Shock

Published by Shorts Magazine: https://madmagz.com/magazine/1766961#/page/57

I have had reason to be grateful for the avoidance of heavy beatings.
Once, riding home on the school bus, I saw someone pick up a brick. I recognised dead-eyed malice. Realised the brick was for me. I leant forward. Bent at the waist.
Shattered glass sprinkled over my head like snow.  

Some years later I was in Malawi. It was night, liquorice black. The double bed I shared for six weeks with two male medical students was no place to spend a Friday evening. We left our room and pottered across to the house where the others were staying.

The compound was surrounded by a high wall topped by coils of barbed wire. Our steady thumps at the iron gate received no response. This was not surprising: the guard was partially deaf and almost blind. Unusual qualities for a guard - but he looked deeply frightening. His face a snarl of scar tissue, his club nobbled and remorseless. Usually we would get Ryan, Laura, Jenny or one of the others to let us in but the party was underway and no one answered their phone.

In the far corner of the compound the rocks on the wall were irregular enough to permit hand and footholds and there was a tree with branches reaching across the wall from the garden. I could scamper up the wall, grab onto a branch, climb into the tree and lower myself softly to the ground to let Alex and Ben inside. 

This started well enough. My footwork was nimble and I scaled the wall and reached for the smooth limb of the tree with my right hand. But in the moment after my leg swung over the top and my left arm reached to match my other hand on the branch something unexpected happened.

The compound next door was more heavily fortified. In addition to barbed wire and glass topped cement on the lip of the wall there was the slow hum of an electric fence. I was aware of this and kept my distance. Alas, not enough. With a sudden snap the current arced and I received a shock to my arm as if a rifle shot had gone through it. BANG! 

I fell out of the tree. The leaves and branches crashed down as I tumbled earthward. I was dazed, in pain, and on my back. Now the guard, though hard of hearing, was not dumb to this commotion. In the darkness I saw him coming for me, yelling wildly, his club held aloft, ready to strike a crushing blow to the vault of my skull. 
“It’s me! Adam! Stop! Ahhh!”
At the last moment he held back.
I entered the house sheepishly. The pain in my arm lasted all night.

I had come to Malawi on a student exchange between St Andrews and the College of Medicine in Blantyre. The partnership has helped the Malawian College to increase the number of doctors it graduates from seven per year to seventy in less than a decade. The rationale for the student exchange was less clear.

At first the idea was to prepare cadaveric prosections to help with anatomy teaching. After a day or two of cutting up inadequately preserved bodies in a hot room however, it became clear that they were basically just rotting. It was the biggest waste of time you could conceive of.

We added no value at all being there. Mercifully we were at least spared the delusion that we were important or useful. We attended lectures, snooped around hospital ward rounds, and paid earnest visits to various NGOs who provide much of the healthcare in the country. In the evening, we drank lukewarm beer and played table tennis.

A favourite refrain of the English nephrologist in the Queen Elizabeth Central Hospital, was: 
“Are we winning here?”
The honest answer was usually not really.

Healthcare workers in Malawi face great difficulties in their practice. Most of these are resource driven: when a doctor sees a patient they have a severely limited range of investigations they can run. If a diagnosis has been reached care has to be taken that the drugs they prescribe are available at all. Frequently they are not. 

Human resources are also limited. The responsibilities carried by individuals are often far higher than in the UK. The English renal specialist was responsible for the entire medical department and was consulting on patients beyond the scope of his normal practice. Third year medical students clerk and monitor bays full of patients and most district hospitals are run without any permanent doctors at all. These are staffed instead by Clinical Officers with two years of formal training.

There is a global shortage of doctors and nurses in absolute terms: 4.3 million fewer than are needed by the estimation of the World Health Organisation. This universal failure of supply creates a situation in which health workers participate in a global market for their skills. Poor countries struggle to compete.

