Читать книгу The Patient - Olive Kobusingye - Страница 11
Оглавление‘Makerere, Makerere, We build for the future, The Great Makerere
Great, Great and Mighty, The walls around thee
Great, Great and Mighty,
The gates beside thee.
One day he was an ordinary physician at Mulago Hospital, teaching medical students and seeing an endless stream of patients, the next he was a cabinet minister with all the trappings that came with the title. Dr. Emmanuel Lumu, appointed the first Ugandan Minister of Health at Independence in 1962, felt like he was wearing someone else’s skin. Not that he was unaccustomed to high society. He had his friend Kabaka Edward Mutesa to thank for that privilege. The attention he got as a minister though, was different. Some days he missed his more modest position at the hospital. As a minister, he had to worry, not about the patients under his care, but about the entire country’s health system with all its warts and pimples. There were too many patients for too few hospitals and health workers, the medical school was largely dependent on expatriate staff, Kenya and Tanzania were unhappy that Makerere was not producing enough medical graduates for the whole region, and were threatening to start their own schools, and he had no predecessor to turn to for advice. Dr. H. J. Croot, who had been minister under the colonial government, was unlikely to be helpful as the conditions of work would be vastly different. He was grateful to the technical staff at the ministry who pulled together a few documents to guide his thinking. He quickly put together a team to draft the national health strategy for the newly independent Uganda.7
***
The days leading to 9 October, 1962, were memorable to Ugandans for many reasons. The excitement was palpable. It was akin to the expectation of the first serious downpour after a long dry spell, only more intense. All across the country, the independence storm broke forth with loud claps of thunder and lightning. While many rural Ugandans did not fully understand the significance of what was happening in faraway Kampala, with the lowering of the Union Jack and the triumphant ascension of the Ugandan flag, as bold and beautiful as the women that danced to the loud drumming throughout the night, those that had experienced the indignity and scorn of the colonial master up close knew freedom had come. Nowhere, perhaps, was the awareness of the difference between colonial master and servant sharper than within the medical fraternity.
***
Nkore worked as a senior clerk at the District Commissioner’s office in Kabale. He had heard a lot about the independence plans. On the morning of 9 October 1962, just as he was preparing to leave the house, his pregnant wife quietly announced that the baby might be arriving the same day. “Really?” Nkore asked, not quite absorbing the full import of the information. The wife could tell that his mind was already out there in the Independence frenzy. Besides, what would he do to help even if he were home? Cane and hat in hand, Nkore was already half out of the door when he asked if she had alerted the midwife.
“Yes, she is aware.”
“Good”, and with that he was gone.
So, while the rest of the country was preoccupied with the Independence preparations and festivities, Mrs. Nkore’s one thought was the imminent arrival of the baby. The friend and self-taught midwife that had helped her to deliver previous babies was on high alert, and had been for days. Both women knew it could not be too long now. By midmorning, however, all discomfort had subsided, and Mrs. Nkore thought she might have misread the signs. She went about her chores without any sign of labor. In the evening though, with hardly any warning, her waters broke. In a couple of hours she gave birth to a bouncing baby girl. Nkore returned long past midnight to find that the baby had arrived in his absence. “Of course the baby must be named ‘Independence’,” he exclaimed, as soon as he heard of the birth. Independence, or Kweetegyeka, in Rukiga. By the time the baby was a month old, nobody but the father used the whole name, considered too weighty for a tiny little baby. Everybody else called her Kweete.
On 16 October 1962, the New Mulago Hospital opened its doors amidst great pomp and fanfare. Queen Elizabeth’s cousin, Her Royal Highness the Duchess of Kent, traveled to Uganda to officiate at the opening. Alderdice, a former Medical Superintendent of (the old) Mulago hospital, writing in the Lancet of August 1963, said this of the new hospital, “A 900-bed hospital has been constructed in Kampala, Uganda, of a standard that compares favorably with teaching hospitals of recent design elsewhere.” With regard to the medical school, he was equally full of praise. “Throughout the course, standards obtaining in the best British medical schools apply. … Library facilities for students and staff are of a very high standard. The Albert Cook library has the best collection in East Africa and very few journals to which a member of staff may wish to refer are not available.”
***
At Mulago the intention was to build a 750-bed general hospital (to which was later added a private wing of 130 beds). Once the figure of £2 million for the building, £220,000 for medical equipment, and £80,000 for an extension to the nurses’ home was arrived at and voted by Parliament, the architect and the planning committee were determined to cut their cloth accordingly. Although experience elsewhere in Africa raised serious doubts about the adequacy of the money voted, the hospital was in fact completed and equipped virtually within this figure.
Two factors helped to keep the costs within bounds. The first and more important was the speed with which the hospital was designed and building started: the whole project from the first sketch to completion took less than five years; and this gave less time for prices to rise. The second was the determination of the architect (who controlled expenditure and held the vote book) and the planning committee to keep within the figure set, even though this meant a good deal of give and take.
