at his bed. The old man was ready to die and kept his mouth closed to avoid any word about life. The other old man was the patient referred from the Finnish-Lutheran mission hospital in Engela on whom the broken femoral neck was fixed. This man read in a well-thumbed bible. He thanked for the operation done that he could use again his leg very soon.

The old woman whose left leg was cut off due to a malignant bone tumour had kept the will to live and to help her daughter with the two small grandchildren as far as possible, since there was no man who did care for the family. I changed the bloody dressing on the short leg stump. The woman asked when she could be discharged and I spoke of two to three weeks. I passed in turned direction the theatre building and went to the intensive care unit next to the square. The patients of the high risk were in stable conditions what were recorded in the patients’ files. The nurses told that the injured brought by the military helicopter and got the right arm amputated were picked up by a military ambulance the previous night at around nine “as it was agreed what the men of the ambulance told”. I took note without mentioning the useless discussion with the officer in the theatre dressing room. I wished the nurses a quiet day and left the ward.

I made a turn to the post office where the box was empty, and to the mini-supermarket to buy a grey bread of the tastelessness, a spread sausage, a tin with orange marmalade and a pack of Stuyvesant. I arrived at the flat when the young colleague came from the other side and passed the place between the guesthouse and the flat. I put the bag with the goods bought in the kitchen and waited at the open verandah door for the young colleague. He entered the small sitting room and stood in front of the verandah table and looked at the written paper sheets and piled-up papers what had reached the height of some centimetres. The young colleague found the extent of the writings remarkable.

I brought two cups of coffee and put the cups on the small table between the out-seated armchairs. The colleague praised his time in Oshakati where he had learnt so much for the future and did regret for the neglected condition of the hospital which many people were depending on. I told that I came back from hospital now where I had removed lymph nodes from the armpit for histology on a young woman of a suspected breast malignancy. The young colleague called the superintendent a moneymaker. In this regard, I told the story of a dentist with a name of a Huguenot origin who had worked in the dental department of the hospital for quite some months. He was obsessed with the greed for quick money in the turbulent time that he charged the settings of crowns on his accounts in many cases also for clients when a crown was not needed, contradicted and not set. Some clients complained that the crowns had fallen out after a short while that the dentist had put in a new crown. Other clients were amazed at the high charges on their accounts and that they could not find a crown in their mirrored open mouths.

Medical aid questioned the high number of crowns set in the short period of time that it started an investigation by interviewing the clients including the look into their mouths and compared the dental status with the fee numbers and charges on the accounts. Some clients had a few teeth left and others had rotten dentures with a strong halitosis that there were no places for a crown as it were stated. The scheme came out: the crowns were put in place on the accounts but not into the mouths. Clients demanded the paid amounts back from the dentist. The demands of repayment became more and more that the dentist left with the money paid and his wife Oshakati overnight for South Africa.

The young colleague said in regard to people of the greed for quick money that the ‘rats’ take advantage of the war related upside downs to fill their bellies like pigs. “The behaviour of the forced-up greed for profit is criminal and does harm and discriminate the medical profession at large”, he added. I replied: “If one thing is wrong, the whole system is wrong. The morals have reached the low in this corner of the world. The system is corrupt and rotten and will sink like an old vessel when the new vessel is already in sight.” I expressed the sincere wish that the new vessel carries the booster for bringing back the morals up to standard, since the people deserve justice and a life in dignity.”

The young colleague who had his roots in the African soil like Dr van der Merwe, said: “It is a piece of truth of the low standard that money makes African people powerful and that money has the bigger saying than education. The materialism has gained ground also in Africa that the traditions and values of the old African cultures are drying up. Education and culture have slipped down to the low of illiteracy in terms of intellectual and spiritual degeneration.” The young colleague painted a black picture by saying that he cannot imagine that the blacks will be more educated than the whites that the morals will suffer from the shipwreck. The new people will grasp the levers of power. They have learnt from old people the handling of power for the advantage of the new elite. “I think the other skin colour will not make a big difference”, the young colleague added and took a neatly folded paper from the table and gave it to me with the words: “These are my words of farewell to you”.

I unfolded the paper and read :

To A Friend

I’m leaving you and need you so much

where I’m going to, it has been changed

my mind took a different view and opinion.

What I saw before is no longer meaningful

as what I have seen and experienced with people

who live with hunger and renunciation.

I have never suffered of these basics

when I passed school and university

I had to eat and had my own bed

and had the books to bring up my knowledge.

Here I have learnt that I knew little

about people suffering of these basics

because I have not considered them properly and honestly.

I have blinded myself by things of affluence and wealth

and did not think that this only belonged to the whites.

You taught me to be a doctor with a human face

to see the needs in the patients’ eyes and hearts

you taught me the humbleness which is needed

to understand what most important is in life.

Now I go back to a place where things are white

and I know that it is only a question of time

because skin colour should not make the difference

if it comes to honesty and human caring.

I will remember you as my teacher regarding the blacks

who guided me in the direction of the greater values

which are more important than I thought before.

May God bless you and the suffering people

who struggle so long for peace and freedom.

I took time in reading to perceive the spirit between and beyond the lines. I was deeply moved when I thanked the young colleague for his words and regretted that he left the hospital where doctors with a ‘human face’ where needed so much. “What will you do when you are back in South Africa?”, I asked him. The young colleague said he like to do a postgraduate in surgery, but there is the problem of money. “My parents have sacrificed much to enable me to study medicine. There are three other children younger, but not less talented who were looking for a respectable profession as well. I cannot lie on my parents’ pocket longer, but rather to earn the living by myself.” I told how I had earned my living as student by doing several part-time shops. “That is impossible in South Africa”, the young colleague said and added that he will work as a general practitioner where he thought to do a good work for and on the people.

“You have the great gift to be a good doctor, since you are a good human being with an open mind for the needs of the people”, I said. The young colleague stood up and expressed his wish of keeping in contact. “I will write you, but now I thank you for all that you have done for me. I wish you the best for the future. The change is visible that it will come soon.” I accompanied the young colleague to the gate where we gave each other the hand and said goodbye.

The three Casspirs were mud-dirty when they returned from the veld with the sitting-up squads and took the sharp right curve in front of the gate on the way back to the camp. The young colleague passed the place between flat and guesthouse when we greeted each other the last time before he disappeared on the sandy path between bushes and trees. I closed the gate and went back to the flat. I leant the verandah door by and went to the kitchen for a cup of instant coffee with the chicory supplement and put the cup on the verandah table. I took a seat on the verandah chair at the verandah table in the small sitting room and lit up a cigarette and read the young colleague’s words of farewell again.

This poem arose from a deep-rooted humanity that the reading moved my mind. I learnt the wording and had it in my mind after the seventh reading. The poem had a melancholic pensiveness especially in the saying: “Now I go back to a place where things are white” and “because skin colour should not make the differnce if it comes to honesty and human caring”. In the reflection it became clear that a long way had to be gone, since racial segregation went deep into the blood of the blacks and deep into the dried-up mud and other crusts. Hunger, poverty and indignity of the blacks and the privileges and preferences in life for whites, both had lasted too long and had created a deep valley of injustice and inhumanity.

But the time has come that more whites packed their bags and boxes for the departure to Windhoek and the coastal towns of Swakopmund, Walvisbay or Hentiesbay. Others went deeper to the south like the Free-State in South Africa where the communities were still and mainly white, while the ‘black masts’ were in sight in the far north. People were also packing things into their bags and boxes what did not belong to them and were registered with the Bantu-administration that had given up control and responsibility to its greatest extent. Things like porcelain, tea and kitchen things, and bed linen, sheets and towels were moved from the north to the south despite the washing-proof marks ‘SWAA’ [South West Africa Administration]. There was no order neither in the region nor in the white run administration that things started moving away from the north.

Everyone had the storm clouds of change in his and her eyes and in mind that the empty bags were filled for the way into an uncertain future. The system of injustice and white superiority reacted indulgently to the whites who took everything for granted and took with as much as possible on their final trip to the south. It were the desk sitters with the meaningless faces and short necks and bulging buttocks on the lower and middle floors, and the masterminds with the sphere or cube heads on the top floors in the pyramidal administration buildings, and all of them were trained in the ‘pretorianic’ view through the windows at the south front, and all of them had followed the ‘pretorianic’ instructions and orders through the years without any criticism and hesitation and without any self-criticism.

These opportunistic sitters and nonsense writers started thinking how they would survive and rather change smoothly from one system into the other system with keeping the ‘sit-out’ salaries and the additional allowances on the same level. Administration sitters had no illusion that the white era was running out and the window view had to be changed from the south to the north, what had to be exercised and practised accordingly in the same opportunistic manner. The ideal situation was thought in this way that the whole pyramid tower got turned of one hundred and eighty degrees, since in the old time there were no windows at the north side of the pyramid according to the ‘pretorianic’ architecture. This shortsightedness of the running-out system was one essential part of the design and architecture and the change from white to black was not expected.

Now and under the storm clouds it had been revealed that the old window placements were wrong and no longer suitable that all the desk sitters in the various floors of the white administration started exercising the turning and nodding movements with the cube heads on the broad and short necks to the other side in becoming a smooth turncoat for the new system at the right time. Views and thinking had to be changed into the opposite direction. It had to go to the north to the Angolan border where the Ovambos would come back from exile with the PLAN [people’s liberation army of Namibia] fighters on the Soviet and East-German military vehicles, the howitzers and Stalin organs and tanks of the outdated Soviet T-series. Vast amounts of Kalashnikovs were expected to cross the border as well.

The long-term objective of the promoted administration sitters remained the comfortable life behind the big desk on an upholstered swivel chair with a high backrest in an air-conditioned office with little and meaningless work of little responsibility, but for a high-responsibility salary with all the plus-allowances like in the white-run system before. The old tradition should remain that an attractive secretary should serve the tea with some snacks and something else. Also in future she shall deny the presence of the ‘overworked boss’ with the stereotype that he is hindered or in a long-lasting meeting, while he reads the newspaper or picks his nose with a look through the window or makes some private calls or other things. The change from one system to another system should be not more than a routine change when only the skin colour of the superior has changed. It should not compromise the life with its regular payments of the monthly salaries and the various extras and the certainty of a good medical aid and a good pension. The administration people exercised therefore the turning and nodding movements of their heads and minds right in time to be ready as turncoats for the big swing from the old system into the new system which always requires some unscrupulous skills as well.

The time has come for the turning and nodding movements of the necks and the brains with the ‘black masts’ in sight. It became a kind of slogan: “Black up!”, which hammered in the administration heads with the good noses for the ‘smell’ of the upcoming political and socio-economical changes going with the timely turned opportunistic skills. On top of the Bantu-administration and above of the white ‘Sekretaris’ was [more for optical reason] the black ‘prime minister’ with a few black resort ministers who officially were not members of Swapo. The ‘prime minister’ was leader of a regional Ovamboland party which had parted from the ‘Turnhalle Alliance’. The parties of the alliance had moderate programs and consisted of black people of other tribes as well as of white people who did not categorically reject the colour bar and cooperated with the white administration by following the ‘pretorianic’ instructions of the South African administrator general who got his instructions from the power centre in Pretoria or directly from the South African president. [The former Ovambo-minister of trade was a well known businessman in that time whose warehouses were left out from getting blown up and burnt down. He disclosed in a newspaper after independence that he was a registered Swapo-member since many years.]

Dr Nestor became the first black superintendent in the history of the hospital

That the ‘black masts’ came closer to the political scene, it became evident when Dr Nestor in a dark jacket and trousers with a blue shirt and open collar sat as the first black superintendent in the history of the hospital one Monday on the swivel chair behind the large desk. The desk was moved to the opposite site in the room where it was when Dr Witthuhn was the civilian superintendent. The white pale-faced doctor with the bulging pockets on his linen jacket was removed from this post overnight as fast as he had become the short-term superintendent. I entered the room for the morning meeting when I saw as the first this remarkable change which I recognized as a good development and congratulated Nestor for his new position. We had a short chat in which the new superintendent mentioned that Dr Witthuhn would become the acting medical director, though the white ‘Sekretaris’ of the Bantu-administration had offered him the post what he had rejected due to the commitments and the merits of Dr Witthuhn.

The change in the hospital administration was a remarkable step in the new direction and the colleagues made big eyes when they entered the office, because it was difficult to understand that the change had gone so quickly. The rail points were set on ‘black’ and the point setting had started in the north. Dr Nestor opened with a very short introduction the meeting and came to the central point that only a few colleagues were left at the hospital who had to carry the huge burden and workload. He asked for understanding of the critical situation and for a strong commitment what was needed to manage the work. The total number of doctors at the hospital were eleven of which one colleague had to go to the Lutheran mission hospital in Onandjokwe once or twice per week which was in the east of Ondangwa and was run with its more than hundred beds by nurses only. Eleven doctors at the referral hospital stood against a population of close to six hundred thousand people in a geographic area from the Kaokoland in the west over the long close-to-border strip to the mine town of Tsumeb in the east that together was larger than Switzerland.

