What I learned in Andara
We hadn’t chosen Africa for our elective because we thought that we could be of any help. We had grown up and become cynical since our freshman days. Realistic – that was what we called our objectives. How could we, five years into our studies without having seen a single case of malaria, expect to be useful? We decided on Andara Catholic Hospital, in the remote Namibian jungle, 200 kilometres from the nearest city, yet only across the river from Angola. We would learn to be resourceful, we resolved. And having the freedom to roam over all areas of the hospital – wards, outpatients and casualty – to see many cases of malaria, tuberculosis, and AIDS.
The fig tree was our connection with the outside world. Our wireless internet, intermittent at best, somehow found its signal here. But when it rained there was no reception at all. I had never seen rain so impenetrable. The afternoon thunderstorms hid Angola – usually visible across the Kavango River, and thundered on the
corrugated iron roof of the hospital.
When the rain fell, people kept away from the hospital. All except emergency cases, where patients would be extricated, groaning and shivering, from under water‐laden tarpaulin sheets or fibreglass covers over the back of family utes. Everyone owned a ute in this part of Namibia, picking up hitch‐hikers, chickens, dogs.
Hitch‐hiking along the river road was the way most people arrived at hospital. Our own village, Andara, was not more than a collection of thatched houses, the Catholic mission and the hospital. And the two shebeens – pubs – that competed with the Catholic Church. Roads were rudimentary, diving between trees that hid the huts along the river.
The Andara Catholic Hospital itself was a blaze of red among the jungle greens. The walls, holding four wards and 120 beds, were scrubbed clean, and the waiting area smelled just like a hospital should, aseptic. The wards, though, smelled like porridge – maize meal mixed with water, served three times a day to patients, and congealed and half‐eaten, in metal bowls beside each bed, as we completed our morning ward rounds. My stomach churned at the sight every morning, and at the sickly sweet smell of decay – now I finally knew what that meant – emanating from patients left to languish, without an affordable hope of convalescence.
Yet in the birthing area was a CTG machine. Nobody used it, of course, and nobody knew why – women here gave birth completely naked, unadorned, threatened constantly by midwives with the imminent death of their unborn – but it was seen as new technology, an improvement. “Things in southern Africa used to be really bad,” said Dr B., our supervisor. “I remember when I was an intern and I needed to cannulate somebody, I had to write a script for a cannula, and the patient had to go and buy one from private healthcare. And of course, if I missed, I’d have to send the patient off to find a cannula all over again. We learned to ration things.”
The young goatherd
In the corner of the male ward was a patient who was different from the rest. He was young, and hid his timid face in the hollows of his elbows. He was brought in by the police, a nurse tells me. The Indian nursing sister had dedicated her life to service in this far‐flung outpost, and had become fluent in Thimbukushu, the local language, resplendent with acrobatic clicks.
It turned out that the boy was not from Namibia, either. He was barely seventeen, and a goatherd, living across the wire fence 40 kilometres away, where Namibia met Botswana. He had chased a goat across the border fence when he was shot. The goat was eager to feed in the grasslands of the Mahango Game Park, just inside Namibia, and he was mistaken for a poacher. Shot on sight. The bullet ricocheted through his pelvis, perforating bowel and bladder. He was dispatched to the nearest regional hospital, 200 kilometers by ambulance, for emergency surgery. The surgeons at Rundu returned him to Andara hastily, with no handover. Nobody knew if the bullet was still lodged in his pelvis. The Andara radiographer had resigned two weeks prior.
“There are some interesting things to think about when you work in Andara,” said Doctor N., one of the four doctors at Andara, walking away from the boy’s bed, laughing while shaking his head. “Why have a shoot on sight policy for poachers? All this for a goat ...”
All this for a goat, I thought. How much did this goat mean for the boy’s livelihood? The fate of the animals in the Game Park, too, was related to the people. Spill‐over from 27 years of bloody civil war in Angola – rival factions backed by Cold War superpowers – resulted in slaughter of men and animals alike. The desperate attempt at containment? Shoot all who look like poachers. It makes you think about how everything is interlinked – how one’s health is dependent on others. Somebody’s decision in the US, in Russia, eventually leading to our boy curled into a ball, catheter draining, in remote, rainy Andara.
There was an outpatient clinic every morning in Andara. The nurses, with their language skills, took the histories. The doctors, in five‐minute consultations, examined the patients – white powdered gloves leaving finger marks on dark skin – and dispatched them, with or without treatment. Sometimes we’d help with the histories. “Chuchu?” – any pain? “Badiku |ngani?” – satisfying click coming off our teeth – fatigue? We learned resourcefulness and flexibility through the foreignness of the process. What do we do when the full blood count machine – one of only three metal boxes in the pathology department – breaks down?
And even though I tried hard to be realistic, I discovered that something had been rekindled. I thought that I had, somewhere along fourth year medical school, abandoned the idea of pursuing public health. Yet through discovering the interconnectedness in health, I found something in Andara that I thought that I had lost.