Helmut Lauschke - For Justice, Understanding and Humanity

A nurse pulled the operating coat over me and tied the laces over my back. The instumenting nurse held the scalpel in her right hand when I entered the theatre room and pulled over the gloves and approached the operating table. I cut out the lesion and marked with a stitch the proximal end of the excision for the topographic orientation of the histological findings and covered the large defect with a skin graft taken from the right thigh and fixed it with thin stitches. The operation had been finished after the dressings and bandages were put on. The patient were brought on the trolley and carried to the recovery room. I thanked Dr Lizette and the nurses for the good cooperation and left the theatre room for the dressing room where I pulled off the sweaty green shirt and green trousers and dried the skin on head, neck and chest and put on the civilian clothes. I left the theatre building and took the passage to the outpatient department to see the patients in consulting room 4 where the Philippine colleague had started working two hours ago.

When I passed the waiting hall I had seen the ten-year-old girl with the swollen right upper arm in company with an old woman. Both say on the third bench in front of the consulting room. I took my seat at the table and asked the nurse to call the old woman with her ten-year-old grandchild. They entered the room and the old woman took a seat on the chair. A second chair on which the back was broken off was put for the girl left to the chair with the grandmother. I showed the X-ray of the grandchild’s right upper arm to the grandmother by going with the pen’s tip around the bony lesion.

The grandmother kept her eyes on the X-ray and followed with great concern the marking with the pen. The girl with the beautiful face looked with innocent eyes at me to get the glimmer of hope that the doctor can help her. Her eyes expressed the full trust in the doctor, while the desperation drilled a hole into my heart. I told the grandmother that the bone lesion is a highly malignant one that threatened the life of her grandchild. Fortunately, there were no secondary tumours [ metastases ] in the lungs and on the ribs on the X-ray of the chest visible, but only the amputation of the arm can save her life. I had the greatest difficulty to speak out the sentence with the amputation. It caused the impact of a ‘grenade’ on the grandmother who gave the grandchild a hug with her left arm.

The girl’s eyes lost the hope and became deeply sad. It moved desperately my heart that I became speechless for a moment. Grandmother stroke with her left hand over the grandchild’s head and hugged her again with her left arm. It took minutes of silent thinking and silent despair when the grandmother agreed with the operation and gave her consent and signed the operation form. She stroke over the head of her grandchild who became stunned with tears in her eyes. I put her name on the preliminary operating list. I got speechless because of the mutilation as the result of this operation.

Grandmother and grandchild left with the completed admission form and the signed operation form the consulting room for the orthopaedic children’s ward. Both did not turn their heads back to me. I felt very much sorry for the girl in my heart when grandmother pushed the swing door open to pass through and were followed by the stunned grandchild with the big tears in her eyes. The tragic blows had hit heavily the family: the mother was sick and had to care for smaller brothers and sisters, the father was torn in pieces by a landmine and the ten-year-old girl with her beautiful face and the tears in her eyes was on the way for an amputation of her right arm. I knew that the girl would never smile again as she had done in the afternoon of the previous day when she came alone and trusted the doctor that he would do something good on her.

It was lunchtime and Nestor asked me at the dining table for my opinion about the comment of the matron when she proposed that the superintendent should contact Swapo to explain the danger of the shootings for the hospital and its patients. I supported her proposal and recommended that the superintendent has not to lose time to do so, if the hospital should be kept running. Nestor replied that he will think about it. He was a Swapo-member since 1974 what he did confess some years later. Nestor told with a face of great concern that the military authority watched with eagle’s eyes the hospital and keeps up the suspicion that Swapo-fighters were hiding on this premises. He mentioned in this regard that the ‘Sekretaris’ had given him a ‘friendly’ warning. “It is shilly-shallying that one side mistrusts the other side”, Nestor said and looked on his plate. I thought of the tight-rope walk when I asked him, if he had spoken to the medical director. “He cannot help and advised me to handle the matter cautiously, since he does not trust the military and the ‘Sekretaris’ as well”, Nestor said pensively.

We spoke of the injured of the previous night. Nestor expressed his horror of the war causing these mutilations. I said it were his black brothers who shot the shell from a Soviet cannon. It was not only a critical, but rather a dangerous situation with the hanging position between the chairs when the chairs were moving permanently that the hospital hung on a thread that could tear every moment. However, efforts from the hospital administration were needed to come out from the hanging postion to make the lives of the patients and of the working staff saver. Aware of the implications of the decision that had to be met, Nestor repeated his sentence of hope that the madness will come soon to an end.

There were other big problems that the rural hospitals in the north, some had more than hundred beds, were run by nurses who treated the patients with TB, malaria and other common infectious diseases. They did small surgical procedures as well and saw huge numbers of outpatients on a daily basis. The nursing staff had serious problems to cope with the heavy burden of work that they asked urgently for a doctor. “We must help the nurses, though we are only a few doctors”, the superintendent said. He suggested that one of the black colleagues should join the hard-working nurses in those hospitals once per week, since they speak the language of the people and were familiar with their tradition and culture. I understood the point and offered my help spontaneously. It was rejected by the superintendent who said that I was needed most as a surgeon at the Oshakati hospital. We left the dining room and parted in front of the door of the secretary’s office.

I passed the waiting hall of the outpatient department with the fully packed benches and entered consulting room 4. The first patients who came for follow-up wore casts on their arms or legs. I reviewed the X-rays in comparison with the previous ones and removed the forearm cast on an old woman and repaired a short leg cast on a young man by putting on some new plaster layers. I came back from the plaster room when the Philippine colleague showed the X-ray of an old man on whom one hip did not show a joint cavity. The colleague asked what can be done knowing that a hip prosthesis was not available for these patients with the ‘empty hands’ and that the technical facilities did not exist at Oshakati hospital. I answered that only a stiffening operation [ arthrodesis ] can be done which could take away the hip pain from the patient.

The old man said in his language what the nurse translated, he will think about it. He grasped his long stick with both hands and pulled himself awkwardly up from the chair. He stood in his frailty, while his hands held tensely the stick in the height of his chin as he were something to say. He kept quiet and accepted his status of poverty, because it was his life. So he left in a limping gait the consulting room. The colleague gave the well-thumbed and creased health passport with the prescribed pain killers and some anti-inflammatory drugs to the son who followed the poor old man who was his father.