The critical situation lay as a dark cloud over the heads of the few doctors who continued the work under the compromised conditions. There was no place for playing with words. The meeting got the seriousness and austerity that corresponded with the reality. The first black superintendent promised to work hard in the interest of the hospital and its people, though the problems were as much as old. He said that he will not give false promises. Dr Nestor was the first superintendent who announced that he will continue his medical work in the wards of internal medicine and will participate in the call roster for the nights and weekends that included the anaesthetic calls as well. Colleagues and matrons gave him an applause for this bold announcement.

The faces of the participants looked serious, but not hopeless. It began a new era with a new atmosphere of a spontaneous and reality-related team spirit. It was the team spirit of which the lean white matron had spoken in the past that had become a stillbirth due to the intrigues and traps of Dr Hutman who was ‘the lieutenant of the devil’. The lack of antibiotics, of the TB and malaria drugs and other patient-related problems were discussed and the new superintendent promised to contact after the meeting the central pharmacy in Windhoek to get the reason for the delay of delivery. With this clear statement the meeting had ended and I got the impression that the participants left the room with concern, but also with a spark of hope.

After the meeting Dr Nestor asked me, if I had an idea to get new doctors for the hospital, since the workload was too much for the few doctors and the replacement of the army doctors had finally ended. I thought of the situation in West Germany where a glut of doctors did exist and young doctors could be interested to work in Africa gaining a lot of experiences in a short period of time. The suggestion attracted Dr Nestor that I drew the text for a small advertisement in the German ‘Ärzteblatt’ which I translated. Nestor was excited and told that he will discuss the matter with the medical director showing him the draft. The text was approved that the letter were typed and sent at the same day to Germany together with a covering letter of the medical director.

I was busy with a difficult operation what was a multiple thigh bone fracture. The sweat dripped from my face. It kept a student nurse busy to dry my face in short intervals when Dr Witthuhn looked from the washing passage into the theatre and congratulated me for the brilliant idea and the text design for the advertisement. “Your idea was fantastic. I have sent the advertisement already to Germany,” he said in a state of excitement. I felt a kind of relief on the medical director. It was the reflection on the advertisement and the response with the theoretical possibilities that I clamped my thumb when I put the holding forceps onto the bone.

Dr Witthuhn disappeared and his sonorous voice echoed through the corridor when he spoke to some nurses. Dr Lizette did the anaesthetics and was quiet. She was obviously amazed at the fact that a black person had become the superintendent of the hospital, though she appreciated Nestor as a sympathetic colleague. The theatre nurses praised the change and expressed the hope that the hospital would see better times in the near future. “The improvement will not come overnight”, I said to slow down their expectations. The nurses replied that they trusted both the new superintendent and the medical director, since they were familiar with the needs of the people. There was a gleaming in their eyes as they would see the coming of the new era with the ‘new vessel with the black masts’.

I was soaked in sweat when I put the patient with the Philippine colleague and some nurses from the operating table on the trolley where Dr Lizette pulled out the breathing tube from the patient’s throat and put the oxygen mask on his face. I removed the wet operating shirt in the dressing room, dried the skin over the head, neck and chest and put on a dry shirt. I went to the small tea room and prepared a cup of tea. Lizette was silent like speechless to the fact that a black person became the superintendent. She had refilled her cup with tea and stirred the teaspoon of sugar in when she said that the clock in Oshakati goes faster than in South Africa. I added that I believed this as well that the clocks close to the Angolan border were ahead compared with the clocks in the southern parts of the country far from the war. Lizette felt the atmospheric change in the theatre and sipped of the tea. She was confronted with the phenomenon of a great surprise by the change with its historic dimensions and submitted herself to the self-control of a higher alert. Lizette took her husband into her consideration who was the psychologist in the uniform of the SADF. It was his task to treat young soldiers who had sleepless nights by depressions and nightmares or other disorders because of reservations according to their education and religion. He as psychologist had to bring them back in line to follow the strict military orders with shooting a person dead.

The next patient was put on the operating table in theatre 2 for revision of the below-knee stump where the bone had perforated the soft tissue and had to be shortened. Dr Lizette induced the anaesthesia and the Philippine colleague and I dried our hands with sheets of blotting paper in the washing passage when a power cut occurred. A nurse pulled the operating coats in the twilight over the surgeons who had difficulties to put the hands into the poorly powdered operating gloves. We took the seats on two stools in the operating room and waited for the power return. We did it without a word of complaint, since this interruption was a common incident. The anaesthetic nurse pulled up the blinds to allow the daylight into the theatre room and the instrumenting nurse put the instruments on the instument table back in place. Lizette was not familiar with this kind of incident and asked with an undertone of resignation how one could work under these circumstances.

The question remained unanswered, since everybody knew that the work had to be done and the disturbances had to be taken into account. The people in need dictated not to give up. Everyone followed silently his or her thoughts and expectations in the waiting period which was longer than usual. So I thought of the young colleague who had flown back to South Africa and had arrived on the airbase ‘Waterkloof’ next to Pretoria where he was welcomed and embraced by his parents and brothers and sisters who thanked God that the son returned well and unhurt. I asked myself what the young colleague would tell about the north and its people and his work at Oshakati hospital. Could this colleague draw a realistic picture of the heroes and the ‘rats’ and of the sinking apartheid vessel, and if he could transmit the imagination of the coming new vessel with the black masts. I had put the young colleague like Dr van der Merwe at a good place in my memory, since both were good human beings and dedicated doctors who were devoted to their work that patients and nurses trusted their humanity and skills.

The light went on and Dr Lizette said spontaneously ‘thanks’. The instrumenting nurse gave the scalpel and I incised the skin around the perforating shin bone stump in the fish mouth shape and cut off the muscle attachments from the distal ends of both the shin and calfbone stumps. I shortened the stumps and smoothed the edges with the bone file and put the skin-muscle flaps over the stump ends and fixed the soft tissue coat with some stitches. The shortened below-knee stump was long enough to be fitted with a prosthesis after the wound has healed.

After the operation, the Philippine colleague left the theatre for the outpatient department. He went to the dressing room and changed his clothes, while I took a short break when Lizette entered the small tea room for a cup of tea. Her speech was back when she said that she was amazed how fast things were changing what was unforeseeable one week ago. I agreed and tried to explain the situation with the people who had suffered under the segregation by putting them down to beings without the basic human rights, and under the war situation so much. Lizette asked with great concern regarding the future: “Do you think the blacks will do it better?”

It was a question where the answer was hardly to predict. I said: “One should hope, but more worse like now is impossible. The people are tired and sick, many have lost their relatives or lay poor and broken in front of their huts or are deceased by starvation, sickness and maltreatment. A generation will pass before the wounds can heal.” Features of great concern was on her face. It was readable from her moving eyes that Lizette did not trust the blacks, if they come to power. “The colour will change, but the blacks will do nothing better for the people when they come to power”, she said. She saw black in the future before the black future with the black crew has begun. She saw even more black than I could imagine who had the sandy tones with the various grey shades in mind where biracial children with beautiful faces were put from a certain dark tone onwards and despite their intelligence and charm behind colour bars to a life of desperation and privation. Dr Lizette was white, but of an African origin that I was not.

We went back to theatre 2 for the amputation of the right foot on an old and emaciated woman. All five toes of the foot were dead and dried up. The operation was the below-knee amputation and it was clear to everybody around the operating table that the old woman would never walk again. I put the dressing on and a bandage around the leg stump and wished the old woman a merciful death which had grasped already her right foot. The ‘body-light’ patient was lifted on the trolley and brought to the recovery room. Dr Lizette told that she had given only little of nitrogen monoxide [laughing gas] and more of oxygen. She was relieved that the patient had survived the operation.

I thanked Dr Lizette and the nurses for the teamwork and left the theatre room. I changed the clothes in the dressing room and left the theatre building for the outpatient department where the Philippine colleague was working on the patients in consulting room 4. I took my seat at the table. A mother had a small girl on her knees with the skin-connected fingers on both hands [syndactyly]. I remembered the girl when I had seen her the first time what was six months ago. The nun doctor Maria Gottfried from the Catholic mission hospital in Oshikuku had referred the girl with the question, if I could help. I explained the kind of operation to the mother and told that I would start on the right hand, while the operation on the left hand should be done some months later. I admitted the girl and the mother thanked and carried the girl on her back to the orthopaedic children’s ward with the admission form in her right hand.

The Philippine colleague showed the X-rays of an old man who complained of pain in both knees due to an advanced arthrosis and asked what could be done. I explained that a stiffening operation [ankylosis] of the knees would be indicated, since a knee prosthesis for the poor people was unthinkable and also technically at Oshakati hospital impossible. The old man said that he will think about it. He stood up with the health passport in his hand and the grinding sounds in his knees and left the consulting room for the dispensary to collect a small plastic bag with the prescribed anti-inflammatory pills. Some casts were removed and others applied after fracture reduction in the plaster room, and wounds were treated in the casualty theatre room. The half of the benches were cleared up when the colleagues made a break for lunch that the Philippine colleague was to take with his family.

Dr Nestor took a seat at the dining table. Both struggled cutting the meat with the blunt knives. Nestor spoke of the new surgeon and asked me, if I have met this doctor. I told that the paediatrician had introduced me to the new doctor when I had left the theatre. We shook hands and called our names when the paediatrician said that this is the new surgeon. It was all and the two doctors continued their conversation. The meeting lasted two minutes. Nestor stopped chewing and asked with a face of regret, if that was all. I said yes. We spoke like friends when Nestor said that this behaviour was inappropriate. He mentioned that the new colleague was a hard worker who does a great work at the Lutheran mission hospital in Onandjokwe. He said that he will speak to the colleague. I asked, if the new colleague had some knowledge in orthopaedics that we could rotate on a yearly basis from surgery to orthopaedics and vice versa that I as a surgeon could keep up my surgical skills.

I had done orthopaedics with respect to the request of doing bone surgery on the many patients and injured. Nestor understood the point, but he couldn’t answer the question regarding the orthopaedic skills of the new colleague. He said that he will speak about this point with him. The superintendent came back to the advertisement which was sent to Germany. He said, if German doctors would react positively then the shortage of doctors at the hospital could be solved and the hospital could be run more smoothly. I was convinced that German doctors would respond to the advertisement, since West Germany had a glut of doctors that graduates were waiting for a place as houseman in a hospital or for a postgraduate training in an academic hospital or for a place in a joint practice.

The difference between the north and the south could not be bigger: north of the Mediterranean, the doctors stood in long rows waiting for work under the optimal working conditions with up-to-date technical equipment, and south of the Mediterranean, the patients stood in long rows waiting to be seen and treated by the few doctors working under poor conditions with the defective and outdated technical equipment. In other words: the north was rich and had an abundance of doctors in relation to the small number of patients, and the south was poor and had only the few doctors in relation to the huge number of patients.

We left the dining room and parted in front of the secretary’s office. Dr Nestor as the new superintendent entered the office and closed the door of the secretary’s office. I took the way on the small concrete passage to consulting room 4 to continue the work on the waiting outpatients. An old man sat on the chair with a broken wrist confirmed by the X-ray. I put the man on the couch in the plaster room, gave the injection for local anaesthesia and reduced and immobilized the wrist with a padded cast. When the cast had dried up I cut the cast in length on the dorsal aspect with the oscillating saw to prevent the compression on the blood circulation by swelling of the soft tissue what causes a nerve and muscle damage leading to the clawhand [Sudeck disease] with permanent stiffening of the fingers. Forearm with cast were hung into a neck-arm sling as a holding support. Treatment and pain killers were noted in the health passport. The old man thanked for the help and left with the instructions the plaster room for the dispensary to get the medicine prescribed. I took the X-rays from the windowpane and put them into the bag and removed the plaster from hands and forearms in the bucket with water and went back to the consulting room and put the bag with the X-rays on the pile of the other X-ray bags.

The Philippine colleague had problems to reduce a dislocated shoulder, since he didn’t follow properly the second step of Kocher’s rotation manouvre with the outside rotation of the right-angled flexed arm. I helped the colleague that the humerus head jumped back into the shoulder socket [glenoid cavity]. A circa ten-year-old girl sat on the chair with a right swollen upper arm. There were signs of inflammation and the girl complained of pain by pressure. The girl told that she had fallen some weeks ago and had bumped the arm against a stone, but there were no marks of contusion or abrasions. I filled in the X-ray form and sent the girl for radiography. She came back after circa half an hour and sat on the chair. The bag with the X-rays lay on the table when I came from the plaster room with spatters on the clothes, sandals and rhe feet. I pulled the radiographs out of the bag and looked at them, while the girl looked at me as an innocent child.