A. A. Alderdice, M.B. Sydney, M.R.C.P. The New Mulago Hospital. Lancet August 3, 1963.
On 22 February 1966, Health minister Dr. Lumu had a premonition that the Cabinet meeting he was going to attend at State House would not end well. He nonetheless prepared a technical brief about the plans for the new regional hospitals in case he had to give an update. Political tensions had been rising, and allegiances had been shifting back and forth for months. Although the Uganda People’s Congress had managed to build a clear majority in the legislative house, the party was deeply divided, and things were coming to a head. Minister of State Grace Ibingira had abandoned all subtlety as he sought to pull the rug from under Prime Minister Obote. Lumu had been in meetings with the Ibingira group, and they were beginning to feel confident of their advantage both in Parliament and in Cabinet. For his part, the Kabaka of Buganda and President of the republic, Sir Edward Mutesa, was considering pushing Obote out, and creating a new government. It would seem that he had gone so far as to seek the advice of Attorney General Godfrey Binaisa about the legal implications of removing Prime Minister Obote from office. Clearly, all of this plotting was not discrete enough, as Obote’s checkmate move would soon reveal.
Driving through Entebbe town, Lumu noticed that there was unusually tight security. A bigger surprise awaited him at State House. He arrived to find that rather than the usual Cabinet meeting, there were only three other ministers waiting to meet the president: Mathias Ngobi, G.B.K Magezi, and Grace Ibingira. A fifth minister, Balaki Kirya, arrived shortly afterwards. Beyond the brief greetings, nobody spoke. Every man sat quietly with his own thoughts. Obote was seated in his usual spot. Sam Odaka, his personal assistant (aide-de-camp), was the only other person in the room. A soldier came into the room, and Obote asked the ministers to follow him. At the door they were met by soldiers who led them to a waiting van. Some seven hours later they were ushered into Patiko prison in Gulu, and later transferred to Kotido in Karamoja where they were imprisoned without trial. Seated in a remote prison in Karamoja, Dr. Lumu could not have felt more removed from his patients and students at Mulago. The purging of the Cabinet to remove the troublesome Ibingira and his group was not the end of the political headaches for Obote. It heralded more turbulence as Obote sought to consolidate his control and eliminate all possible threats to his presidency. On 30 April 1966 Obote announced a new Constitution which was passed without debate, and he was then promptly elected President under the new constitution.
President Milton Obote talking to Narendra Patel,
Speaker of the National Assembly. DS Archives
***
The operating rooms on the ground floor of Uganda’s largest and most prestigious hospital were abuzz with activity. Thursday was the main theatre day for Red Firm, and Dr. Sebastian Kyalwazi, who had returned from Britain a year earlier, had a long list of patients lined up for surgery. It was said that he had been among the top students in the exams that saw him becoming a Member of the Royal College of Surgeons of Edinburgh. For many of the junior staff that was wonderful news, but it came with a fair amount of confusion. Was he now to be treated the way they treated Prof. Ian McAdam? Was he going to have special theatre gowns with his name on them? Up until that time only the white doctors had personalized gowns. The easy bit was his joining the white doctors in the surgeons’ room, but these other privileges were still somewhat unclear. In that exclusive club Kyalwazi would soon be joined by another British trained Ugandan surgeon, Alexander Odonga.
In truth Kyalwazi and Odonga did not have to be as good as their British counterparts to attain membership to the Royal College of Surgeons. They had to be much better, in order to be considered as good. The door to the surgeons’ room was very narrow indeed for the so-called natives, and the Ugandans that got in during those early days were resilient and especially brilliant. The struggle for equal professional recognition went as far back as the late 1930s, in fact for as long as the Africans had a role in ‘modern’ medical care other than that of being the patient.
Kyalwazi pushed through the main double-door entrance to the theatre and made an immediate left turn into the surgeons’ changing room. Here the doctors would exchange their street clothes and clinical coats for special gowns, usually used only here. In a couple of minutes he had changed, and he exited the changing rooms directly into the main corridor within the theatre. There were six spacious operating rooms, each separated from the next by scrubbing bays, equipment storage, and trolley preparation space. Inside each theatre was a new operating table with special overhead lighting that incorporated a camera for televising operations. On one wall was a board on which the instrument nurse would record all the instruments on the trolley, and the number of mops and towels at the team’s disposal. At the end of each procedure the nurse would do a loud count to be sure that no instruments or swabs were left in the wound. On the other wall was an X-ray viewer that allowed the surgical team to display any X-ray films that might be needed for the procedure. All theatres were fitted with piped oxygen and suction facilities.
Kyalwazi checked the board in the surgeon’s room to confirm what theatre he had been assigned, and then made his way down to Theatre 2. The anesthetist was busy securing an intravenous line on the first patient. “Maama, wasuze bulungi?” he asked the patient. “How was your night?” He always made a point to talk to the patients before they were put to sleep.
