As our flight approached Manzini we encountered a dramatic thunderstorm with lightening flashing off both wings of our aircraft. The power had blown out at the airport when we landed and so we were led by flashlight through the dark and torrential rain into a small terminal the size of two railroad boxcars. The six of us on that aircraft that identified ourselves as members of the MMI health team were then spirited through the chaos and gusty downpour to a waiting van. I had given my poncho to one of the ladies as she dashed to the fan: a courtesy that would be repaid a thousand fold by this new friend, Hazel. Coursing through the slick and darkened roads our small team gave a sigh of relief as we approached a small house aglow with candle light at the end of a dirt road. It was here, after shedding our sodden coats, that we got our first glimpse of each other faces. Faces I would never forget and would, in fact, meet again years later in some of the remotest corners of the world. As it turned out, I was the only guy in our huddled mass, other than the project director Dr. Pete Obregon, who had already been in Africa a month or so. The six ladies came from London, Canada and the U.S.
Pete wasting no time in asking if I was up to flying out the next morning with him in a single engine plane to Mozambique where we would be working in an outpost well into the bush. I had to quickly scale back my supplies and personal belonging to the bare essentials. Pete’s cautionary words concerning protection from malaria in Mozambique, prompted Hazel to lend me her specially treated mosquito netting which deterred the little vermin from even resting on the netting which may be in contact with your skin.
Six a.m. found Pete, myself, and an interpreter cramming supplies into every inch of storage of the little Cessena as the rising sun began to burn through the lingering damp air from last nights cloudburst. With earphones on to drown out the noise we slowly rose above the hilly terrain of eastern Swaziland heading first to Mabuto, the capital of Mozambique to present our papers and then on to this nameless village.
1 stayed in the plane as the other three went into the empty terminal in Maputo with our passports and my application for a visa. Afte3r a considerable time the three emerged from the terminal with furrowed brows and pensive looks which did not bode well.
When I asked what the problem was they haltingly said …you. First they apologized for not allowing me time to get my visa in Swaziland and then advised me that customs officers would not accept my application in country. I was now considered an illegal alien and not allowed to return to Swaziland or to continue on with the project. When I went into the customs office I merely asked if there was a fine I could pay that would ameliorate the situation to which he promptly replied $570 cash…and which I promptly paid. The swift resolution salvaged the project since further delay would have prevented the pilot from reaching our destination and returning to Swaziland before dark.
As we churned northward above the coastline of the Indian Ocean toward the straits of Madagascar, the view below was that of endless sand dunes until we banked westward over the arid plains and round thatched huts to a narrow strip of land nestled in a brush strewn field. Our pilot vented his anxiety as a hundred villagers, in awe of this spectacle, began running along side the landing aircraft, precariously close to the wings and propeller. As we landed I thought… we are now on another planet. The colorfully dressed villagers took their measure of us with gentle smiles while we transferred our gear to a waiting jeep. Assured that his human cargo was now in the hands of his trusted contact, our pilot revved up his engine and mumbled his way down the runway in a flurry of dust as the locals again dashed alongside playing bumper tag with the ascending aircraft.
An hour over bumpy dirt roads brought us to mission abandoned by the Portuguese Nazarenes when the communists came to power and subsequently the site of renewed fighting and destruction during the civil war which drove the communists from power. A portion of the remains still serve as a health facility manned by a medical and dental technician. The recent civil war had been cruel to this area with, not only the forced termination of the mission, but the ravaging of wild life and the insidious placement of those ubiquitous stealth killers… landmines. I was personally unaware of the landmine threat until one evening, while trudging from the watering hole down in the low veldt back up to our quarters, Pete cautioned me to remain strictly on the trail. Thinking he was reminding me of the venomous cobra and deadly puff adder I asked if he had seen any snakes yet? He said off the trail the greater danger was the landmines and informed me of two recent explosions that had killed a roving cow and then a goat.
Otherwise, life here was primitive and simple. Kernels of corn wee still mashed in a wooden bowl mortar and pestle style and were the mainstay of their diet. Crops were sparse and the occasional cornstalk, wilted and feeble, was nurtured like a child crying out for a drop of moisture. Drinking water for all of us was drawn from a pit on the low veldt storing merely a few inches of murky water which was carefully rationed and ported by children each day up to a cluster of huts a kilometer away. As would become apparent in many later projects on the outskirts of civilization, the preeminent issue that divided those people with hope from those in more desperate straits was the availability of clean water.
The overcast ski failed to break during the week and the frequent sighting of minesweepers cast appall upon the team’s mood. Mosquito netting covered our sleeping bags which were packed fairly close together on the floor while evening meals were taken by candle light. Three girls, who had prepared out meals in a near-by hut, brought our food to our quarters each night. They would come and go in darkness so dense that they seemed to be swallowed up in pitch within a few strides from the dim light of our candles.