I got shocked and felt sad and looked long and pensively at the X-rays without saying a word. The Philippine colleague asked me, if I was not feeling well. I did not respond by speech, but handed the X-rays over the table to the colleague who looked at them and returned the X-rays speechlessly. I had the problem to explain to the girl what I saw on the radiographs, while I looked at them again. I asked the girl for her mother. The girl said that she came alone. Her mother could not come, since she was sick and had to look after four younger brothers and sisters. “Have you a father?”, I asked her. The girl got tears in her eyes that I was irritated. I thought the beautiful girl started to understand the seriousness of the situation.

The reason for her tears was that her father was torn to death by a landmine a month ago what the girl answered. I stood up and left the room to get some air. I was shocked by the heavy blows, the fate had hit the girl and her family. I came back and dried the tears with a sheet of blotting paper from the girl’s face. I took the seat and gave her a smile to comfort her. The girl replied with a clean and innocent smile from her beautiful face which met my heart. I asked her, if she had a grandmother. The girl said that she has a grandmother. So I asked her to come back on the next day with her grandmother that I can explain the problem. The girl stood up. She dropped a curtsy toward me and left the consulting room.

I got deeply moved when I looked at the girl’s fine movement and the swollen arm. I put the X-rays into the bag and put the bag aside on a separate place with the certainty of the beginning of an extremely sad story. The Philippine colleague gave a look of sympathy over the table. He understood the heavy burden that laid down on my shoulders. I was distracted in my mind for quite some minutes. The beautiful girl came with a compound of problems of which a cylinder could be ‘pulled out’. The volume of this cylinder was too big than to fill it with words. The size was shaped by the power of fate that could hardly be understood and reasoned with the normal tools of human intelligence. The magnitude of this case was comparable with the accident of Kristofina who were hit by a lightning in an apocalyptic night during a torrent-like rainfall when the flash had charred her shin bone.

It was around six o’clock in the evening when the waiting benches were cleared up. The Philippine colleague and I washed the hands and the nurse cleaned the table from the piles of X-ray bags and the various forms and the packed plastic syringes, and closed the wings of the two windows. I thanked her for the good work done. The doctors left the consulting room and passed the waiting hall. We parted outside of the outpatient department building and wished each other a quiet night. The Philippine colleague left the hospital for his family and I made a short evening round through the wards to look after the operated patients of the day.

The nurses of the late shift expressed their satisfaction regarding the change in the hospital administration. They said that the change was the basic step to improve the hospital situation. I listened, but my mind was occupied with the girl and her swollen arm due to a malignant bone tumor. After having seen the patients in the intensive care unit, I left the hospital after seven. The sun lay as a blazing fireball on the horizon and submerged within minutes with pulling back the red and violett rays from the evening sky. Watching the magnificent light spectacle, I took a longer way on which I tried to digest the remarkable events of the day. I formed the ball of the day and turned the ball into the various directions forward and backward in trying to understand of what the ball was made that it could submerge beyond the thinkable horizon as the sun did behind the visible horizon.

It was the change from one day to another with all the changes around and inside the ball, and the amazements and speechlessnesses similar to the observation when the flame burns down the wick in the centre of the candle what made the story of life so thoughtful.

I showed the permit to the guard at the checkpoint who took a look into a journal given by a woman through the open window of her car when she passed the lifted barrier rod without control. The guard said ‘goeienaand!’ [good evening] and let the doctor pass without taking notice of the permit. The other soldiers at the checkpoint followed the nonchalance in contrast with their instructions, but with a smile. I pulled off the sandals in the verandah when a huge detonation shaked the village and the power was cut off. I lit up a cigarette and took a seat on the step in front of the verandah door.

Elands with the long ninety-millimetre barrels and Casspirs with the sit-up and rifle-armed squads took the sharp curve and speeded to the exit of the village for a field patrol. The heavy vehicles left behind big sandy clouds on the gravel road. I sat still on the step when heavy guns roared and grenades detonated with sharp noises. The heavy howitzers from the camp started firing and shook the village with each shot. The impacts were heavy and followed by long dull sounds. “The hard fists of the desperate last battle hit the field and shook the surroundings of Oshakati with its anxious but helpless people, goats and the few thin cattles in a zone of a losing war with the sinking apartheid vessel”. This was what I got in mind when I lit up a cigarette. The sky put on its nightdress as an ocean of sparkling stars and the broad moon sickle pulled up the humorous face of a clown as there is something to laugh at or to grouse about that everything was a misunderstanding that things had to be understood in another way. The Elands came back with headlights on full beam what put the front walls of the houses in a glaring light when they took the sharp right curve in front of the flat. The Casspirs were still in the field to complete the business of revenge with the debit order of torture and shootings.

I went to the kitchen for a cup of tea and something to eat from the tasteless grey bread spread with margarine and sausage. The huge detonation was still in my ear when I ate the slices. The telephone rang and I thought it was the nurse from outpatient department who informed me of injured people who were brought. However, it was Leon Witthuhn who mentioned the advertisement and the importance to get more doctors at Oshakati hospital. He said that the detonation had shaken his asbestos house. “We need more doctors, if this goes on”, and he expressed the shock he got. “It is the madness that comes up to us. What can we do, if a grenade hits the hospital? Can you imagine the catastrophe?”, Leon asked.

I could not imagine the extent of such a disaster. I tried to calm the acting medical director by saying that I do not wish the hospital a grenade. I immediately came aware that this remark was everything else than a soothing pill in terms of a tranquillizer that the friend had needed for the night. The question flashed through my brain, if there could be a human being who wished another human being a grenade impact that was not only possible under the escalating circumstances, but had to be taken seriously into account after the laws of the probability. I tried to lower the worries of the friend and said that I was convinced that the young German doctors would react on the advertisement who like to collect their practical experiences in the shortest period of time.

It was an optimistic remark, because who of the Germans would take the life risk to work under war and other miserable conditions at Oshakati hospital? I asked the friend after his girlfriend and recognized that he should have asked the question earlier to divert the friend from his concerns. The mood went up and Leon told that he will fetch her on the weekend. “I didn’t tell her of the grenade impacts, because she is very concerned about the security situation. In each phone call, she is asking about security.” “I agree, but we are also human beings”, I replied and wished the friend a quiet night.

I sat for a moment in the outseated armchair to continue supper when the telephone rang again. I set the cup with the cold tea back on the table and put up the receiver. It was the nurse from the outpatient department who informed of three seriously injured which were brought ten minutes ago. She said that she tried several times to call me, but the phone was engaged. I explained that I had a call from the medical director who was concerned about the huge detonation which had shaken the village. The nurse told that the tremor had jumbled up the drugs in the cabinet and had smashed the glass in four windows. I stuffed the rest of the second slice into my mouth, emptied the cup of cold tea, put on the sandals in the verandah and drove with the beetle to the hospital.

I speeded over the gravel road that the wheels jumped up and down through the potholes. A big sand cloud followed the car and caught it up when I stopped in front of the closed barrier rod at the heavily guarded checkpoint. I showed the permit and told that I was in hurry. The guards believed the doctor and lifted the barrier rod without inspection of the car. The hospital gate war far open and not guarded by the gatekeeper. I parked the car in front of the two windows of the short wall of the intensive care building. The place in front of the outpatient reception was empty. The people who normally stayed overnight at this place should have moved to another place inside the premises. I thought that the people had expected koevoet with the Casspirs after this huge detonation which was not far away.

I entered the waiting hall and saw three trolleys with injured people. The first injured had a torn-open stomach with a prolapse of torn intestinal loops. On the second injured the right forearm and the left leg were missing. The upper arm and the leg stump were tied to stop the bleeding. The third injured had a torn face on which the left ear was missing. He could not see on his left eye due to a piece of metal that had injured the lens and stuck in the eyeball.

The nurse had taken the blood samples for cross-match and a young nurse had found the lab assistant and had given him the three samples. Infusion bags with physiological saline solution were put on each injured. I informed the anaesthetic doctor on call who was Dr Nestor, the new superintendent, and the theatre staff of the emergencies. One injured after the other were carried on the trolleys with squeaking rollers to the theatre building. The first operation was on the injured with the torn-open stomach. I had carried him to the theatre room 3 where I and two nurses put him from the trolley on the operating table. Dr Nestor appeared in operating clothes with a slight delay. The shock after the detonation was still in his face.

He pulled up the syringe for the induction and adjusted the levels of oxygen and nitrous oxide [laughing gas] on the anaesthetic machine. The instumenting nurse laid out the instruments on the instrument table, while I washed hands and forearms over the large zinc tub in the washing passge. The lab assistant brought four bags of blood for the patient and the first bag were connected for transfusion, while the other three bags were put in a thermostat to warm them up to body temperature. The patient was cleaned with the brown disinfectant solution and covered with sterile green sheets. I made a midline incision, while the nurse held the prolapsed bowel away. Blood were sucked from the abdominal cavity. The ruptured and bleeding spleen were removed and the bleeding mesenteric vessels were ligated. Intestinal loops with big tears were cut out and new bowel connections [anastomoses] were done. The urinary bladder was torn and were sutured. Other tears on the descending colon segment and the left kidney were sutured as well. Two wound drains were put in, one under the left diaphragm and the other to the deep abdominal pouch [of Douglas]. The closing of the abdominal wall was complicated by the torn tissue that had partly to be cut out. The operation went over two hours when the wound were dressed.

Dr Nestor had difficulties to bring up the blood pressure to a measurable level. All four blood units were given during the operation. The condition of the patient was critical and the operation were done in head-down position of the operating table. All hands took part to bring the patient on the trolley who were carried to the recovery room.

I went to the small tea room and filled two cups of tea, one for Nestor and one for me, and put the cups on the pen-scribbled wooden plate of the small club table. “Have you an idea where the detonation had occurred? It couldn’t be so far from the hospital”, I asked Nestor when he entered the tea room. “We can be grateful that the hospital wasn’t hit.” Nestor agreed, because nobody could imagine the extent of the catastrophe in such a case. “I hope the madness comes soon to an end. The damage is already big enough”, he said. I thought for a moment of the young colleague and writer on the book about the forbidden love who has predicted a speedy end of the system which was run-down morally and politically. He said that the end cannot take long, since the black masts were in sight.

The black superintendent understood the metaphor and got a smile what I interpreted as a smile of hope. He said that the time is overdue and he put his trust in the power of the united nations to bring the system of injustice and segregation definitely to an end. The picture of the two black specialists whirred through my mind who were talking to each other apparently on important future-related topics that they gave me not more than two minutes to greet the new colleague.

Dr Nestor and I left the tea room and went to theatre 2 and put the injured with the missing right forearm and the missing left leg from the trolley on the operating table. The lab assistant brought five bags of blood and Dr Nestor connected two bags for simultaneous transfusion to the injured. The operation consisted of ligation of the big vessels and of shortening of the big limb nerves and the long bone stumps which had to be covered with skin-muscle flaps. The flaps were prepared and kept in place by stitches. The wounds were dressed and bandaged over the stumps. The patient was carried to the recovery room where the first patient was still under observation with the oxygen mask on his face. The third injured needed plastic-reconstructive surgery on his torn face with the missing left ear. It was impossible to save the left eye. The metal had torn the lens and iris in pieces and stuck deep in the vitreous body [transparent jelly-like tissue filling the eyeball behind the lens].

The reconstruction of the eyelids took long, since the left inner eyelid corner [canthus] was torn up to the lacrimal point. Of the lost ear some skin-cartilage debris were left that I shaped a kind of ear which had less than half the size of the normal ear. The tip of the nose and the cartilage part of the nasal bridge were missing what made the reconstruction extremely difficult. The defect got covered by a rotation flap from the right cheek and the nose became flat with an angle at the end of the bony part of the nasal bridge. There were defects on the torn lips which were closed by shifting parts of the lips after mobilization. The operation lasted more than four hours and more operations were still needed on the face to a later stage. It was quarter past five when we left the theatre. I did not think of sleep and went under the shower in the dressing room where the first rays of the sunrise came through the window. I dried the skin and put on my civilian clothes. I went to the tea room and boiled water for a strong tea when I put two tea bags in the cup. Nestor had not fully recovered from the shock. He went home for a short rest and refreshment.

It was one of the sleepless nights of which there were so many to get through regardless of the physical and mental conditions. The workload was heavy, but the work had to be done. Fingers on both hands were dressed because of pressure sores, excoriations and cracks on the skin by frequent handwashings and the use of defective instruments in the huge number of operations. I left the theatre tea room to start the ward rounds earlier and looked after the operated patients in the intensive care unit. Two of the three patients of the night were in critical conditions with low blood pressure and high pulse rates. On the first patient with the prolapse of the intestinal bowel where some injured loops were resected and an anastomosis was done, the two abdominal drains produced blood in smaller amounts. The dressings on the shortened stumps of the second patient who lost his right forearm and his left leg, were bloody that new bandages were put on. New bags of blood were ordered from the lab in consideration of the possibility that all blood units were used during the operation and no more blood was available.

