The Last King of Scotland Read online

  ‘Hello,’ said the man, smiling broadly. ‘So, another Scotsman. I think Scottish doctors must be taking over Uganda. You know of Mackay, presumably, who set up Mulago, the big hospital in Kampala, way back when? I was trained there by Scottish doctors myself, before I went to the US.’

  ‘We get about,’ I said, squinting against the sun above the Land Rover roof.

  ‘Nicholas Garrigan, William Waziri,’ Merritt announced grandly. ‘William’s mainly in charge of our field trips – we do vaccination and spraying programmes all around the villages here – in fact I was thinking it would be good, William, if you took Nicholas out on one soon. Familiarization.’

  ‘Certainly. I’m going out again next month.’ He smiled at me again. ‘Come along, by all means. See how the wananchi live.’

  He drove off, the spare wheel case like a badge on the back: Cooper Motors, Kampala.

  ‘What are the wananchi?’ I asked Merrit.

  ‘The common people. The citizens. It’s like a term of respect.’

  We continued our tour of the perimeter. ‘That’s the X-ray darkroom. We made a mistake putting it on the eastern side. When the sun is at its highest, it beats on the wall. Makes it like an oven, spoiling the negatives. We haven’t got the money for much radiology anyway. You’ll find you have to be quite sparing here, equipment-wise. And with drugs.’

  ‘How do you get supplies?’

  ‘Billy Ssegu, he’s our business manager, the one who was doing the queues. He goes up to Kampala in the Land Rover once a month to beg from the Ministry. He does his best but sometimes we can’t even get antibiotics or simple analgesics.’

  We were right at the far edge of the fence now. I noticed that there was a funny smell where the ground dipped unnaturally – in the way a grave does after a year or so, when the earth has settled down.

  ‘But all my other problems pale in comparison to this,’ said Merrit, pointing at the subsiding ground, which was covered with grass except for an uneven brown crust at the edges. I moved forward, wondering what he was going on about.

  He grabbed my arm. ‘For God’s sake, be careful. It’s not solid. Well, it is solids.’ He chuckled. ‘This is our cesspit, Nicholas. It may not smell like it now but, believe me, it does when the water-table’s up. The problem’s the marshy ground. The stuff doesn’t drain away and in the rainy season water comes into the pit from the surrounding area and makes it overflow. Tidal wave of shit. Very unhygienic. On the worst days we have to close the clinic down until an engineer comes from Kampala to siphon it into a tanker. We really need a proper septic tank but I can’t see it happening in my lifetime.’

  ‘It’s funny,’ I said, ‘with the grass on top, you wouldn’t know it was there.’

  ‘You would’ve done if you’d stepped in. Look.’ He pushed at the grass with his foot and the whole thing moved, swaying gently on itself as the crust touched and parted from the neighbouring turf.

  We turned around to go back.

  ‘Oh, yes. There’s that, too.’

  He pointed to a tarpaulin-covered mound some way over the other side of the fence; nearby, the wire was broken by a small gate made of flattened, pale blue Stork margarine tins nailed on to a bit of wood. We went through the gate and down a well-trodden clay path through the scrub.

  ‘Cleanliness next to godliness, litter next to the latrines,’ Merrit said.

  I could see a circle of ash under the edge of the tarpaulin.

  ‘This is the rubbish pile for burnables: everything from old dressings to lousy blankets. There’s a rule that everyone on site brings a bag a week – you have to rush at it or the flies get you – and on Guy Fawkes Night we have a bloody great fire.’

  ‘Isn’t that waiting a bit long?’

  He gave me quick look from under his wiry eyebrows as we walked back towards the buildings – as if to say, don’t tell me how to run my hospital. But all he said, and mildly, was: ‘It’s too dangerous to have a lot of fires, we have to watch for the bushes going up. Anyway, the locals like it big.’

  Near to the entrance to one of the buildings, hard by the pathway, was a tentative effort at a little garden. It was mainly full of weeds, in between which a few cabbages and tomatoes were losing the battle with nature.

  ‘We encourage the families of the longer-term patients to grow vegetables,’ said Merrit, ‘but they haven’t quite got the hang of it. Everyone has to provide their own food, you see.’

