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John Hult: |
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“I can see! I can see!”In May 1958 the monsoon rains had generously renewed the parched earth with life-giving moisture. The countryside around Kiomboi Hospital had been transformed from desert brown to a lush panorama of multiple shades of green. At the 5,000-foot altitude of the Iramba plateau, a gentle breeze moderated the 80 degree temperature to create a perfect sunny day.
Blind Iramba widow Late in the afternoon a small pedestrian caravan approached on the narrow sandy road. The column was led by several adults of varying ages. With fluid grace the women moved briskly along, balancing a variety of loads on their heads. Perched delicately on the head of one young woman was a teakettle, a store-bought status symbol in this society. Bringing up the rear was a small boy about six years old firmly holding the front end of a five-foot walking stick. Directly behind him, holding the other end of the staff, walked a spry little woman with snow-white hair. Barefoot and wearing only a loin cloth, the child was leading his blind grandmother in the traditional Iramba manner. (White canes aren’t of much use in the African bush.) Welu and her family had arrived seeking help for her blindness. For nearly thirty years Kiomboi Hospital had been known as a place where eyesight could be restored. The little group had walked for three days from their remote village over fifty miles away. No other transportation was available to them. Even if they had had a vehicle, the roads to their village were made impassable by the heavy rainfall on the sticky gumbo soil. This gummy, swampy terrain, known as mbuga, was almost impossible to traverse even with a 4-wheel-drive vehicle. With one of our African nurses acting as interpreter, I interviewed and examined Welu. She was extremely alert and answered questions promptly and decisively. She spoke only Iramba, a melodious but very difficult tonal language. Welu understood virtually no Swahili, the lingua franca of Tanganyika, which was the only African language with which I had any familiarity. Predictably, she was illiterate. There had been no schools nor any written words in the Iramba tongue when she was a child. Likewise, there were no calendars, so she knew neither the year nor the date of her birth. We were able to determine that she was at least seventy because she was already married and had given birth to two children by 1917 when the Wadachi (the German colonists) left. The year 1919 became the historic milestone during which German East Africa became the Protectorate of Tanganyika administered by Great Britain under the League of Nations. Even in remote areas, this event was well remembered by the Africans, including Welu. She had given birth to nine children, five of whom had died in infancy or early childhood. She was now the matriarch of her clan, highly venerated and respected. Except for her close-cropped white hair and blindness, she appeared surprisingly youthful. Only a few wrinkles lined her ebony-hued skin. Her only garment was a black cotton sarong. Tribal markings tattooed her forehead and cheeks. She wore several strings of colorful beads around her neck. The soles of her bare feet were well protected by unbelievably thick calluses. About twenty years earlier she had noticed difficulty in seeing the fine stems of grass with which she wove beautiful baskets. Since this was one of her special skills, losing this creative outlet was especially frustrating. Gradually she lost more vision. For ten years she had been so blind that she could only distinguish light and dark. Using my ophthalmoscope, I determined that she had advanced cataracts with complete opacity of the lenses. Since this was a matter of great moment to all, we had a conference with all the members of her clan who had accompanied her. I indicated that we could almost certainly improve her vision with an operation. Both she and her family agreed that we should go ahead so we scheduled surgery for the following morning. How does an American pediatrician acquire a skill as demanding and technical as cataract surgery? Before going to Africa I knew that this would be one of my responsibilities. There were no ophthalmologists in Tanganyika with its population of nine million. In apprehensive anticipation I had taken some training from a Minnesota ophthalmologist. In Africa I was fortunate to have the supervision of a doctor who had done extensive eye surgery in both China and Tanganyika. During my four-year term, I removed cataracts from over one hundred patients. In all but one of them, we saw significant improvement. That person had retinal disease concealed by the cataract. In an ideal situation, we would do one eye and then wait until it healed to do the other. In Welu’s case, we agreed to operate on both eyes on the same day because it was urgent that the family return home to plant their crops. If they waited much longer, there might not be sufficient food that year. A smiling student nurse, attractively attired in a pin-striped green uniform, guided our patient into the women’s ward and settled her into bed. Counter-pointing Welu’s dark skin, the white hospital gown altered her appearance dramatically. She projected an almost regal aura as her family stood around her bed attending to her various needs. Supper-time arrived. Actually, it was the only meal of the day for this Iramba family. Customarily at noon they drank a portion of magai, a slightly fermented non-intoxicating mixture of water and ground millet. We did not prepare meals for our hospital patients since most preferred to eat food cooked by their own families. Welu’s daughter cooked a large bowl of ugali on an open fire in the lean-to kitchen behind the hospital. (Ugali is prepared by cooking cornmeal in water to a dough-like consistency.) Welu and her family gathered in a circle around the bowl. Very skillfully, each took a small portion, rolled it into a ball, and popped it delicately into the mouth. At home they would have had a side dish of meat and vegetables called mboga. This was eaten by making a hole in the ball of ugali with the thumb and scooping up some of the side dish. The Africans thought that our method of eating with knives, forks, and spoons was messy. Their mode certainly made dish-washing less complicated. Soon after sunset Welu settled down for the night. Her daughter and grandson reclined on a grass mat under the bed. Unlike some families, they did not usurp the patient’s bed. (On several occasions, while making night rounds, we would find our patient sleeping on the floor and a more privileged member of the family occupying the bed itself.) In spite of the eerie calls of prowling hyenas and night birds, everybody was soon fast asleep. Early next morning Welu was given a mild sedative and taken to the operating room. Before surgery one of our nurses prayed aloud in Iramba that all would go well. As a recent Christian convert, Welu was visibly moved and responded with a very audible, “Amen!” I made the appropriate incisions under local anesthesia and removed cataracts from both eyes. During the surgery, she neither moved a muscle nor uttered a word of complaint. Both eyes were covered with protective dressings, sandbags were placed on both sides of her head, and the patient was returned to the ward. Two days after surgery, with several of our staff in attendance, I removed Welu’s bandages. Unaccustomed to the bright light, she blinked and tried to focus. One of the nurses, who had determined that Welu had never been near a white person, asked her; “What color skin does Daktari have?” Welu gently touched the skin of my forearm. Her eyes widened. “And what color is his hair?” the nurse continued. Welu hesitantly reached up to feel my mop of straight, bright red hair. After a brief pause and a look of astonishment, she exploded in a paroxysm of simultaneous laughter and flowing tears. We all laughed and wept with her. She could see! She could see! With a little help from a pair of glasses, she could weave her colorful baskets again. With her walking stick, she could chase away hyenas who furtively attack blind elderly people. Maybe she would go to the new adult literacy classes and learn to read. Once again she could exult in the magnificent sunsets over the Rift Valley escarpment to the west of her home. For the first time she would be able to thrill to the bright smiles of her young grandchildren!! |