The face of the third patient after plastic-reconstructive surgery due to the extensive injury was widely covered with the head dressing except the right eye and the mouth with the reconstructed lips that were swollen. The circulatory system was stable and the patient was on infusion drip. Antibiotics were ordered for all three patients. The intensive care unit was overcrowded that those patients in stable condition were transferred to the general wards. I looked after the old man with the inoperable colon cancer in the surgical ward. The old man breathed with the longer intervals in between and was about to bring his life to an end.

I went to the female ward where the old woman after the above-knee amputation due to the femur malignancy showed a strong will to live. She waited for her discharge as early as possible to support morally her daughter with the two small grandchildren. The leg stump of the old woman looked satisfactory that I discharged the patient earlier after putting on a new dressing and bandage. I gave the necessary instructions which were translated by the nurse and agreed by the patient. I understood that the human aspect played the major role in the decision of the old woman.

The other old and emaciated woman after the below-knee amputation due to the forefoot gangrene had the great problem to find the inner peace. She told that she did not know to cope with her life, since she had nobody who would look after her. She had two sons and both had left her. One son was a worker in a South African mine and where the other son was, the old woman could not say. I felt the predicament and plight in which this old woman was and I knew that the words of sympathy I gave to the patient could not improve her hopeless situation.

The nurses told that the huge detonation had smashed some windowpanes. I went to the children’s ward where some children ran around in the bedrooms and the corridor. The nurse showed me the admission of the previous day which was the small girl with the skin-connected long fingers on both hands. The girl was on the operating list for separating the fingers on her right hand. The detonation had also smashed windowpanes in the children’s ward. The nurse said that some beds had moved over the place and the children were deeply shocked that they sat up and screamed of fear. I understood the great concern, but what could I say to calm down the agitation? What I said was that I would report on the broken windows in the morning meeting.

It was time for the meeting and I set off for the superintendent’s office. Dr Nestor sat behind the large desk and made some notes. The lean white matron with the pale face and her black deputy had taken their usual seats straight opposite to the superintendent’s desk. Colleagues entered the room in small crowds together with the pharmacist ladies. The pharmacist husband in charge of the medical store arrived later. The last was the black paediatrician who passed the room with the right hand deep in his trouser pocket. He took a seat on an upholstered chair at the window front under the rattling air conditioners and crossed the right leg over his left. His eyes focused something in the far distance and on the ceiling. The Philippine colleagues sat side by side showing that they belonged together. The two anaesthetic ladies also sat together and had a chat.

Dr Ruth and I sat on the hard chairs opposite to the window front. The fright from the detonation of the previous evening was still readable on the faces of all participants. Dr Nestor opened the meeting by saying that the hospital was not hit. He expressed his hope that the hospital would be spared in future as well, since a blow by a shell would be catastrophic. The white matron said that the impact of the shell was only some hundred metres from the hospital. She proposed that the superintendent should get in contact with Swapo to explain the critical situation for the hospital. “They should know about the consequences it would have for our patients. If the life of our patients is at risk, a way of communication must be found before it is too late”, the matron argued and her point was taken by the superintendent who made a note.

The black paediatrician took the word, though he had nothing substantial to say in regard to the seriousness of the hospital situation when he mentioned the problems with the military authority which would consider such a contact as a hostile act. The white matron disagreed. She said that the life of the patients had to be regarded as the top priority. Everything else has to come afterwards. It was again her unbroken commitment and dedication to the innocent and helpless patients in regard to their safety, while the paediatrician crossed the left leg over his right leg and stared into the space beneath the ceiling. Both, matron and paediatrician were farsighted, but the farsightedness of the matron was exclusively directed toward the hospital and the welfare of the patients.

The spark had jumped over and the superintendent thanked the matron for her suggestion which he liked to discuss with the medical director. Everyone did imagine that such a contact was like a tight-rope walk with the risk of a crash. The superintendent asked for comments. I agreed with the matron’s proposal and said, one cannot be silent if the life of innocent people is at risk and no one can accept any kind of killing or mass killing. Dr Nestor looked at me as he didn’t expect such a comment. The white matron did silently reflect on her statement and the others attendees kept quiet that the superintendent asked for more comments. He looked at the faces of the participants, but they kept locked their mouths. I felt sorry for the new superintendent who was confronted with the majority of taciturn people who did not take a stance in this critical time.

Nestor opened the second button under the collar. He had understood that he had to meet the decision and to carry the heavy burden of responsibility without the moral support of his black colleagues as he had possibly expected. The superintendent had a serious face by taking the burden. The faces of the participants looked into other directions or as the paediatrician at the ceiling in exactly that moment when the eyes of the superintendent were to meet the eyes of this particular colleague. Nestor did not leave the subject. He asked if the detonation had caused any damages. Nobody responded that I reported on the broken windowpanes in the outpatient department and in the wards. I said that broken glasses could endanger the children in particular. The superintendent made a note and said that he will look that the broken glasses get replaced as soon as possible.

He informed the forum of his telephonic conversation he had with the central medical store in Windhoek to get an explanation for the delay of the delivery of the ordered drugs. The reason as was told was the delay of transport from South Africa, but in the meantime the drugs had arrived and the orders were packed and ready to be collected that the hospital bus could take the drugs in the course of the week. The superintendent said that he had informed the bus driver to collect the drugs from the central medical store. The other important point was that Dr Nestor had contacted the secretary of the administration because of the unacceptable toilet situation at the hospital. The secretary had promised to send people from the works department within the next days to bring the toilets in order.

The white matron praised the efforts of the superintendent in regard to the stinking toilet facilities when the black matron supported her with pulling her grimaces of disgust. Finally, the superintendent mentioned the operations on the three seriously injured in the night and praised my hard work and skills. He said that my commitment does not know a word of complaint. Nestor closed the meeting with the words: “I wish you a good day.”

The paediatrician stalked with the face of great importance and his right hand in the trouser pocket through the room and left as the first the superintendent’s office followed by the other colleagues and the pharmacists. I changed some words with Dr Nestor and made some encouraging remarks. Nestor thanked for this kind of support with a smile. “You should know that you are not standing alone.” With these words of confirming my support, I left the office and closed the door.

I changed the clothes in the dressing room and thanked Lizette in the tea room who put a cup of tea for me on the pen-scribbled wooden plate of the small club table. She said that the detonation had caused such a fright that she had nearly fallen out of the bed. Her husband had wondered that the house was still standing and not damaged. The impact was not far from the military camp. “We had luck once again”, I replied and Lizette drew the hypothetical conclusion that things could otherwise go wrong. She asked about the injured and I mentioned the details about the injuries and operations. Lizette called the word ‘disgusting’ and asked which kind of life one can expect after one of these injuries. She answered her question that there would be no future with joy and dignity.

Dr Lizette confessed that she had learnt the fear in Oshakati, since she had not the right imagination of the war reality in the north that she could not get in South Africa. If her parents were informed of the reality in the north, they would have said no, you should not go to Oshakati. I brought a point that there are advantages as well, if one does not know everything or the full story. Lizette understood and put a charming smile on the point.

We went to theatre 2 for the operation on the girl with the skin-connected long fingers on her hands [syndactyly]. Lizette put the girl into sleep and the instumenting nurse cleaned the right hand and forearm of the girl with the brown disinfectant solution and covered the rest of her body with sterile green sheets. The skin incisions were done in a zigzag pattern with preparing small skin flaps from the hand dorsum for covering the skin defects in the interdigital folds. The fingers were separated and the skin defects on the lateral finger aspects were covered with multiple small zigzag triangular flaps and the rest with small pieces of full-thickness skin grafts which were taken from the flexor side of the right forearm. I appreciated this kind of surgery with the plactic-reconstructive challenge to improve function and aesthetics of the hand. It was a long operation due to the particular challenge which required patience and skills from the surgeon. The fingers were dressed and the hand got bandaged in fist position. The operation took two hours.

Lizette praised the art work during the small tea break. She asked after the outcome of these operations and I was able to give good news. In the same break Lizette mentioned the young colleague and writer of the story of the forbidden love of the racially mixed couple. She said that this colleague was an interesting person what I fully agreed with and called him an extraordinary person in terms of commitment and gift, since this colleague was devoted to his work as a medical doctor who critically reflected on the burning points of apartheid. “He had put his finger on the small-mindedness of the ruling system. If this colleague keeps up his strength of protest and got his fingers not broken that points on the evil of the moral seediness, we can expect something extraordinary from him.” Lizette said that she spoke with her husband about the colleague who regretted of not having met this doctor.

“How is your husband?”, I asked. “He comes back quite often exhausted. Then he sits in the armchair and is sunken in the world of thoughts”, Lizette answered. I had no problem to imagine the psychologist sunken in his thoughts, because it was psychologically a dubious enterprise to encourage young soldiers without experience to shoot human beings dead, if the young soldier was of a higher level of education and had the pensive character with the fine sense regarding life and its values including the Commandments. Lizette and I had faces of concern about the madness of killings what was against human reason and reasonableness, and an arrogant imposition against the clear conscience. The blades of purpose and reservation did not pair to one scissors where the problem stood between the gaping blades with the axiomatic antagonism of sharpness and cutting properties. The gap between those blades was psychologically not to fill and to close in the understanding of the common sense and in such stronger terms irreconcilable with the human conscience.

I left the tea room to continue with the operations. A young man lay on the operating table with a ruptured left shoulder edge joint and the stand-out position of the lateral end of the collarbone. The anatomic disorder was called ‘the piano key phenomenon’ when the lateral end of the collarbone should be pushed down to get its anatomic position, but came up again when the pushing finger was taken off. After a curved skin incision, the shoulder edge joint were exposed and the lateral end of the collarbone were pushed down into anatomic position and fixed in this position with two wires inserted from the lateral aspect through the shoulder blade spine into the collarbone. The bones were tightened together by the tension wiring in the figure-of-eight shape.

The correction osteotomy [bone cut and internal fixation] on the thigh bone of a fourteen-year-old boy was the next operation. The shaft fracture had healed with a malalignment in valgus position [kink with outward deviation of the leg]. Therefore, the bone shaft was cut through the kink with the oscillating saw and the shaft parts were brought in anatomic alignment and stabilized by a long nail put into the medullary cavity. The layers of the soft tissue were closed with sutures. A dressing and bandage has finished the operation.

Humane psychology versus war psychology

Dr Lizette said during the tea break, while the nurses cleaned the theatre room that her husband would not do long this work with the war psychology, because the demands were simply too high which exceeded the normal physical and mental capacity by far. “What is normal in a war?”, I asked and said: “Also we doctors are over-challenged and over-burdened, but war does not care about human issues and needs, because war is the destroyer of civilization and mankind. War is the devil who swallows the people and its children with the ruthlessness of the laws of likelihood.” Lizette said that war has its own psychology which differs by far from the psychology of her husband. I had the picture of a canyon in mind with the steep faces of the war psychology on one side and of the other psychology on the other side. I said: “I’m not a psychologist, but as far as I understand psychology, it is directed toward the human being to achieve the internal balance and freedom and the internal peace and rejects any destructive attempts that the war brings to a large extent.”

“The war psychology is not more than a grimace of disgust and destruction that has nothing in common with a psychology of human reasonableness with the great and fundamental values of mankind. It is the schizophrenia in the sick brains of our time and particularly in the moral-diverted brains of the loudmouthed politicians who don’t know what the psychology stands for. They connect the one with the other, the psychology in the human-educated way of civilization with the grimace of disgust and destruction. The ugly face of war psychology belongs in the devil’s pot of the pathology of ‘human’ sciences.”

I felt the agitation of Dr Lizette who stood in front of me. I stopped the elaboration about psychology and its pathology with the ugly face of the war psychology when both doctors went back to theatre 2 for the last operation. An old woman lay on the operating table who had a skin lesion on the right forearm with the clinical signs of malignancy. I washed hands and forearms and was with my thoughts far away to ask and discuss with colleagues the dubiousness and manipulative susceptibility of the psychology and its pathology.

A nurse pulled the operating coat over me and tied the laces over my back. The instumenting nurse held the scalpel in her right hand when I entered the theatre room and pulled over the gloves and approached the operating table. I cut out the lesion and marked with a stitch the proximal end of the excision for the topographic orientation of the histological findings and covered the large defect with a skin graft taken from the right thigh and fixed it with thin stitches. The operation had been finished after the dressings and bandages were put on. The patient were brought on the trolley and carried to the recovery room. I thanked Dr Lizette and the nurses for the good cooperation and left the theatre room for the dressing room where I pulled off the sweaty green shirt and green trousers and dried the skin on head, neck and chest and put on the civilian clothes. I left the theatre building and took the passage to the outpatient department to see the patients in consulting room 4 where the Philippine colleague had started working two hours ago.