  We came in through the laundry door. Piles of sheets and towels and faded green theatre gowns were stacked on either side. We passed through an archway into a long ward full of cast-iron truckle-beds, each with their neatly written reports and fever curves pinned to the end. Auxiliaries moved around the patients, patrolling wooden equipment trolleys down the aisles. Merrit clapped his hands.

  ‘Hello everybody,’ he said loudly. ‘This is Doctor Garrigan, who’ll be joining us.’

  Then he took me round, meeting the staff. One, in particular, I noticed immediately. Leaning over what looked like a severe smallpox victim (his legs covered in eruptions), she had luxuriant auburn curls tied in a slightly severe bun and was wearing a pair of canvas trousers and an open-neck white shirt with buttoned, military-style breast pockets.

  ‘This is Sara Zach,’ said Merrit. ‘She’s here with us from the medical faculty of the University of Tel Aviv.’

  ‘Hello,’ said Sara Zach, as she turned round to look at me.

  Her skin was a deep coppery colour, almost as dark as her hair. I could see a faint glistening of moisture standing out from the pores in it.

  ‘Welcome to our clinic.’

  Her accent came out strong on the word clinic and I toyed with its ups and downs in my head – klinik, kalinik, klienik? – as she put her lint and tweezers aside. I noticed how strong her hands looked as she did so, the outlines of the tendons in them clearly visible.

  ‘Is that smallpox?’ I said to her, as the man in the bed groaned.

  She laughed powerfully, the muscles in her throat moving the collars of her shirt.

  ‘We would have him in isolation if it was. No, it is just a bad case of putse fly. It lays its eggs in your clothes while they are drying on the line and then they burrow into the skin. You have to draw the larvae out with Vaseline – it suffocates them – and then pick them with tweezers when they come out to breathe. There is no way to do it but mechanically.’

  ‘Of course,’ I said, blushing.

  ‘I made similar mistakes myself on arrival,’ she said, smiling. ‘Tropical medicine here is very different from in Israel.’

  A ray of sunlight, shooting suddenly through one of the windows in the ward, alighted on her forehead. The bones in her face were brutal in the way they stood out, almost ugly; or at least, not attractive as usually considered. In fact, her whole way of carrying herself was like this.

  ‘I am afraid I must get back to work now,’ she said to Merrit curtly.

  She reached into the trolley for the tweezers and bent back down over the old man’s gleaming, Vaseline-covered leg.

  Later, I met the Ugandan auxiliaries, who lined up to shake my hand as if at a wedding. Later still, Ivor Seabrook, an old Englishman with – clinging to his white shirt as if it had been thrown there – a broad yellow tie. Above that flopped the desiccated grey hair and smiling, destroyed features of the long-term tropical alcoholic.

  ‘Tsetse fly. Tryp, y’know,’ he said, pointing a finger down at the sweating, shaking boy he was attending. ‘Not much of it up here at all, but it’s a kind of speciality of mine from Bulawayo days.’

  ‘One of the old school,’ Merrit whispered as we toured the beds. ‘Bet you 100 shillings he tells you his soldier-ant story before the end of the week.’

  We peeped into the mortuary and then through the windows of the isolation ward and the operating theatre. In the latter, the glass was steamed up from the sterilizer but I could make out the two Cubans. They looked comical in full surgical fig – green masks over their faces,
and bare legs poking from under their gowns as they moved around the table. One of them looked up from under the steel lamp and waved a pair of forceps at us.

  Then we went up a long corridor to have a look at the pharmacy, where a big white fridge was burbling away among the racks of labelled bottles. On the floor next to it was a small green plastic bucket with a dozen or so paper spills in it, their ends blackened from where they had been lit and extinguished.

  ‘It works on paraffin,’ said Merrit, opening the door. ‘A bit old-fashioned, I admit, but – you can’t trust the generator.’

  I spent the rest of the day acquainting myself further with the clinic and its procedures. Then, before supper, I went out on my own for a walk above the compound. I stepped warily up the grassy tracks, yet was still a little breathless by the time I reached the top of the biggest hill.

