For Justice, Understanding and Humanity. Helmut Lauschke

nursing staff according to the reduction of the bed capacity in the hospitals together with the closings of small community or privately run hospitals.

      Africa is the continent where the sun triggers off the reflex of the exotic with the great distances, the width of the deserts, the clear night sky and the pristine habitats of the wild animals. Dr Nestor laughed and his fist knocked the hope for more doctors on the table. He got attracted by his imagination that the German doctors would respond, since from South Africa there was nothing to expect after it has withdrawn its doctors from the hospital. “The military does force us on our knees, but we will not give up”, Nestor said with an undertone of bitterness. I agreed and said that the few doctors left will stand as a unit with straightened knees. “We will pass the critical time and keep the hospital running and if we work sore our fingers.” It was a strong saying of an unconditional motivation when we left the dining room.

      On his longer round in the children’s ward, I looked after the ten-year-old girl whom I hopefully did save her life, but took certainly away from her the quality of a normal and a cheerful life. The girl lay in bed with a tear-stained face. Her eyes were red which looked hopelessly. I gave a smile of deep sympathy and understanding what however remained unresponded. The girl kept the great sadness on her face that I was unable to ease. There was no point of light. I stroke her hair as her grandmother has done in the consulting room. The girl took it with running tears. She started weeping bitterly that my eyes got moist as well. It was the sad lesson that I couldn’t comfort the girl in her despair. I left her and left the children’s ward.

      Outside the ward I wiped off the tears and went to the outpatient department to continue the work in consulting room 4. The Philippine colleague was busy in the plaster room to reduce a lower leg fracture on a child and to put on a long leg cast. I took the seat at the table, while a mother put her three-year-old girl on the knee and held up the girl’s right lower leg which had the clubfoot deformity. I explained the operation to the mother who agreed and gave the consent for the operation that I admitted the girl and wrote her name on the preliminary operating list. An old man who was accompanied by his son entered the consulting room and took the seat. The man had a spotted grey cataract and was blind. He showed his right hand which had a bayonet deformity on the wrist. The son told that the father had fallen. I took father and son to the plaster room where I put the father on the examination couch and gave the pain injection into the fracture gap. The son held the thin upper arm of the father and I pulled with one hand the old man’s thumb and pushed with his other hand the radial knot into place. I put on a forearm cast, while the son held the father’s hand up by pulling his thumb.

      “Is that all?”, the old man asked his son and the son asked the doctor. I removed the plaster spots from his hands and made some notes and prescribed the pain killer in the health passport and gave the passport to the son who helped his father to sit up. The father thanked for the work and that it was painlessly done and left the plaster room guided by his son. A young woman sat on the chair. She put the tip of her right index finger on her right thigh where a needle was inside. I palpated the resistance and removed the needle in local anaesthesia by a small skin incision in the casualty theatre. I made a few stitches to close the incision and put the dressing on the wound, while the nurse injected the tetanus antitoxin. A twelve-year-old boy were carried on a trolley to the consulting room with a broken right ankle. He had fallen from a tree. The X-ray revealed an inner and outer malleolar fracture. The boy was brought to the plaster room and got a short-lasting anaesthesia. The fractures were reduced and the foot with ankle got immobilized in anatomic position by a short leg cast.

      It was around six o’clock in the evening when the last patient was seen and treated. The seven cleared-up benches were reserved for those patients who were brought back by the hospital bus from Windhoek. It was a large crowd of people who entered the waiting hall and started occupying the benches with their bags and some with their children and with sheets and other things. More people left the bus and filled the semicircle around the bus to get their bags and luggage from the driver who cleared up the big luggage hold under the passenger area. The shutters of the luggage hold were opened on both sides that one could look through. The driver went around the bus and took the luggage out from both sides of the hold and put it on the square in front of the people in the semicircle. The bigger bags were piled up in the reception hall next to the entrance to the outpatient waiting hall.

      After the patients have taken their luggage, the boxes with the drugs and infusion bags were taken from the luggage hold and carried on the trolley to the waiting hall. Finally, the bus driver took the big freezer box with the transfusion bags from the co-driver’s place which were carried on the trolley to the hall. The returned patients had to be seen by the doctor who was on outpatient call. This doctor had to decide, if the patient could be discharged or had to be admitted. The doctor on call was Dr Ruth who started the screening work. I went through the wards and looked after the operated patients of the day. The ten-year-old girl after amputation of the right arm was sleeping. The nurse had given her the pain injection. I looked at her sleeping face and saw the broad grieving rings around her closed eyes with the spots of dried-up tears. I read from her face that she had a fight in her troublesome sleep against the attempt to get reminded of what was done on her.

      I left the hospital and crossed the square when I looked back to the outpatient reception where people and mothers with children prepared their sleeping places for the night. Cardboards and papers were spread out on the front passage surrounded with bags, tops and bottles. Young women breastfed their babies and wrapped them in cloths and carried them on the back. Old women puffed on short pipes what had the sharp smells of herbal-tobacco mixtures. Old men fiddled clumsily on the long sticks. Old and young sat side by side. They stared over the square, rummaged in bags and pockets and put out spoons and tins and ate from tinplates and pots and drank water from plastic bottles. Spoons clattered in the pots. The people spoke hardly to each other.

      It was sunset and the sun dived the sky for some minutes in a red-violet blaze of colour. I took the way back to the flat as a walk under the great light spectacle of a ‘dramatic’ transfiguration. I showed the permit to the guard at the checkpoint who had no objection. Dogs strayed around and the cats were hiding. I pulled off the sandals with the sweaty cork soles in the verandah and the sweaty shirt in the sun-heated sitting room. I went to the small kitchen and filled the kettle half with water and put it on the gas flame for a cup of rooibos tea. I stirred in two teaspoons of sugar and took the cup with for a seat on the step outside the verandah door where I lit up the cigarette. It was an evening as the countless evenings were when I returned tired and exhausted from the hospital to spend the rest of the day in loneliness. I looked at the sky and saw the first stars coming out in the early darkness.

      The ten-year-old girl knocked in my mind. She was weeping about the loss of her right arm. It was a great tragedy which I compared with the tragedy of the fourteen-year-old Kristofina who was hit by lightning which had burnt the right lower leg and had charred her shin bone. Kristofina passed away a few hours after admission. The ‘lightning strike’ on the ten-year-old girl was the malignant bone tumour on her upper arm [humerus] why the girl had to sacrifice her right arm. I saw still the amputated arm on the spread-out paper on the floor where the dark blood ran out from the cut-off end and formed a small lake of blood that clotted and stuck the arm to the paper. The question was: which kind of life could this girl expect. It was a question which I could only hypothetically answer.

      The traumatic impact was inconceivable in respect to the psychological trauma. The girl was a right-hander and understood the world from this side. The change from right to left would be the greatest break and the learning process had to start right from the scratch. The prominent right shoulder board with the extremely short arm stump had lost any functional meaning. The girl’s body with the broken-off anatomy had an aesthetic deficit of a significant degree for the rest of her life. The stroke of fate and the surgery had crippled her human shape so much that loneliness and sadness would accompany the girl through the years to come.

      The night sky stood in full splendour. I stubbed out the cigarette in the sand and emptied the cup of tea. I stood up, put the cup on the sink and took a seat at the verandah table in the sitting room and started to write down some of my reflections:

      With ten you were