When I passed the waiting hall I had seen the ten-year-old girl with the swollen right upper arm in company with an old woman. Both say on the third bench in front of the consulting room. I took my seat at the table and asked the nurse to call the old woman with her ten-year-old grandchild. They entered the room and the old woman took a seat on the chair. A second chair on which the back was broken off was put for the girl left to the chair with the grandmother. I showed the X-ray of the grandchild’s right upper arm to the grandmother by going with the pen’s tip around the bony lesion.

The grandmother kept her eyes on the X-ray and followed with great concern the marking with the pen. The girl with the beautiful face looked with innocent eyes at me to get the glimmer of hope that the doctor can help her. Her eyes expressed the full trust in the doctor, while the desperation drilled a hole into my heart. I told the grandmother that the bone lesion is a highly malignant one that threatened the life of her grandchild. Fortunately, there were no secondary tumours [metastases] in the lungs and on the ribs on the X-ray of the chest visible, but only the amputation of the arm can save her life. I had the greatest difficulty to speak out the sentence with the amputation. It caused the impact of a ‘grenade’ on the grandmother who gave the grandchild a hug with her left arm.

The girl’s eyes lost the hope and became deeply sad. It moved desperately my heart that I became speechless for a moment. Grandmother stroke with her left hand over the grandchild’s head and hugged her again with her left arm. It took minutes of silent thinking and silent despair when the grandmother agreed with the operation and gave her consent and signed the operation form. She stroke over the head of her grandchild who became stunned with tears in her eyes. I put her name on the preliminary operating list. I got speechless because of the mutilation as the result of this operation.

Grandmother 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 body and loss of the major part of the left ear, had dark-stained blood spots.

After the workday of twice around the clock, I left with my beetle the hospital. I saw in the rear-view mirror the people who prepared their sleeping places in front of the outpatient reception. The gatekeeper chewed on a piece of meat and held a bigger piece of meat in his left hand when I passed the gate. The gatekeeper pushed the gate wings together with his right hand. The sun was already sunken, but the sky had still the violet touch. I switched on the headlights and drove to the post office. There were two letters in the post box which I put on the passenger’s seat and drove to the mini-supermarket for a small box of milk, a grey bread and something to spread on the slices and a pack of Stuyvesant.

I had not reached the flat when a convoy of five Elands with the long ninety-millimetre barrels and the headlights on full beam took the sharp left curve and blinded my eyes five times that I stopped driving. The convoy has passed and left back a sandy cloud on the gravel road. When the cloud dispersed I started the engine and drove the last fifty metres to the flat and put the car on the parking place. I closed the gate by pushing the latch into the notch and wished myself a restful night. The sandals with the sweaty cork soles were left in the verandah when I entered the small sun-heated sitting room and put the bag with the shoppings in the kitchen and the milk and the sausage in the fridge.

I looked for the senders of the two letters. One letter with a handwritten envelope came from South Africa and was stamped in Pretoria. The other letter with the typed envelope that came from Germany. I put the letters on the small table between the outseated armchairs and went back to the kitchen to make a cup of rooibos [red bush] tea and something to eat. I put the stuff on the small table and ate my supper. I felt exhausted and drank from the tea and tasted the tart aroma of the bush. It reminded me of the people who walked barefoot or in self-made sandals with soles cut out from scrapped tyres to look after their small herds on the arid ground with the sparse vegetation. I took a second cup of tea and lit up a cigarette and opened the envelopes. The handwritten letter came from Dr van der Merwe.

Dr van der Merwe wrote that the ‘Herkules’ was jampacked and the returners were excited. The plane touched smoothly on the ‘Waterkloof’ airbase where the families and friends were waiting. The greetings with parents and friends were heartfelt. There were tears of relief and happiness in their eyes that he and his wife had returned unhurt from the far north. The father brought the homecomers to the farm not far from Bloemfontein in the Free State where they were warmly welcomed by the workers and their families. He knew some of the workers since he was a child and spoke even their language. They stayed two weeks on the farm where they were spoilt. He weighed the cattles and put the brand marks on them and repaired engines. He shot two kudus and followed the track of a leopard which had killed three calves. It took three days and two nights when he shot the leopard from the hideout in a tree.

He and his wife enjoyed the life on the farm and both gave the joy to some workers’ children as well. Van der Merwe wrote that he would have become a farmer, if he were not a medcial doctor. They left the farm after two weeks of nature and rest and returned to their flat where they met their friends. Life in South Africa had changed. The black people are seethed with unrest. The signs of resistance against whites are obvious. The crime had increased especially in Johannesburg. Robberies and murders occurred every day in South Africa. Farmers and their relatives were robbed and murdered. The people carry guns to defend themselves and their families. The white-ruled system is close to come to an end. The big change is in front of our doors.

Dr van der Merwe had contacted the academic hospital in Bloemfontein to start his postgraduate in orthopaedics, since he had appreciated the work in orthopaedics at Oshakati hospital so much. He asked how things were in the north when the few doctors had to cope with the work, if the wards are still overcrowded and the toilets are still stinking, if the air conditioner in theatre 2 is repaired and the old and defective operating table is replaced by a new table. He asked about my life and thanked for everything I have taught him. Under my professional and human guidance and advice he had collected a wealth of experiences and directives of great value that he will keep in mind for his life. Van der Merwe wished all the people in the north a better future what he did not describe in details. He wished the people strength to go the last part on the path to independence. He wrote that the war would accelerate the great upheaval that will move as a powerful roller from the Angolan border downward to the south and seal the end of the apartheid system. He expressed the wish to see another again in Namibia or in South Africa and gave greetings to the colleagues and the nurses.

It was a handwritten letter of a friend who was a highly dedicated medical doctor with a human face at Oshakati hospital. He was respected by the nursing staff and the patients. Dr van der Merwe was a son of the African soil who loved the African people and respected their diverse cultures and traditions. He practised in an exemplary way humbleness, honesty, diligence and humanity which are some of the important aspects of being a good doctor whom the people could trust.

Regarding the great upheaval, Dr van der Merwe had predicted it in an open conversation at a hot evening in his caravan what was the third of the five caravans on the right-hand side of the small path opposite to the tattered picket fence with the rolled-out barbed wire. I also remembered the pleasant young Ms van der Merwe who had prepared a cold lemon tea with ice cubes. Now he saw the sheet lightning in South Africa and I could imagine it as the last act of a long era. This era was historically and from the human point of view a tragedy for the black people and for the white people became the end of the era like the awakening in front of a deep canyon.

It was the flaw with the illogical and anachronistic pattern in the white thinking. The realization comes too late that a social system of segregation and discrimination regarding the other-than-white skin colours could not work due to the practised inhumanity and injustice. This system had to disappear definitely and shamefully. The black storm on the ‘pretorianic’ stronghold stood before. The anachronistic ‘concrete’ heads of the last stubbornness will sit behind bulletproof glasses in the modern ‘Wagenburgen’ [waggons put together as a fortress], but they cannot hinder and not repulse the heavy storm which will bring the historic change.

I got the long Angolan border in my mind as an ignited fuse that led to the tremendous escalation of war what consequently gave the strong impulse to the ‘roller’ for its southward movement with an acceleration of the sinking apartheid vessel and the docking of the new power vessel with the black crew of the new era. One of the final questions was: To whom belonged the country and the continent? The answer should be fair and just: To all the people who do respect each other and in particular to those people who have their biological and cultural roots in this African soil. That should be the case for the San-people [Bushmen] as well who are the oldest inhabitants in sub-Saharan Africa. They are short in length and bright in their sandy skin colour and lived some thousand years in harmony with the nature.

San-people were highly specialised track readers and skilled hunters with bows and arrows. The South African army used them as tracker ‘dogs’. Most of their natural habitat were taken away from them either by the whites or by the blacks who pushed these people deeper into the desert by ignoring their basic rights on land for their living and by neglecting their needs as the oldest inhabitants. The San population had therefore decreased dramatically due to the dry, vegetation-poor and karst environment they had to live in. Alcohol has destabilized the rest of the San community to a large extent.

Archbishop Desmond Tutu brought the attitude of the whites to the point: “The whites came with the bible in their hands and we had the land, but after a short while they had the land and we had the bible.” The whites became the landlords that the black people became field workers degraded and depressed with their families into full dependency from these landlords and deprived of their human rights on the white farms what was originally the land of their fathers and forefathers. The whites ruled with the white muscle power and with clips round the ears and with cudgels and more. All this had started with the segregation and the colour bar that had resulted in the wealth of the whites and the poverty of the blacks. This imbalance could not last for ever and should not be without consequences in terms of justice, righteousness and human dignity. In this understanding, Dr van der Merwe mentioned the ‘apocalypse’ in his letter which would sweep over on South Africa as well.

I put the letter aside and read the typewritten letter from Germany in which was drawn the affluent society where the faces looked seriously as they had lost the ability to laugh and to enjoy their prosperity. The people were under permanent stress. Air and noise pollution in the city reached the limits of the tolerance and the unemployment jumped up as never before. The social security contributions are ridiculous. The youth is unprepared and unwilling to learn and the juvenile delinquency is on the rise. The people become like outsiders of one to another. It was a depressing description of the situation in the west-German society in the second half of the eighties.

Materialism has degraded and mutilated the spiritual and other values of great importance and the Mammon had swallowed much of the culture of humanity with the great believes in humanism and religion. The high finance of the big businesses ruled the economy and politics, and those who controlled the newspaper and media industry had the final say. The profiteers with and without the dark beards, but with the specialized noses for money were busy as always and ususal, whether in Frankfurt or Johannesburg. Mankind does not get away from the brink of decline and decay.

I put the letter aside and emptied the cup of the cold rooibos tea. I read the psalm 34 when David called: “What is that for a man who desires life and loves the days to see the good? Therefore, keep your tongue from evil, and your lips from speaking guile! Depart from evil and do good! Seek peace, and pursue it!” How far had mankind drifted away from David’s call!

The cocks crowed and the new day began. I left the flat earlier for the hospital to enjoy a walk in silence of the morning. The sun sent the early forerunners from the horizon. Dogs strayed from one roadside to the other as they had lost something last evening. Cats jumped out of the roadside ditches and whizzed into the high grass of a large front garden as they had seen something what was hiding there. I showed the permit to the guard at the checkpoint and said ‘goeiemôre’. The greeting remained without reply, since the guard had a dream and rubbed his right eye with his hand. The morning gave the calm to the other guards who stood leant back against the closed barrier rod and chewed on pieces of biltong.

A thin segment of the fireball appeared over the horizon when I reached the hospital. The gatekeeper sat on the chair and held the morning egg in his right hand and looked at it from various aspects. We exchanged the greetings and I crossed the square where the Casspirs had pressed the tread of the nightly raid into the sandy ground. Some of the many people of the evening lay wrapped in blankets and sheets on the concrete passage in front of the outpatient reception. The missing ones had moved to other places inside the hospital premises. I entered the first building with the intensive care unit and passed the private consulting room with the hanging sheet over the door frame. The nurses of the night shift told that koevoet had done the night inspection. They went from bed to bed, but have done it faintly. They asked for a glass of water that they got and thanked for.

The three patients who were victims of the blast in the huge detonation the night before, were in stable condition. The face of the third patient after plastic-reconstructive surgery was severely swollen. The flat nose due to the missing cartilage bridge had given the patient the shape of a goat’s nose and the small left ear looked like a mongoose ear. I changed the dressings on these three patients and completed the records. Then I left the intensive care unit for the general wards.

I went to the children’s ward to see after the ten-year-old girl who was on the operating list of the day for the amputation of her right arm because of the malignant bone tumour. It was the grandmother who agreed with the operation and had signed the operation form. The girl with the beautiful face had sad eyes which looked anxiously. I stroke her head to comfort the girl as the grandmother had done in the consulting room, though I knew that I couldn’t take away the sadness to continue life with only one arm. However, my hand was not the father’s hand who could do better in this difficult situation. This I felt, since there was no change in the girl’s eyes. The sadness in her face moved me tremendously and I could cry together with her about the big negative impact that the operation would have. A large-scale tragedy had overcome the girl and her family with the loss of her father and her sick mother. I left the girl whose fate I couldn’t change and looked after the other children of whom many had improved and were running in good mood through the corridor and bedrooms. The nurses in the male and female ward reported on the nightly koevoet raid which went without big disturbance.

It was time for the morning meeting. Dr Witthuhn as acting medical director had taken a seat on an old upholstered chair at the window side under the rattling air conditioners. It was Dr Nestor who had decided that the medical director should be Dr Witthuhn despite his white skin, this with respect to his outstanding commitments for the benefit of the hospital and its patients when he was the superintendent. The white Bantu-administration however had with view of the expected power change offered the post to Dr Nestor to be the first black medical director. The matrons, the pharmacists and colleagues were attending the meeting except the one black female doctor who more or less did never attend.

