Malamulo Hospital

I shared Freddy's room, sleeping under a mosquito net. I felt reassured to know that I was out of reach of the little malaria carrying pests and soon fell asleep. Morning brought a busy day as I accompanied Dr Kotz - watching and assisting with surgery, going on ward rounds in the African, Asian and European hospitals, watching an emergency operation in Obstetrics. We also went down to the "leper colony", where the new nursing sister was in charge. She was also the operating room supervisor.

So this was the famous Malamulo! (The name is derived from the local word for the commandments.) "This is what it means to be a mission doctor," I thought. "This is what I've always wanted to do and what I am training for!" Pictures of the leprosy patients, with missing fingers, toes or even hands or feet, had appeared on the pamphlets used for promoting appeals for charity, but seeing them face to face was a new experience.

There was so much to see and learn; yet conditions were vastly different from Groote Schuur, the University hospital in Cape Town. The operating theatre consisted of a single room, with wooden window frames that were partly destroyed by termites; the holes stuffed with paper. The surgical scrubbing area consisted of a single cold water tap protruding from the wall, over a basin. Surgeon, assistant and nurses (usually in reverse order) had to scrub with a stiff brush and blue laundry soap for the stipulated five minutes and then immerse the hands and forearms in 70% alcohol - a truly tingling experience!

Assisting with operations was exciting - at last I could see the practical use of the long hours that had gone into memorizing the details of anatomy. As I gained confidence and experience, Sigi allowed me to do simple minor surgery. Sister Guy, who had to give the "general" anaesthetics when required, silently criticised the slowness of the "student doctor", made doubly so by my inexperience.

Even so, we found ourselves more and more in each other's company. I decided that Nurse Lilian needed an escort for the daily trip to the leper colony, which was a mile away. Walking past the church, press, high school, teacher training and girls' work buildings was interesting; then past maize fields to the leprosy hospital on the far side of the stream. These walks gave us a chance to discuss each other's backgrounds.

I started with a safe question. "Are your parents still alive?"

"No, they both died when I was young and I was brought up by my aunt in Lowestoft, the most easterly town in England. Have you heard of it?"

"No, I'm afraid not," I admitted.

"Well it's mainly a fishing town, but is a popular seaside resort in the summer."

"Where did you take your training?" I continued.

"I started in Ilford, near London, but had to leave because of Sabbath problems. Then I went to Norwich. That was during the war and I was in air raids in both places - all rather terrifying! But one had to just carry on."

She laughed and went on to describe some of her war-time experiences, then added, "But you must tell me something about yourself!"

"On my father's side, I am descended from the British settlers who came out to South Africa in 1820," I began and proceeded to tell about Baden-Powell and the siege of Mafeking.

"What about your mother?"

"She was from America and came out with her father, Milton Robison, who was known as 'M P' for short.

"I know him!" Lilian exclaimed. "When I arrived by boat three years ago, Milton Robison and his wife Anne took me on a day trip to Hermanus, while I was waiting for the train to Kanye."

"So you know my Grandpa!" I remarked. I continued by telling her of Spion Kop and Helderberg Colleges and grandpa's part in them.

"But listen how I've been going on! I must be boring you."

"Not at all!" she replied. "It's very interesting. Here we are back at the hospital. You'll have to tell me more later."

"With pleasure!" I replied.

The blossoming friendship did not pass unnoticed; in fact it was actively encouraged. Ethel Kotz invited the British nurse over for meals and Dr Kotz suggested that I do a "house call" in the nearby village - and take a nurse along to assist me! One Sabbath afternoon, Mary Ford, another English nurse, arranged "a walk to the dambo", and invited Lilian, her roommate, and the lonely medical student to go along. She explained that the "dambo" was the Shire river valley but we were only going to walk to a high point from which we could get a panoramic view of the valley.

As we walked, through tea plantations, around maize fields and past banana groves, I said, "I've been thinking about some of the experiences you told me about the other day. How you were in London during the blitz. I suppose we really had it very easy in South Africa. We were not directly affected, although we had rationing of petrol and there was a blackout in Cape Town, with the street lights shaded and motor vehicles had specially dimmed headlights. At Helderberg we did have slit trenches, which were intended for use if we were attacked by Japanese submarines and all the windows facing the sea had to be blacked out. You’ve been to Helderberg, so you know it's on a mountain, about 4 miles from the sea and it was feared that a submarine might come into the bay and shell us. Fortunately they never did, although they did fire a few shells at some lighted buildings near Durban."

Our conversation was stopped by a tropical downpour, and we decided to turn back. Cutting some large banana leaves, we used them as makeshift umbrellas but still got soaked. This did not dampen our spirits and I still remember it as "some enchanted Sabbath afternoon".

The following week I found the courage to ask, "Do you have any boy-friend in England or back at Kanye, where you were before you came here?"

With a laugh and a flick of the head, which released a few ginger curls from the starched nurse's veil, she replied, "I've been too busy for such things. I have friends back home, but none 'special'."

That was a relief - at least there was no competition!

My worst experience at Malamulo was one Tuesday when Dr Kotz was away in Blantyre-Limbe, doing the "town clinic". Sister Mary Ford found me in the out patient department and said, "I have an OB patient who has been in labour for more than twelve hours and has been pushing for one-and-a-half hours and she is not making any progress. I've phoned Dr Kotz and he suggests you could put on the forceps and deliver the baby."

"But I haven't studied obstetrics yet! That's for this coming year!"

"Dr Kotz and I feel you are the best person in the hospital to do it. I'll explain to you exactly what to do."

How I wished there was another doctor, but there wasn't. So I proceeded to scrub up, examine the patient and apply the blades to the baby's head.

"Now you just have to pull and the baby's head will come out."

I pulled and tugged until I was sweating but the head did not come out. It did not even move! While I took a rest, Mary Ford phoned the doctor again.

"He says we will just have to give the patient a sedative and prepare the operating theatre. He will do a caesarean section as soon as he gets back."

I was greatly relieved that both mother and baby did well, in spite of my efforts! Such an experience might have put me off OB for life, but although I did not know it then, I was later to specialise in Obstetrics and Gynaecology.

The six weeks elective passed all too soon. By the time I had to leave, I had made up my mind that Lilian was someone special, whom I would like to get to know better and she seemed to have similar feelings for me.

On the long trip back, by 'plane and train, I often smiled as I remembered the good times we had enjoyed together - taking Kotz's dog, King, for walks in the evenings, walks to the leper colony, working together in the operating theatre. We had made plans that, when her furlough was due in July, she would come down to Cape Town to complete her midwifery training. I read and re-read the letter Lilian had given me the night before I left. We had promised to write often, but neither of us could have imagined the full significance of the past six weeks!

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