  I stood there – in that evening air, in that coming primal light of ancient stars – and listened to the crickets and the bullfrogs as they sang in their peculiar counterpoint. Looking over the valley, which seemed as if it might go on for ever, I spied out the land, taking possession in my head of the darkening papyrus swamps, the slopes dotted with banana and coffee, and the brown smudge of the Rwizi River – and I felt wonderful.

  I don’t know how long I was there, it could have been half an hour, it could have been an hour. I went down on my knees at one point and on the grass in front of me I saw a cricket, struggling about in foamy stuff – like cuckoo spit – its perfect serrated legs moving pathetically to and fro in the close, white bubbles. I wondered whether the muck might be shot out by the bullfrogs, some kind of anaesthetic projectile to dull the senses of their prey. I poked around in the undergrowth but couldn’t find one, though the croaking, incessant during all my search, seemed ever so near. It was only when I heard a crack of thunder that I realized I ought to be getting back to the Merrits, as night was falling swiftly. My eyes had dimmed along with the light, which I had not noticed going.

  It rained heavily on the way down, vast theatrical swaths of the stuff whipping up the banana plantations and pulling at the coffee bushes. The track made a natural watercourse down to the bridge over the Rwizi, and I had to watch my footing as the dust turned to mud. As I passed a village above the clinic, I could hear the sound of children’s laughter, and splashing too, as figures cavorted in the lamplight. Rains like these were an opportunity for a good wash, no doubt, and a bit of messing about.

  I was soaked through by the time I got back to the compound. Late, on my first night: I don’t think Mrs Merrit was pleased, as I had to go back to my own bungalow and change.

  ‘Oh,’ was all she said, when I first came to the door tramping red mud. ‘You’re all wet.’

  I zipped across the divide in the slanting rain. Taking off my wet clothes, I got a towel out of my suitcase and rubbed myself down, before dashing back over.

  Having eaten, I felt refreshed and calm as I got into bed. Even the machine-gun noise of the rain on the tin roof didn’t disturb me; in fact, it made me feel oddly impregnable, in a castle-keep sort of a way. The storm got much worse, and from where I lay, as I dozed off, I could see flashes of blue lightning through the mosquito grille in the window, making the whole room flicker. I thought of the old cinema in Fossiemuir, and I dreamed that night of a horrible, Godzilla-like encounter between cricket and bullfrog – the sawbones legs of the one, the glaucous eye and long tongue of the other. Where I was in it, spectator or actor, I didn’t know, I couldn’t tell.

  8

  The days came and went. I put some plants into old paint pots and hung them from the joists in the veranda roof. It was there that I came to write up my case notes in the evenings, and the journal I started keeping. Not every night. You couldn’t rely on the electricity. In fact, everything there was uncertain. There was morning mist and oppressive heat, and the time passed in an unholy mixture of languor and franticness. Like bursts and blips against the static of the radio. Or the way the million sound of the massed cricket band seemed to punctuate the fabric of the land itself. Sharp against flat.

  Someone died of an amoebic liver abcess one week at the start, and I was soon treating more intestinal parasites than I had ever dreamed existed. And other nasties: feet mangled from gangrenous tick typhus; yaws with their look of a burn or a brand; the florid measles rash on a malnourished child.

  Another time, an infected dog-bite on a young girl’s nose. The pus pulsing beneath like an underground spring. Me holding my breath as I lanced and packed it, with Sara keeping the screaming child down on the plastic couch. Her hand was strong and bronzed, her nails as hard and bright as diamonds. We left the wound open overnight to dry.

  Sometimes, with the parasitic cases, elephantiasis had set in, and the swollen legs were particularly horrible. I remember one poor woman who presented. It was as if someone had knelt down in front of her and blown air into her big toe.

  ‘Like a cartoon,’ I said to Sara as we scrubbed up.

  She looked at me sternly over the basin. ‘Nicholas, you are not clinical enough about things. You ought to learn to be.’

  We locked up and walked down the hill to the compound. We could see the moon over the papyrus swamps. She asked me about Scotland.

  ‘I never met a Scot before,’ she said, parting from me slightly to skirt a puddle. ‘I don’t know what they are like.’

