For Justice, Understanding and Humanity. Helmut Lauschke

cut off the girl’s arm

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

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

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

      The Philippine colleague did an internal fixation on the medial tuber [malleolus] of an ankle joint in theatre 2. He was busy to insert the tension screw. The patient was a woman who had slipped over a rolling stone, while she carried a bucket with water on her head. I changed the clothes in the dressing room and went to the outpatient department to see after the waiting patients in consulting room 4. A mother put her six-year-old girl on the chair on whom a monstrous deformity was cut off from the right hand [macrodactyly] that was twice as big as her foot. The operation was done a couple of weeks ago and the mother brought the girl for the follow-up. The girl looked happy to be freed from this ugly monster and that her hand got for the first time a functional meaning as she could grasp and keep small objects like a pencil between the thumb and the small finger. She demonstrated her skills and scribbled some lines on a piece of paper. I felt the satisfaction that I could improve the aesthetics of the hand shape and gave this hand a function and the girl a better quality of life. The mother was happy. She told that she will send her daughter to school what was impossible with the hand monster that had to be carried by her left hand. Doctor, patient and mother had a smile of relief and gratitude on their faces and the date for the next follow-up were noted in the health passport.

      A man of around fifty years of age took the seat on the chair and held the leg prosthesis with his right hand. The bone stump was prominent and had thinned and inflamed the soft tissue coat. A revision with shortening of the bone shaft was needed that I admitted the patient and put his name on the preliminary operating list. An old woman supported by another woman walked with difficulty to the chair. She stood by holding the right hand on the backrest and pulled up with her left hand the long-hanging dress over her left knee. The old woman kept her head bowed and indicated with her left index finger the swollen knee which she could not bend. I helped the old woman for a seat on the chair and cleaned the skin over the knee with the disinfectant solution and put a needle into her joint. An amber-coloured fluid of a big amount ran through the needle into the kidney bowl. I had removed the needle when the old woman felt the relief and flexed the knee. She was one of the many old people who came to the hospital with advanced alterations [arthrosis] of the knee joint for release of the effusion. An artificial joint could help a number of patients, but this was not affordable for the poor people in the north and also not feasible at Oshakati hospital. I explained to the old woman that only a stiffening of the knee could take away her pain, but she rejected this kind of help. She said that she needed her knees. I prescribed the anti-inflammatory drug in her health passport. The old woman left accompanied by the younger woman the consulting room for the dispensary in the waiting hall to receive the small yellow plastic bag with the pre-packed tabs for no longer than one month or only two weeks, if a drug shortage was in sight.

      A child with a broken right forearm sat on the knees of the mother. I went with mother and child to the plaster room and reduced the fracture in a short-lasting anaesthesia and immobilized the arm with a long cast in flexed position of the elbow. A young man had dislocated his left thumb. It were reduced in local anaesthesia and immobilized on a splint. The next patient was a woman who had cut off the tips of her left index, middle and ring finger with a panga. I put the patient on the operating table in the casualty theatre and anaesthetized the fingers and covered the defects over the stumps with flaps in V-Y-shapes. The nurse gave the anti-tetanus injection. A boy entered accompanied by the father the consulting room. He limped with the left foot wrapped in a rag. The boy had stepped in pieces of glass and had cut his toes. The father carried the son to the small theatre room and put him on the operating table. I cleaned the toes and the forefoot and gave the anaesthetics to the toes affected and removed some splinters and sutured the wounds. Dressings and bandage were applied and the nurse gave the booster injection against tetanus. A mother brought her baby on whom the sixth finger on both hands and the sixth toe on both feet were ligated to separate them from the blood supply. The surplus fingers and toes had fallen off that the hexadactyly [six fingers] were brought back to the normal pentadactyly [five fingers] with five fingers and five toes. Lunchtime had started thirty minutes ago when I left the consulting room. Three of the seven waiting benches were cleared up.

      The kitchen man filled the plate with rice and put a lobe of meat and the two pumpkin halves on the plate and spread with a big kitchen spoon the sharp chilli sauce over the rice. Dr Nestor and the paediatrician sat at one table that I took the next table. The friendly kitchen man with the dark spots on the white kitchen clothes cleaned the table from the used plates, cups and cutlery. I ate the rice and the half of the meat and the flesh of the pumpkin. The ten-year-old girl was in my mind, I had cut off her right arm.

      The paediatrician left the dining room and Nestor came to the table and took a seat. He saw the sadness in my eyes and asked for the reason. I told him the story: The father was torn in pieces by a landmine a few weeks ago and the mother was sick who had to look after the girl’s younger brothers and sisters. I had cut off the right arm on the ten-years-old girl because of a bone malignancy in the upper arm. Nestor got a serious face from one second to the other. He put his right arm on my left shoulder and looked at me with sad eyes. After a minute of a thoughtful silence he said that we as medical doctors have to do our work which is to help our patients. “More than saving the girl’s life, you cannot do”, he added and changed the subject knowing that nobody could give the poor girl the right arm back.

      He asked in connection with the text of the advertisement in the German ‘Ärzteblatt’ for my opinion, particularly if German doctors would be interested to come to Oshakati. A small advertisement was commissioned for what Dr Witthuhn as the medical director was ready to pay from the small and restricted hospital budget. I was concerned, if the small size could catch the eyes of the readers, but I answered the question positively and said that a glut of doctors exists in West Germany that goes parallel