Healthcare provision tends to worsen the further you move from the city. We visited some villages in the Muona district. In a poor country Muona is at the end of a road to nowhere (the extension of the route having been washed away by a flood). It wasn’t easy to get out of. We travelled twenty kilometres on the back of someone’s bike, then hitched a lift across a river in a fishing boat, then took another bicycle taxi to a paved road from which we were able to catch a minibus back to Blantyre. This was an excellent adventure for us but it presents a major obstacle for those trying to get their produce to market. As a result economic activity is low and Muona is astonishingly poor. 

We visited the local hospital. It was almost empty. This was not because people weren’t ill but because the hospital had recently been forced to increase fees and no one could afford treatment. 

The reason for the price rise was that the Catholic mission which for years had funded the hospital and local school had run out of money. Dwindling congregations and fewer coins going into donation plates at European Masses has resulted in people dying for want of basic care in a village in Southern Africa. No secular organisation had stepped up to help fill the deficit and the government has not been up to the task. 

Yet Muona is peppered with half-constructed buildings started by donors who promised much but ran out of money or inclination before anything useful was achieved. It is easier to start things than to finish them.

*

“Ndili bwino kaya inu”
The young man said he was fine. We lifted his bed sheets to find a bullet wound in his left leg. The tissue was not viable and would be amputated above the knee later that day. The ubiquitous greeting is not always informative.

The President of Malawi, Bingu wa Mutharika, had proven himself to be a thug. Though at first praised for his anti-corruption stance, low-deficit budget and for subsidising Malawian farmers, he had grown increasingly erratic. After winning the 2009 election, Mutharika metamorphosed into the nepotistic, kleptocratic caricature of a regional dictator. He expelled the UK ambassador, lost millions of dollars in aid money and ordered live ammunition to be fired on crowds in four Malawian towns where people had gathered to protest against government corruption and fuel shortages. Nineteen people were killed. The patient in Blantyre was another of his victims. 

Fergal Keane, a long-time Africa correspondent at the BBC, discussed the paucity of coverage the continent receives by Western media outlets. He notes the depressing truism that “African news is generally only big news when it involves a lot of dead bodies.”
This form of journalism, packed with bloodshed but largely shorn of analysis or historical context, is shocking but unhelpful:
“The powerful images leave us momentarily horrified but largely ignorant…having compassion without understanding.”

On the day of the protests and reprisals in Blantyre, our group was holed up in the main compound. We played chess, read, talked, and waited for something to happen. At first there were loud noises - sounds of vehicles and shouting. Then it all quietened down. The prudent thing would have been to sit tight inside the four walls of the compound. But for Alex and I, it seemed that the best available option was to go and get some chicken. We wore shorts and running shoes in case we had to flee.
Fortunately we didn’t have to dodge any untoward strafing and the chicken was very good. 

Things ended badly for Mutharika. Not even the Presidential food taster could prevent the 78-year old from collapsing with a cardiac arrest on the morning of April 5th, 2012. For two days his supporters kept up the pretence that he was still alive. They even flew the President’s corpse to South Africa to “receive care” as they schemed frantically to manoeuvre Bingu’s brother Peter into power.

Eventually the South African government grew weary of the chicanery:
“If the Government of Malawi was not going to announce the death of President Mutharika, then President Jacob Zuma of South Africa was going to do it.”
Mutharika’s decomposing body, plastered with makeup, was flown back to Malawi for his funeral. The official date of death on a cross at the public viewing was changed multiple times.

Though farcical, these events were deeply shocking: a state using violent means to suppress peaceful democratic resistance. Yet the events were barely reported.

The lesson came later: small, resource-poor African states do not really matter. At least to Western eyes.

*

After our attachment was over, we travelled to Lake Malawi in the back of a flatbed truck. At the lakeside we repaired an old catamaran and took it out into the warm water. At night we lit fires and walked on the beach.

Then it was time to go home. We boarded a plane and said goodbye to the dry country, the scrub trees, the soft, brown paths, and the dust as we banked right, head up, and all you could see was sky.