***
Karungi’s earliest memory of Kweete was at a family gathering. It might have been a wedding or a funeral. They could not have been older than seven years. All the kids were running around, and Aunt Adrine reminded them repeatedly that Kweete was not to run too fast or she would end up in the hospital. Kweete looked just fine to the other kids and so the warning fell on deaf ears. In a sea of children of all ages, three little girls were inseparable: Karungi, Biitu, and Kweete. Like Kweete, Biitu’s full name was hardly remembered and rarely used. Few would have made the connection between it and the English royal name Beatrice. While Karungi and Kweete were first cousins, Biitu’s family was from a different clan, although their homesteads were only a stone’s throw apart. During the school holidays, Biitu would sometimes arrive at her friend’s home early enough for breakfast, and she might not return to her own home until after supper. The parents had long stopped the threats and beatings that they had used to try to keep her away from Kweete and Karungi, who Biitu called Rungi. The parents should not have worried though. The only mischief the girls ever got into, if it was that, was to climb every fruit tree on the property. Otherwise, they usually spent the days playing hide and seek, ‘kwepena’, marble games using riverbed stones, and hunting for guavas and other fruits. It was later, when the girls were nearly ten, that Kweete became critically ill, and had to spend nearly two months in hospital. The doctors determined that she had an infection involving the inner lining of her heart, on top of the asthma that had bothered her episodically since she was about four. Because she missed the most critical term of the school year, she had to redo the class, falling behind her peers by a whole year. For Karungi the following holiday was not much fun as Kweete could not climb trees, did not want to run around, and she absolutely could not play in the rain. These restrictions were to remain for the next several years. The following year Karungi’s parents sent her off to boarding school, so her contact with her two soul mates was further curtailed.
With Rungi gone to boarding school and Kweete not well enough to join her in their usual escapades, Biitu now had no choice but to take on the chores and tasks that her mother insisted were essential for every girl’s survival. She was taught how to peel matoke perfectly without looking, how to winnow and grind millet, and how to take care of little babies. Her mother told her this was the meaningful education, not the reading of books that had little to do with real life. Without Rungi and Kweete life was dull but not lacking in activity.
***
In the evening of 19 December 1969, Professor Ian McAdam, the Head of Department of Surgery, was just exiting the hospital when he heard on the car radio that President Obote had been shot at while leaving Lugogo sports stadium, where he had just closed the UPC annual delegates’ convention. Usually by this time McAdam would already be at the club, but on Fridays he sometimes did an evening round to especially make sure the post-operative patients were comfortable, and to preempt calls late in the night. As he swung his car into Kira Road to head towards Mulago roundabout and on to the doctors’ club, he saw a convoy speeding towards the hospital entrance from the opposite direction, sirens blaring. His sixth sense told him to turn around and head back into the hospital. By the time he made the full turn at the roundabout, the motorcade had disappeared into the hospital. He returned to the parking that he had just left on Level 3, and entered the hospital through the Casualty Department. The previously calm waiting area was busy. There were soldiers and police officers standing around, and although he had taken the precaution to put on his clinical coat, they would not let him take the lift. He walked straight through to the main staircase in the central block, and then ran up to the 6th floor, taking two steps at a time. As he came up to the landing he was met by the 6th floor Matron and two younger doctors.
“We have been trying to reach you”, the Matron said, visibly relieved to see him.
“I heard the news on the radio. I was just leaving so I turned and came back.”
“This way please. He is in Room 1.” Room 1 on Ward 6B was the top VIP room. The entire floor had been cordoned off, and for the duration of the President’s stay there were soldiers at the entrance, and the elevators were closely guarded.
Dr. Kyalwazi arrived shortly afterwards. The two surgeons reviewed the patient and ordered that he be taken to the theatre immediately. They then called Dr. Martin Aliker, the dental surgeon, to join them in theatre.
The stories from Lugogo were as varied and numerous as the people willing to tell them. Some said an assassin had taken a shot at the President as he emerged from the hall, but that the split second before he pulled the trigger, a super-alert Obote had spotted him and dived to the ground, which was how he survived. The bullets that followed, according this version of the story, were by his security as they both covered him and tried to take out the assassin. Others swore that Mr. President had really not survived a bullet, but had had a little too much to drink. They argued that any bullet that knocked out his teeth and injured his tongue would have ripped through his brain, or at the very least shattered the jaw. As it was, the news from the hospital was that the President was safe and stable. Obote himself insisted later that someone tried to kill him, and that he got broken teeth and a tear in the tongue from the gunshot. Over time the stories were laundered in bleach and dyed every color of the rainbow, so it was impossible to know what really happened. What was remarkable though, was that the head of state was rushed to Mulago, which at that time was synonymous with the highest level of medical care in the country, if not in the region. The time for presidents to move with their own emergency medical teams complete with an operating theatre on wheels, as was rumored to be the case with a later administration, and for evacuations to European capitals on the first sign of a medical ailment, was yet to come.