The black paediatrician had taken his seat next to the director at the window front as well. He started a conversation with the director which caused a laugh of the paediatrician, while the black superintendent opened the meeting with a ‘good morning’. The paediatrician continued chatting that the medical director had to put it to an end. Dr Nestor informed the attendees that the missing drugs had arrived with the hospital bus. The bus had a delay of one day because of a wheel change due to a flat tyre. The superintendent told that no patients could be sent to Windhoek in the following two weeks for intern-medical and urological specialist treatment, since the specialists were on leave and the wards at Katutura Hospital were overcrowded.

Dr Nestor gave a brief report on the conversation he had with the koevoet commander who had asked, if his people behaved better during the nightly raids. He could not answer the question, though he had not received new complaints in this regard from the nurses. He however had asked the commander, if he considered the raids as helpful. His answer was that no Swapo-fighter had been found in the hospital yet what however could not exclude that they will do so in the near future. He promised to discuss the matter with the brigadier. Dr Witthuhn who was the acting medical director, said that the hospital administration is powerless against the military that it is useless to object. The black paediatrician considered the topic as explosive. He did not see the necessity to follow up the topic of the nightly koevoet raids and rather suggested to be quiet.

The courageous matron expressed her different opinion. She said that the hospital administration is obliged to do everything possible to ensure the resting night peace for the patients that would accelerate the recovery time and would reduce the overcrowding of the wards. So were her arguments of practical relevance. The paediatrician leant back and kept his legs crossed, while his eyes viewed along the asbestos mats in the ceiling. The acting medical director reiterated his experiences with the military that it would not deal with the nightly peace argument of the matron.

The superintendent gave room for other points to speak on. Dr David the physician took the floor and described the unhygienic conditions of the wards in the internal medicine as catastrophic, this not only because of the defective bedsteads, the dirty mattrasses, the spotted bed linen and sheets, but also because of the poor washing and toilet facilities and the missing hospital clothes and the lack of washing bowls and spittoons for the TB-patients. He criticized the insufficient and lacking meal portions for the patients of the low protein content, and emphasized the urgent need of milk for the convalescence and improvement of the poor nutritional status. The superintendent understood the problem and requested the matrons to look into this matter and to take care that the meal portions are sufficient and the patients get milk of one litre each per day.

The matrons did not object, but the matron highlighted the critical situation to provide the wards with more hospital clothes, bed linen and sheets and washing bowls and spittoons, since the storeroom for clothes is empty and a few washing bowls and spittoons are left on the shelf that were defective and useless. The superintendent made a note and responded that new hospital clothes, bed linen and sheets and washing bowls and spittoons should be ordered. In terms of improving the washing and toilet facilities, I expressed the hope that the ‘Sekretaris’ will send soon people from the works department who should bring the defective things in order. The superintendent underlined the notes from the previous day.

The acting medical director gave notice that a medical student from Germany will come to do a part of her practical year at Oshakati hospital. He said that this student will collect her experiences in a short period of time and could assist the medical staff. The superintendent did welcome the news. He raised the hope that the advertisement in the German ‘Ärzteblatt’ should be effective that some German doctors would fill the gap at the hospital. The time was too short to speculate on the effectiveness of the advertisement which was sent to Germany. However, the first intercontinental thread from Oshakati to Germany was spun out which could get effective by the arrival of doctors from above the Mediterranean. The meeting had ended and the attendees left the superintendent’s office with a trace of optimism that the things what were discussed would become transformed into practice.

I went straight to the theatre building and changed the clothes in the dressing room. I entered the small tea room. Dr Tabani was not sitting there as usual and waiting for the anaesthetic doctor, since he had refused to attend the morning meetings with the speeches and comments which had never brought any practical results. He was probably busy with his ward round.

I put the ten-year-old girl into my mind on whom I had to cut off the right arm within the next hour. Psychologically, it would be a very difficult operation. Certainly it had its medical indication with respect to the high malignancy of the bone tumour, but it would humiliate and threaten the life of the girl at the same time. I looked at the chest X-rays again what I did several times before and could not see any sign of lung metastases. I hoped therefore that this operation could save the girl’s life, though it downgraded it to a pitiable being. The result of the operation was unthinkable for the girl that she had never imagined and wished before. Fate had badly crossed a thick black line through her life which was already heavily burdened by the death of her father and the sickness of her mother.

Dr Lizette entered the tea room and called the forthcoming operation a ‘terrible’ one, because also she could hardly imagine the whole impact of the loss of one arm on the girl. The operation had not started and I was still in the tea room when I stood in front of the question, if a short but integer life with both arms would not be preferable against a long life with a mutilated body, since with both arms the girl could laugh what she would never do full-heartedly with only one arm.

Dr Tabani had entered the tea room and looked at my face of concern. He asked me for the reason that I gave him the question about life and life quality. The colleague said after a while of thinking with his soft voice that individual life in its quality is maybe comparable with other lives, but cannot be predictable and measurable. “Any kind of generalization will fail”, Tabani said who was able to share my concern in regard to the young girl and the forthcoming operation. “You have to follow the medical ethics, everything else is beyond your power and capacity”, he added and I made a ‘note’ in my brain.

Dr Lizette left the tea room to prepare the anaesthetic tools in theatre 2 while I showed Tabani the chest X-ray with the question, if he could see a lung metastasis. He screened carefully the radiograph and gave it back with the comment that he couldn’t see such a sign. I thanked for his comment and left the tea room with the sad feeling that the operation had to be done following the rules of the medical ethics. Tabani wished me strength for this operation. The girl was on the operating table and I washed hands and forearms longer than normal because of the heaviness of the thoughtful reflections.

It was an oppressive silence over and around the girl what remembered of the silence of grief in the moment of a child’s burial. The lakes of tears were in the eyes of the parents and other family members and friends who follow speechlessly in the deepest shock the small coffin and say goodbye stunned with a speechless grief and the sounds of sobbing, while the coffin gets lowered down to the ground for the child’s eternal rest. And all this without the opportunity for a last goodbye kiss from the mother and the father. After the service and leaving the grave with the resting child bedded down into the soil, people would start remembering and reiterating their experiences of joy what this child had brought into the family and the family’s life.

To cut off the girl’s arm

I incised the skin on the right upper arm close under the shoulder breadth in the shape of a fish mouth. I ligated and cut the big arm vessels, shortened the arm nerves up to the armpit and cut the muscles after separation from the attachments to the most upper part of the bone shaft which was finally cut a few centimetres below the humerus head. “God, have merci and give the girl a life with some joy. Forgive what I do to the girl!” With this silent prayer, I cut the right arm off and laid it on the paper spread out on the floor. I sutured the skin-muscle flaps over the short stump together and got tears in my eyes when I dressed the wound and put on the bandage on the short stump. The girl was on the trolley when she searched with the left hand for her right arm and could not find the arm. Dr Lizette and a nurse carried her on the trolley to the recovery room, while she was still searching for the right arm. The instrumenting nurse opened the laces and pulled off the coat from me. The green shirt was drenched with sweat when I wiped the tears from my eyes and the sweat from my face. I looked with sadness on the amputated arm on the paper on the floor and removed with the bone nibbler a piece from the tumour and put it in a small plastic container with formalin for the histological examination. A nurse wrapped up the cut-off arm with the paper and sealed it with some plaster straps.

I was depressed when I left the theatre and went to the dressing room where I wiped off the sweat from the head, neck and chest and put on a dry green shirt. I felt exhausted when I filled a cup of tea and took a seat in the small tea room. Dr Lizette sat opposite to him with a sad face. She did not say a word. This kind of an ‘ugly’ operation had taken away her speech. Tabani left the theatre room 3 after a hernia repair. He entered the tea room and went to the small hatch and recognized the depressed atmosphere. He filled a cup of tea and asked how the operation had gone. “Terrible!”, shot this word from Lizette’s mouth that Tabani did not ask about the details. It became quiet in the tea room and everybody had his or her own thoughts, until a nurse stood in the door between corridor and dressing room and called me to help in theatre 1 where Dr Ruth did a gynaecological operation.

I understood this call as a ‘vibration’ to get out of the depression and followed the nurse without finishing the tea. The problem in theatre 1 was a deep-situated colon cancer on the sigma loop. The bowel with the tumour were cut out and an end-to-end connection [anastomosis] between the descending and the rectal colon were sutured. Dr Ruth thanked for the spontaneous help and finished the operation by closing up the abdominal wall by suturing the various layers.

The Philippine colleague did an internal fixation on the medial tuber [malleolus] of an ankle joint in theatre 2. He was busy to insert the tension screw. The patient was a woman who had slipped over a rolling stone, while she carried a bucket with water on her head. I changed the clothes in the dressing room and went to the outpatient department to see after the waiting patients in consulting room 4. A mother put her six-year-old girl on the chair on whom a monstrous deformity was cut off from the right hand [macrodactyly] that was twice as big as her foot. The operation was done a couple of weeks ago and the mother brought the girl for the follow-up. The girl looked happy to be freed from this ugly monster and that her hand got for the first time a functional meaning as she could grasp and keep small objects like a pencil between the thumb and the small finger. She demonstrated her skills 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 by a small skin incision in the casualty theatre. I made a few stitches to close the incision and put the dressing on the wound, while the nurse injected the tetanus antitoxin. A twelve-year-old boy were carried on a trolley to the consulting room with a broken right ankle. He had fallen from a tree. The X-ray revealed an inner and outer malleolar fracture. The boy was brought to the plaster room and got a short-lasting anaesthesia. The fractures were reduced and the foot with ankle got immobilized in anatomic position by a short leg cast.

It was around six o’clock in the evening when the last patient was seen and treated. The seven cleared-up benches were reserved for those patients who were brought back by the hospital bus from Windhoek. It was a large crowd of people who entered the waiting hall and started occupying the benches with their bags and some with their children and with sheets and other things. More people left the bus and filled the semicircle around the bus to get their bags and luggage from the driver who cleared up the big luggage hold under the passenger area. The shutters of the luggage hold were opened on both sides that one could look through. The driver went around the bus and took the luggage out from both sides of the hold and put it on the square in front of the people in the semicircle. The bigger bags were piled up in the reception hall next to the entrance to the outpatient waiting hall.

After the patients have taken their luggage, the boxes with the drugs and infusion bags were taken from the luggage hold and carried on the trolley to the waiting hall. Finally, the bus driver took the big freezer box with the transfusion bags from the co-driver’s place which were carried on the trolley to the hall. The returned patients had to be seen by the doctor who was on outpatient call. This doctor had to decide, if the patient could be discharged or had to be admitted. The doctor on call was Dr Ruth who started the screening work. I went through the wards and looked after the operated patients of the day. The ten-year-old girl after amputation of the right arm was sleeping. The nurse had given her the pain injection. I looked at her sleeping face and saw the broad grieving rings around her closed eyes with the spots of dried-up tears. I read from her face that she had a fight in her troublesome sleep against the attempt to get reminded of what was done on her.

I left the hospital and crossed the square when I looked back to the outpatient reception where people and mothers with children prepared their sleeping places for the night. Cardboards and papers were spread out on the front passage surrounded with bags, tops and bottles. Young women breastfed their babies and wrapped them in cloths and carried them on the back. Old women puffed on short pipes what had the sharp smells of herbal-tobacco mixtures. Old men fiddled clumsily on the long sticks. Old and young sat side by side. They stared over the square, rummaged in bags and pockets and put out spoons and tins and ate from tinplates and pots and drank water from plastic bottles. Spoons clattered in the pots. The people spoke hardly to each other.

It was sunset and the sun dived the sky for some minutes in a red-violet blaze of colour. I took the way back to the flat as a walk under the great light spectacle of a ‘dramatic’ transfiguration. I showed the permit to the guard at the checkpoint who had no objection. Dogs strayed around and the cats were hiding. I pulled off the sandals with the sweaty cork soles in the verandah and the sweaty shirt in the sun-heated sitting room. I went to the small kitchen and filled the kettle half with water and put it on the gas flame for a cup of rooibos tea. I stirred in two teaspoons of sugar and took the cup with for a seat on the step outside the verandah door where I lit up the cigarette. It was an evening as the countless evenings were when I returned tired and exhausted from the hospital to spend the rest of the day in loneliness. I looked at the sky and saw the first stars coming out in the early darkness.

The ten-year-old girl knocked in my mind. She was weeping about the loss of her right arm. It was a great tragedy which I compared with the tragedy of the fourteen-year-old Kristofina who was hit by lightning which had burnt the right lower leg and had charred her shin bone. Kristofina passed away a few hours after admission. The ‘lightning strike’ on the ten-year-old girl was the malignant bone tumour on her upper arm [humerus] why the girl had to sacrifice her right arm. I saw still the amputated arm on the spread-out paper on the floor where the dark blood ran out from the cut-off end and formed a small lake of blood that clotted and stuck the arm to the paper. The question was: which kind of life could this girl expect. It was a question which I could only hypothetically answer.

