For Justice, Understanding and Humanity. Helmut Lauschke

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