Читать книгу For Justice, Understanding and Humanity - Helmut Lauschke - Страница 5

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.