The traumatic impact was inconceivable in respect to the psychological trauma. The girl was a right-hander and understood the world from this side. The change from right to left would be the greatest break and the learning process had to start right from the scratch. The prominent right shoulder board with the extremely short arm stump had lost any functional meaning. The girl’s body with the broken-off anatomy had an aesthetic deficit of a significant degree for the rest of her life. The stroke of fate and the surgery had crippled her human shape so much that loneliness and sadness would accompany the girl through the years to come.

The night sky stood in full splendour. I stubbed out the cigarette in the sand and emptied the cup of tea. I stood up, put the cup on the sink and took a seat at the verandah table in the sitting room and started to write down some of my reflections:

With ten you were a child

when you were hit with your beautiful face

what more frequently hit older and injured people.

Your dreams became inevitably shocked

when they hurried ahead and have seen

what came from the darkness without any light.

You called for your father

loud and then soft, so you have called

who saw you and was on the way

when he got torn loudly to pieces.

You have squatted down

with your hands against your eyes.

You were afraid and you were right

and has learnt to shed your tears

which could not stop.

The arm was the next without being pertly

it was taken from you for some reason

that you couldn’t find in your dream

because there was a corner in the darkness

without brightening by a single spark of light.

What should I say?

There was something hidden in the arm’s bone

that did not look good, because it was bad.

That is that I cut off the bad from you

what was in your right arm.

It is a case if one likes to help

but is unable to do so without a compromise.

When you come back from your dream

and will remember where it was

you will be sad what I didn’t want to be

maybe, you will be angry with me

what I can understand.

You were a young and beautiful girl

to whom it had happened with the arm

which you have used to play and write

to carry the container with water

or put the bucket with water on your head

or gave the goat a smack.

Now the arm is cut off

and you will never get it again.

Poor little girl, what will be

when you wake up?

I put the picture of the girl into my mind as she was trying to fly with the left wing, but dropped as a falling angel and was about to break the flapping wing. It was the picture of the pity and sadness when she raised up the left arm, but where the right arm had to be, there was not more than a short and ugly stub.

I left the table and took again a seat on the step outside of the verandah door and lit up a cigarette. The convoy of the five Elands with the long ninety-millimetre barrels took the sharp left curve in front of the flat to leave the village for the nightly field patrol. The heavy vehicles left a sandy cloud behind and the nose smelt the dry-bitter stuff what was tasted on the tongue as well. The moon was nearly round like a baker’s face and the round face kept silent as it had lost its speech. I looked at the Southern Cross and understood the deadly silence in that ‘rural’ area of an unknown light years’ distance. After this night observation and night reflection I pulled off the clothes and went to bed. I wished that the ten-year-old girl didn’t meet me in my dream.

I woke up bathed in sweat when the cocks crowed the morning of the new day. A missile whizzed through the dream and tore off my right arm. The cold sweat was related to the ‘fact’ that I could not continue the work as a surgeon. I felt myself useless and saw the fundament of my existence falling to pieces. It were the crowing cocks which saved my life and gave me the existence back by pulling me out of the dream what was a hard battle. It brought me back the right arm what I was unable to do to the girl. I stood under the shower when I asked myself the question, if I had tried in this dream to put a new arm on the girl. I felt ashamed that I didn’t try it. I was in the expectation of the new day and drank the cup of instant coffee with the chicory supplement and two teaspoons of sugar to fight the tiredness after the dramatic missile dream. I put on the sandals in the verandah and left the flat without looking at the paper with the writings of the previous evening.

There were no dogs straying around and no cats jumping in the roadside ditches. On my walk to the hospital I looked at the small shelters packed and surrounded with layers of sandbags on the sides of the houses, but no dog lay in front of the shelter entrances and no cat lay on top of the sandbag hills. I showed my permit to the guard at the checkpoint who responded with a long yawn. The gatekeeper put the whole egg into his mouth and rubbed the shells into the sand. His mouth was full that he was unable to say a word of greeting when I passed the hospital gate and did greet him. There were two new patients in the intensive care unit who were operated in the night by Dr Tabani, the one because of an intestinal obstruction and the other because of a spleen rupture after a traffic accident. Since the beds in the unit were occupied, Tabani had transferred two patients to the general wards, the man with the missing arm and missing leg to the orthopaedic male ward and the man after reconstructive surgery of the face to the surgical ward. The man after laparotomy with removal of the spleen and bowel resection was in stable condition. I removed the drains and completed the records and wished the nurses a good day and left the ward.

The girl in the children’s ward after the right arm amputation who gave me the dramatic missile dream at night, lay on the back and slept. The swollen eyelids and the salt crusts of her dried-up tears had taken away her innocence. The child’s face had become features of an adult and of sadness. The pain about the loss of freedom and a hopeful future had weighted heavily her life. Temperature and pulse had risen in correspondence with the increased adrenalin distribution what was triggered by the pain responding hypothalamic centre. I pulled the sheet from the right shoulder and saw the dark blood spot on the bandage. The girl’s heart beats knocked strongly against the chest under the grey hospital shirt that I understood these beats as her resistance to a life, she didn’t want. I stroke her hair and put the sheet back over her right shoulder and completed the record.

The nurse with the heart for children changed the finger dressings on the right hand of the much younger girl after separation of the long fingers from the common skin bridges on the dorsal and the volar side due to the syndactyly. The skin grafts showed a good tendency to heal in and doctor and nurse put on the new dressings and a hand bandage. After all the children had been seen and the records were updated, I asked the nurse, if the children received the milk on a daily basis. The nurse looked astonished at me. When I asked about the condition of the toilets, the nurse smiled and asked, if I still believed in a miracle. I understood and said that I will bring up these points in the morning meeting, and left the children’s ward for a short round through the other wards.

I met on the way to the morning meeting the new black colleague who was a specialist surgeon and on the way to the superintendent’s office as well. The colleague said that he liked to have a conversation with me. I knew of the wish and waited for its realization. We entered the office and the black specialist took a seat on an upholstered chair next to the black paediatrician on the window side under the rattling air conditioners. I took my seat on a hard chair on the opposite side next to Dr Ruth, the hard-working black colleague in charge of the gynaecology department. The matrons arrived late and brought their chairs from the secretary’s office. The superintendent opened the meeting with ‘good morning!’ and introduced the new colleague to the attendees of the meeting. Dr Nestor said that the new colleague is the principal of the Lutheran mission hospital in Onandjokwe and will come twice per week to the Oshakati hospital to do the major surgical operations and should be in charge of the surgical wards.

The Superintendent expressed his hope that the presence of this new colleague would be a relief for the doctors of the surgical department. In this connection, he praised my restless commitment who had operated sore his fingers. The superintendent looked at my right hand with the dressed third and fourth finger and said he could not see Oshakati hospital without my great achievements. The new colleague who was the first black Namibian specialist surgeon did not say a word about his background and postgraduate training he had done in South Africa. The paediatrician whispered something into the colleague’s ear who did not show any reaction on his face. The superintendent asked the new colleague and me for a conversation after the meeting, and for comments from the forum.

The lean matron came up with the hospital clothes for the patients, the bed linen, washing bowls and spittoons what Dr David had complained about in one of the previous meetings. The matron confirmed that the shelves in the clothes’ storeroom were empty and the kept washing bowls and spittoons were defective and useless. These items had to be ordered, she said and the superintendent made a note and promised to work on this problem. Dr David thanked the matron for the immediate reaction. The pharmacist lady announced that the cardboards with the ordered drugs against malaria and TB and some other drugs had arrived. I brought the point of the nurse in the children’s ward that milk were only periodically provided for the children and then in little quantities. This had to be seen as a matter of urgency, since children need the protein to recover from their illnesses and to improve and accelerate the postoperative healing process.

Dr David emphasized the importance of milk as the basic nutritional element in treating the patients. He said that he cannot accept a hospital without the regular milk distribution to the patients and especially to those children who are malnourished as so often seen in this part of the world. The paediatrician did not say a word as he were not concerned about the poor nutritional status of the children. He looked at the yellowed asbestos mats in the ceiling as where there the answer for the protein enrichment of the nutrition.

The superintendent had the face of surprise as he was not aware of this serious problem. He made a note and framed it several times and instructed the matrons to look into this matter of urgency to make sure that the children and the TB-patients get the milk on a daily basis and in sufficient quantities. I mentioned the tiresome topic of the toilets and reiterated the question of the children’s nurse, if I still believe in a miracle. “I am inclined to believe in a miracle, especially in respect of the toilet conditions in the hospital”, I said. It caused a smile on some faces, while the matrons looked with faces of concern. The superintendent was aware of the unhygienic situation. He said that he had spoken to the ‘Sekretaris’ who promised to put things right, but was still waiting for the people of the works department to do the maintenance and repair. I imagined the ‘Sekretaris’ as he had turned up his nose because of the stench that he actually couldn’t smell through the phone. The superintendent made and framed a second note and reminded the forum that no patient could be sent to Windhoek the following two weeks for specialist treatment, since the specialists were on leave in South Africa. It was his final remark and Dr Nestor closed the meeting and asked the new colleague and me to stay.

The triangle conversation

The colleagues, the matrons and the pharmacists had left the superintendent’s office when the three doctors sat in a triangle: Dr Nestor on the swivel chair behind the desk, the new colleague on an upholstered chair on the window side and I sat on a hard chair on the opposite side. The superintendent asked, if the two surgeons had discussed the relevant points in regard to the two departments of surgery and orthopaedics. The new colleague made a doubtful face. He said that there was still no opportunity for an informative exchange of ideas. I added that we have shaken hands when the paediatrician had introduced one to another, but it was a very short face to face confrontation what did last not more than two minutes. The Superintendent pulled a serious face and explained to the new colleague that without my commitment what he called as tireless, there would be no surgery or orthopaedics at the hospital. The new surgeon took this remark with a bitter taste on his face. The superintendent called the numbers of operations done in the previous years which he said were amazing what the new colleague swallowed without a resonance. Dr Nestor proposed that the colleague should take the responsibility for the surgical department and operate the surgical list on Mondays and Fridays and I should take the responsibility for the orthopaedic department.

I asked the superintendent, if he had spoken to the new colleague regarding the yearly rotation between surgery and orthopaedics, since I was a surgeon as well and did the orthopaedics due to the urgent needs at the hospital. Dr Nestor confessed with a serious face that he did not speak regarding this rotation and asked the colleague, if he had an objection against my proposal. The colleague put up a doubtful face that I got the impression that the black surgeon was more interested in surgery than in the culture of a team spirit by accepting such a rotation. I put the triangle conversation in my memory that characterized the situation in that time: “The one should take the demands of the need into consideration, while the other keeps up his decision to be in surgery only.” Finally the new colleague said that he would think about the proposal. It became clear that there was little or no space for building up the team spirit what was needed in this critical period of time.

It was a bitter learning process that the new colleague was merely looking after himself than to become a comrade in sharing the burden and responsibility which could give the hospital a new face of mutual understanding and cooperation. The time was overripe of having learnt the lesson that each kind of apartism rejects team spirit, but the build-up of a community by a real cooperation with a human face should be the fundament of equality, peace and justice. I got the warning of the young colleague in my ear who had said that the blacks will not do better than the whites, if they take the power levers into their hands. I realized with bitterness that the conversation was fruitless, since the blacks saw the light of the imminent change with the black hands on the power levers, though Dr Nestor tried to reach the balance on the basis of fairness and in regard to a justifiable proposal. In the end, the superintendent had to admit that a mutual agreement between the two surgeons had failed. I thought in the moment of a strong disappointment to leave the hospital and this place.

It were the thin and need-folded faces of the poor people that gave me the dictate to stay. I thought of the Swiss colleague who also was a surgeon and said that he would not allow anybody to dance on his nose. This colleague would have packed his bags and left the hospital what he had already done in the time when the military had occupied the chairs of the superintendent and the health and medical director due to the nonsense of the meetings and an administration with the non-acknowledgement of his Swiss specialist certificate by the Medical & Dental Council in Pretoria. He felt this kind of discrimination as narrow-minded when a qualified surgeon was urgently needed in the north. I admired the Swiss colleague for his perspicacity, astuteness and strong-willed decision, though his departure left a bigger workload for the rest of doctors. At his time, there was no team spirit either. However, I hoped that the good spirit would come up, the closer the black power vessel came in sight. It was the Swiss colleague who gave a dark forecast. The three men meeting in the triangle formation with the black superintendent and the new black colleague and me had a lopsided shape with an acute angle.

