Читать книгу For Justice, Understanding and Humanity - Helmut Lauschke - Страница 6

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.