  ‘I’m a reasonably typical example,’ I said. ‘I suppose. But is any nation like something nowadays?’

  ‘Of course! So how do you think you are typical?’

  ‘Well, I like football. And rugby. And I like a drink.’

  ‘Rugby? What is that?’ Her voice, with its strange accent, rose high and curious in the falling darkness.

  ‘You don’t know what rugby is? Seriously?’

  ‘No, I don’t, what is it?’ She gave me a sideways look, the waves of her hair brushing in the opposite direction over her shoulders as she turned her head.

  ‘It’s a game. With an egg-shaped ball.’

  ‘An egg-shaped ball? Are you joking?’

  ‘No, not at all. It’s like football, soccer, only you use your hands.’

  We’d reached the compound, and were standing facing each other between the flower-beds. Light flooded down on us from an arc lamp on the water-tower, her with her canvas bag, me with a sheaf of papers under my arm.

  ‘So that is what it is to be Scottish?’ she said. ‘To like these games?’

  ‘Obviously not just that. But it’s very important.’

  She smiled. Her eyes seemed enormous in the half-light. ‘You are a very funny man, Nicholas,’ she said. ‘An Israeli man would never define himself in terms of a sport.’

  I looked down at her feet. ‘Well … good-night, then.’

  ‘Good-night,’ she said – and then, mockingly, ‘– and you must tell me more about your rugby some time.’

  I watched her walk over towards her bungalow, her canvas bag on her shoulder.

  As I lay in bed that night, after finishing my journal entry, I realized I was a bit cross about her saying I wasn’t clinical enough. It was difficult constantly to take that approach, the diseases being so disgusting. The worms were the worst. I nearly threw up the first time Merrit flipped a patient over and all this, this stuff, like pale brown vegetation, dried ferns or something, spilled out of him and started moving around on the sheet.

  TB and gastro-enteritis were other common complaints – and then there were the special tropical fevers that Ivor liked to get his hands on, like blackwater and dengue. The latter puffs up the face with bruise-like haemorraghes. I would have sworn, if I hadn’t know better, that it was from being beaten up.

  And yellow fever. I remember Ivor coming over excitedly with a dish full of dark, heavy liquid. ‘Look,’ he said, thrusting it in front of me, ‘coffee-ground vomit. Sure sign.’

  Ulcers and suppurating panga (machete) gashes were quite frequent too; one of the problems was that after we’d dressed them they put n
ative medicines – cobwebs, ground bark – on later, and infection would set in again. There were some we could simply do nothing for, like the young man who came in with a flail arm, long and thin as a willow branch, expecting us somehow to unravel the mature development of infantile polio.

  Most of my time was spent doing simple things like percussing patients’ chests, listening for tubercular spots on their lungs, or administering injections. Hour after hour, I found myself wearily changing needles, routine as a factory worker, the orderly rubbing with alcohol the buttock of the next one in line.

  Or analysing stools (each one brought in neatly wrapped in a lush banana leaf) in the evenings in the laboratory, gagging at the smell and swearing as the light of the lamp dipped up and down with the unreliable current. Naturally, we looked at blood too: samples usually went bad on the journey to Kampala so we had to do the best we could with old-fashioned brass microscopes.

  I was fascinated by all that side of it, the shapes as much as what they meant: the smear on the slide of Trypanosoma brucei – ‘Tryp the light fantastic,’ Ivor trilled every time it was mentioned, fluttering his fingers – like a raindrop on inky paper; the squashed mulberry look of gonorrheal cells in urethral discharge. Diplococci.

  The snake-bite cases were a fright. The patients sat there with their swollen feet and calves – usually the bites were from when they’d been tending the matooke plantations – and, in a clay pot or old maize-oil can on their knees, the snake itself. We’d check it against the description in the Fitzsimons snake-bite pamphlet and select the right anti-venom.

  One time a snake-bite case came in, the snake wasn’t dead. It escaped from its pot. Everyone ran out of outpatients screaming. But Waziri knocked it senseless with the tyre-iron from the Land Rover. He brought it out hooked over the curl of the iron and tossed the black-and-yellow thing at me for a joke. It landed at my feet.