I went to the theatre building and changed the clothes in the dressing room where I heard the voices of Dr Lizette and Dr Christine who enjoyed the chat in Afrikaans with laughter in the small tea room. I entered the tea room for a cup of tea and thought about the acute triangle conversation in the superintendent’s office. I imagined the various triangle shapes and remembered the saying of my teacher in geometry that the triangle with the equal angles had the most well-balanced shape. The two doctor ladies realized that the colleague was still in another world that they tried to pull him back on the ground of the reality in this corner of the world. They asked about my impression of the new surgeon. I praised still the well-balanced triangle in my mind that I answered the question in that way: “I thought things would go easier.” It was an answer with the riddle and Lizette started puzzling when she said that something narrow was at the short colleague who would intersperse with his head. I thought of the asymptotic approach when Lizette and I left the tea room for theatre 2.

Dr Lizette put the breathing tube into the throat of a young man who had a multiple shaft fracture of the right upper arm. The instrumenting nurse cleaned the arm with the brown disinfectant solution and covered the rest of the patient’s body with sterile green sheets. I approached with the green coat the operating table. After the longitudinal skin incision on the lateral aspect of the upper arm and a blunt separation of the muscles, I exposed the bone with the fractures and identified the crossing radial nerve. The fragments were aligned in anatomic position and fixed with a long bone plate. The wound were closed by suturing the muscle fascia and the skin.

I thought of the dedicated young colleague and story writer about the forbidden love in apartheid South Africa when the man is white and the young woman is black. These people emigrated to New Zealand where they live in a small village at the Pallis Bay and the young black woman had given birth to a strong boy. I put the dressing and bandage on the upper arm and lifted with two nurses the man on the trolley to be carried to the recovery room. I thanked the team for the good cooperation and bumped absent-mindedly the face against the glass filling of the swing door to the washing passage when I left the theatre room. I pulled off the operating coat in the dressing room and rubbed the nose to get away from the pain and changed the sweaty shirt for a dry shirt and entered the tea room for a cup of tea. The Philippine colleague sat quietly and took his cup of tea when I offered him to assist the next operation what was the medullary splinting of a broken radius. The colleague accepted the offer and led the cup to his mouth.

Dr Lizette had brought a twenty-year-old patient into sleep and had sent a nurse to the tea room to call for the surgeons. The colleague reduced the midshaft fracture and put a pin into the medullary canal inserted through the radial stylus eminence on the medial aspect of the wrist. The next operation was the lengthening of the right Achilles tendon on a three-year-old girl to correct the clubfoot. After the operation, the foot were kept by a cast in a slight dorsiflexion of the foot. The last operation was scheduled for a revision of an above-knee stump due to the penetrating bone. The old man was already on the operating table when a serious hand injury were brought to theatre and the Philippine colleague had left the theatre for the outpatient department. The old man were put back on the trolley and carried to the preparation room, while the young man with the hand injury were put on the operating table. The instrumenting nurse unwrapped the instruments set and put the instruments on the instrumenting table. Lizette had induced the anaesthesia and pushed the breathing tube which was for the old man, into the throat of the young man. I removed the blood-soaked cloth from the hand and a rolled-up and strongly tied cloth from the upper arm.

An artery spurted blood in splashes against my glasses, my face and the operating coat. I pressed the thumb on the artery, while a nurse took off and cleaned the glasses and put them with some small orientation problems back on my nose. I clamped both ends of the spurting artery. The tendon of the strong radial hand flexor and the median nerve were cut through. I held up the arm and the instrumenting nurse cleaned the forearm and the hand and covered the rest of the patient with sterile green sheets. I repaired the radial artery and connected both ends together with fine sutures. I removed the two clamps and brought a small bleeding from the anastomosis after some minutes of observation by a gentle compression with a cotton applicator and one or two additional sutures under control. After this, I sutured the ends of the thick radial flexor tendon with strong stitches together and connected finally the ends of the median nerve with fine sutures to the nerve sheath under the magnifying glasses. The nurse took off the magnifying glasses and put more skilfully the normal glasses on my nose when I started closing the skin over the flexor side of the patient’s right wrist. The hand got dressed and bandaged in fist position and the wrist were immobilized with a dorsal plaster splint to the forearm in flexed position of the hand.

The operation lasted nearly two hours and Dr Lizette urged to go home for lunch that the stump revision on the old man were postponed onto the next day. I went to the dressing room and pulled off the sweat-drenched shirt and washed the blood spots from my face and neck and rubbed the skin dry over the head and chest and put on my civilian clothes. I had no comb that I went with my fingers through the wet hair to bring it little bit in order in front of the mirror with the broken-off right corner on the top. I hurried to the dining room to get something on the plate when I met on the circa sixty-metre long passage the colleagues and the lab assistants who came back from lunch. It was the last minute when I entered the dining room.

The kitchen man cleared up the tables from the plates, cups, forks and knives and put the used dishes and cutlery with some rattle noises to the tin bowls and pots on the kitchen waggon. The kitchen man expressed his regret that only some rice had been left. I understood the situation and was about to leave the dining room when the kitchen man asked me to take a seat at the table. The kitchen man went to the tea kitchen and came after circa ten minutes back and brought a plate with two fried eggs and two slices of the tasteless bread and a small tin bowl with margarine. He put two green apples to the left of the plate and brought a big pot with hot tea and the cup and fork and knife. The kitchen man did all these things with a smile from the bottom of a good heart and with a good feeling for the German doctor.

I thanked the kitchen man for his kindness. The kitchen man said: “Duitse dokter is ‘n goeie dokter” [German doctor is a good doctor] and went back to clean up the tea kitchen. I ate the special meal with appetite and enjoyed the fresh rooibos tea. I drank two cups with two teaspoons of sugar in each cup. As dessert I ate one of the two green apples. The apple sourness wrinkled the mucous membrane in my mouth that I took a third cup of tea sweetened with three teaspoons of sugar to smooth the mucous membrane by comforting the taste receptors. A man in his humbleness is the best from whom people can learn so much, I thought when I helped the kitchen man to put the kitchen waggon over the threshold. I took the passage to the outpatient department, while the kitchen man pushed the heavy kitchen waggon with the jingling and rattling stuff on the other passage to the main kitchen.

The paediatrician crossed the way and spoke about a child in the paediatric ward with an intestinal obstruction who needed an urgent operation. He said that he would not assist in the operation, since he had other important things to do. I passed the waiting hall where the benches were packed with patients and informed the Philippine colleague in consulting room 4 of the laparotomy on the child. I went to the paediatric ward and saw the child and agreed with the diagnosis of an intestinal obstruction that I informed the theatre staff of the operation with the request to fetch the child from the paediatric ward. I asked Dr Christine to give the anaesthetics, since Dr Lizette was still at home for lunch taken with her husband. The two anaesthetic ladies worked in the afternoon in the surgical consulting room together with Dr Tabani and Dr André. The latter was a pleasant young civilian doctor who had recently arrived from Natal, South Africa, with his young wife.

I changed the clothes in the theatre dressing room and went in green shirt and trousers with a tied face mask and cap to theatre 3 where the eleven-month old girl who was the child of a nurse, was on the operating table. Dr Christine induced the anaesthesia and the instumenting nurse unpacked the instruments set and sorted the instruments on the instrumenting table. After this, she cleaned the skin over the chest and the abdomen of the small child with the brown disinfectant solution and covered the rest of the child’s body with green sheets. I opened the abdominal cavity through a midline incision and found on the right side a seven-centimetre long cylinder of a compact resistance. It was an intussusception of the last small bowel segment into the ascending part of the colon. The caecal pouch was pushed with the appendix into the colon as well. I released the content and pulled the invaginated bowel out of the cylinder and made some fixing sutures to prevent a relapse of this disorder and closed the layers of the abdominal wall. It was a short, but lifesaving operation. A dressing was put on the wound and the baby were wrapped in a green sheet and brought to the recovery room. I thanked Dr Christine for her anaesthetic conduct and the nurses for their work. I gave the nurse at the theatre reception the operating list for the next day on which the old man for the stump revision was added.

I changed the clothes and left the theatre building for the outpatient department to assist the Philippine colleague in consulting room 4 in seeing and treating the outpatients. Six of the seven waiting benches were still filled with patients. I entered the consulting room and took my seat at the table. The colleague showed me an X-ray of a five-year-old boy with a long sequester in the right shin bone. The boy was unable to walk since a couple of weeks. The lower leg was swollen and the skin was inflamed and warm and showed some pus secreting openings with a skin maceration around the openings. The child was on the brink to lose its lower leg.

An operation was needed and I explained the procedure to the mother, if the leg should be saved. The sequester had to be removed and the long tibial shaft defect had to be filled with a vital piece of the calf bone. The mother understood, agreed and signed the consent form, and the colleague admitted the boy. It were mainly boys in a poor nutritional status who came with a haematogenous osteomyelitis to the hospital. The swing-over-technique of a compound fibula bone graft into tibial position after sequester removal and trimming the viable ends of the upper and lower tibial stumps were developed first practised at Oshakati hospital. This technique was designed for reconstruction of the tibia to prevent the leg amputation. [This technique was published 1994 in the American Journal of Bone and Joint Surgery].

The hours flew by with removal of foreign bodies, suturing wounds, closed reductions with applying, maintaining and removing of plaster splints and casts when two injured men were brought after a blast accident, one with a broken thigh and the other with lacerations in the face and on the right shoulder and arm. The accident had occurred when a man followed a small cattle herd and stepped on a landmine which tore him in pieces and threw some sharp-edged stones against the others, while the cattles escaped in the bushes. The man with the lacerations were treated in the casualty theatre and the man with the broken leg were admitted. It was the nurse of the night shift who cleared up the things on the table in the consulting room, while the two doctors washed their hands and removed blood and plaster spots from their arms and clothes. The Philippine colleague looks exhausted when he said goodbye and left the hospital for his family.

It was twilight when I made a short evening round through the wards. I entered the children’s ward and looked after the ten-year-old girl after amputation of her right arm. The children ran in shabby and dirty hospital shirts on the corridor. Some small kids were naked. The ten-year-old girl sat up in her bed in the last eight-bed-room which was crammed with ten occupied bedsteads. The grandmother had visited the grandchild and had brought a small tin pot with mahangu pap. The girl ate the pap with the left fingers and had spilled her shirt, since she had still to bring up the eating skills from right to left. The girl was not prepared to smile and I understood the reason, though I gave her a smile which however was not replied, since the girl did not accept this smile as true from a doctor who has cut off her right arm. She thought that there was nothing to smile about in this terrible situation with one arm left.

I read the rejection from the girl’s eyes with the broad grief rings around her eyes that I rather should feel ashamed of having done this severe mutilation on a young and innocent girl. It was a riddle that a doctor was able to do such an awful operation. I asked her, if she had pain. The girl did not answer the question and looked down on the pot with grandmother’s mahangu pap. The nurse said that the girl is getting a pain injection eight-hourly. I felt the strong rejection of the girl who did not accept me any longer as a doctor than to see me rather as a heartless and brutal butcher. I made the notes in her file, but did not touch her hair to avoid any additional emotional trauma. I thought that the girl would push my hand away after I have disappointed her so deeply. I wished her a good night, but the girl did not respond and looked on the pot with the mahangu pap. I continued the round with the nurse and looked after some other children. I left the ward and wished the nurse a quiet night, but was depressed in respect of the poor girl and her future.

I completed the evening round through the other wards where I gave some instructions. I wished the nurses a quiet night and left the hospital. The gatekeeper leant against the left post of the hospital gate and fiddled on his right trouser leg with a tear over his thigh. I passed the gate and looked back to the reception of the outpatient department where people put cardboards and papers on the concrete passage in preparing their sleeping places. Women rummaged in plastic bags, old men fiddled on sticks and old women puffed on short pipes. I crossed the gravel road and took the short path between the damaged picket fence with the rolled-out barbed wire on the left and the five empty caravans on the right. Mice flitted from one side to the other and disappeared in holes and under bushes. When I reached the checkpoint I saw a long row of cars standing in front of the closed barrier, while the first car underwent a meticulous inspection. There was a four-metre long and less than a one-metre broad head-high pit with solid walls in front of the barrier rod since some weeks, from where a soldier inspected the cars from below. The guard next to the control room let me pass without looking on the permit. It was in front and inside the control room where black domestic and garden workers were checked before they left the village. They opened their plastic bags and pockets without explicitly asked to do so.

A leather strap scoured on the wounded big toe of the right foot. I took the sandals into my hand and walked barefoot to the flat. Straying dogs with tails retracted between their hind legs passed in both directions. They held the heads forward and took no notice of me. Five Elands with long ninety-millimetre barrels and with harsh headlights drove the left curve and in convoy along the gravel road in low speed toward the checkpoint for the field patrol. The heavy vehicles passed when I was less than hundred metres from the flat. I closed the gate and took the last metres and put the sandals in the verandah. I pulled off the sweaty shirt and the trousers spotted with plaster and put them over the back of an armchair in the hot sitting room to take a shower. The wound on the right big toe were dressed with a fresh and rolled-up and tied handkerchief. I went to