Squeezed into a tiny cubicle which served as our operatory I observed my African colleagues exercise his profession within the limits of his training. Doing his best with inadequate anesthesia, compromised instruments, poor visibility, and unrefined surgical technique, the poor fellow struggled to demonstrate his competence. It was indeed humbling to see a man work under such trying circumstances with the awesome realization that even with his limited skill he was the only person for miles and miles with any skill at all who might address and relieve the acute misery of intractable dental pain. Having been in surgical situations myself, as a student, wherein the degree of difficulty exceeded my ability, I could relate to the frustration caused by limited surgical skills, however, I had had the benefit of mentors who could take control of the situation and teach me how to expand my skills. This was an opportunity for me now to pass on some of those seemingly small but critical components of surgical technique such as proper position of the patient, posture and angle of approach of the surgeon attaining maximum leverage with instrument placement, and selection of the most efficient instrument. Having a strategy for responding to emergencies such as excessive bleeding or patient fainting helped raised his competence and his confidence to a new level.
By week’s end, my new friend and I had forged a bonding experienced only by those who have shared a foxhole together. I have kept a picture of my African colleague in my office as a constant reminder of the struggle some in my profession experience every day working with the barest of necessities and doing the best their limited training will allow.
Our flight home was somber and reflective as we gazed down at the Indian Ocean below. Our pilot had experienced a whale sighting on his journey to fetch us so we scoured the rolling seas with our eyes peeled in search of a spout and the cry, “Thar she blows”.
Our landing approach in Swaziland caught us by surprise as we saw a red carpet unfolding across the runway. The suspicion that it was not to celebrate our return was confirmed when it became apparent that Prince Charles of England was about to be escorted, by the king of Swaziland, to a private plane on and adjoining runway.
Before beginning our second week of work back in Swaziland, myself and six women helpers and nurses who had remained behind in Swzziland went on safari in Mugambi. In an open jeep with no front window we encountered a small herd of elephants on the trial and soon found ourselves surrounded. Since we were travelling on narrow trails through the brush, there was no escape route as suddenly one of the enraged elephants charged the jeep and began banging the hood of the vehicle with his forehead and tusks. I was sitting in the front seat between our translator and the driver and while the translator appealed through her tears for the driver to find an escape route. The rogue broke off the attack as we retreated ever so carefully so as not to enrage the elephants that were blocking the trail behind us. Although we hd been assured that there were no predator wild cats in this safari area, the experience with the elephants left us wary campers as we bunked down in our open tents for the night. It was all most a relief to get back to work in a clinic setting where I felt I had an even chance of survival.
The hospital where we worked in Manzini was overcrowded, understaffed and broiling with discontent. There were inadequate funds to pay physicians and there was no dentist. Hospital patients were nursed and fed by family members and the mothers of sick children fed and nursed their child then curled up on a mat and slept under the child’s bed in the pediatric ward. Because the mother would be lost o the rest of the family when a child was admitted to a hospital, every effort was made to resolve a child’s illness by the family at home.
A nation-wide strike and political unrest were looming and this coupled with the mass of humanity with highly contagious diseases forging their way through the hospital a caused me to sense my own vulnerability. Reflections of my family and friend back home, in a brief retreat, eased those anxious moments.
Mid week O was asked t travel to a neighboring settlement and share my training with the dental technicians at Good Sheppard Hospital which was founded by an order of Catholic nuns, the Medical Mission Sisters. It was here my path and that of Sr Martha Mahrl crossed.
Having ben introduced to the two dental technicians at the hospital, I observer that their surgical technique, unlike that of the poor fellow in the bush of Mozambique, suggested that they had considerable training in extraction technique and jaw fracture reduction. They were also working out of a fully equipped operatory. I apologized for not having much to add to their considerable skill. Given that their treatments revolved around pain relief and extractions played a large part in that, they asked me what the front lines of the profession were offering.
I shared with them the scope of traditional and surgical orthodontics for skeletally compromised patients including techniques of bone and tissue grafting, implant dentistry, management of facial pain and joint dysfunction, management of congenital growth abnormalities and as well as aspects of sophisticated esthetic and cosmetic dentistry. An apologetic look of inadequacy swept over their faces. I continued, however, saying that 20 years ago when I decided that I wanted to service the basic needs of people that were suffering, I realized I could provide pain relief through the extraction of diseased teeth. I have since found that providing relief from that type of intractable suffering to be the most satisfying service I have ever rendered. ‘You fellows, on the other hand, provide that kind of care and relief every day. In the total scheme of things, it is really you who are on the front lines of dentistry while the rest of us practice some of the more glamorous aspect of the profession. A long pause followed as a satisfied smile crossed their faces.
Before they could speak, however, I asked where they had gotten their training. With that, the older gent, Alexis, opened a desk drawer and pulled out a neatly folder letter that had yellowed with age. Holding it like and relic and speaking with great reverence, Alexis explained that he had been handpicked as a youth by a missionary nun, Sister Martha , who had personally trained him in surgical technique. As Sr Marth drove her dental van around the African countryside providing dental care, Alexis would either accompany her or remain behind and service a specific community. Years later, Alex’s younger colleague would be sent by St Martha to a formal dental technicians school in Denmark to study restorative and prosthetic dentistry as well as surgical technique.
Then, to my surprise, Alexis handed me the letter which was postmarked Dec 1989 and bore the signature of Sr Martha. It was a letter of encouragement, affection and pride in the two men she had left behind after she, herself, had been med-evacuated back to the United States. The handwriting was almost illegible and I read the touching words of a teacher, whose health was failing, to her students whose charge it was, now, to carry the baton. Alex had informed me that she had suffered a stroke and subsequently wrote this letter of love and encouragement with her left hand from what became her deathbed. As I was later to find out from a colleague of Sr Martha, Martha had actually passed away before the letter was sent and it was eventually sent by one of the nuns who found it by her bedside.
My medical colleague, Dr Pete, was summoned to the operating room and asked me to attend the surgery so I bade farewell to my dental friends and to proceed to assist Pete. As Pete and I were leaving the hospital to return to Manzini we happen across the two dental technicians, to whom I again apologized for not having much new to offer them that day. With a solemn look on their faces the two men shook my hand and Aleix said,” you have no idea how much you have given us today. We have often thought of ourselves as forgotten clinicians out on the fringes of the profession providing menial care in an unsophisticated environment, but the perspective you created, acknowledging our critical role in the total scheme of health care and pain relief, working on the front lines, as you said, recharges our sense of worth with a feeling a pride and satisfaction. You could not have given us a greater gift” My farewell response was nothing more than to reply, “The world needs more men like you.”
We returned to the hospital in Manzinzi that evening and it was decided that we would have a group debriefing of our week’s experiences. My quarters were in a small bungalow near the hospital while the rest of our team bunked down in a small house about two miles down a dirt road from the hospital. We all walked the dusty trail from the hospital down through the countryside until we arrived at the house. Getting there was the easy part. After the meeting, the rest of the team prepared for bed while I had yet to walk home, alone, the two miles down the dark trail back to the hospital. We had been warned upon our arrival to only go out in groups, not to stray from the hospital and by all means, not to go out at night. I was about to violate all three warnings at one time. As I stepped out on the porch and heard the screen door clank closed being me I knew it was now only me and the African night. I thought of going back in but the lights were clicking off rapidly inside so I was stuck on the porch. As I made my way down the path, the three or four little bungalows nearby all had killer protective dogs patrolling their property at night which I did not see in the pitch before me. The stillness was suddenly broken by the growling and gnashing of a several rapacious dogs. I was unaware, at first, that they were behind fences since it was too dark to see, but my heart was racing with the expectation that my throat would soon be pierced and that my body would be ravaged and mauled into carrion. Now, being in the middle of this howling assault, I could only continue on. I counted my steps outloud to distract myself from the dogs. Finally, after 100 or so paces I emerged from this vortex drenched in sweat but knowing I had passed the lion’s den. I was relieved and quickened my pace.
Within moments, however, another challenge beset me. Off in the distance, about 200 yards out I could see a dim pair of headlights heading my way down the trail. I could not imagine why a small vehicle would be on this dirt path so late at night, so sensing impending danger I turned and considered walking back to our team bungalow. No sooner had I taken a step but the dogs began gnawing at the fence with their blood thirsty growls. I opted to confront whatever it was that was coming down the road rather than chance a dog breaking free of the chain-link fence. By now the little vehicle was about 100 yards away and suddenly it stopped, put on only its dimmer lights while two men got out of the car and disappeared in the shallow brush by the side of the road. I paused for about a minute to collect myself. Then I eased my backpack up from my back and placed it firmly on my shoulders. I took off my hat and placed it away up on top the back-pack. Being only 5’5″ tall and 145 pounds in reality, I now cast the silhouette of a 6’3″ behemoth. As I got closer to the parked vehicle I started shouting and cursing like a drunken sailor. I stumbled along the road challenging anyone there to come and get a piece of me while I waved my walking stick in threatening sweeps and swoops. My heart was now beating at the same rate as it had when I encountered the dogs. In the dim light all that could be seen of me was my outline, and I must confess, I probably looked pretty formidable. As good fortune would have it, the two would-be assailants remained in the bush until I passed and was well down the road. Now, in reality, the two guys may have just gone into the brush to relieve themselves, but my heart remained unconvinced as my heart rate soared up to 180 beats per minute. I insisted that future de-briefings be done at the hospital during daylight hours.
With the project winding down, I decided I had two more adventures to complete. One was to visit Kruger National Park in South Africa for a safari and the other, to visit Capetown. I was informed that the only way I could get to Kruger from Swaziland was to rent a car and drive to South Africa and do the safari on my own. This was a considerable challenge since the roads were considered unsafe and there was a risk of assault plus the vehicles were to be driven on the left side of the road. I put a notice up on the hospital bulletin board that I had a car and a hut in Kruger that would accommodate three. The following day two Canadian volunteer nurses, who had never met each other, scratched their names on my note. The day after, we were off. One girl read the map while the other kept reminding me to stay on the left side of the road. They acted as both animal scouts and good companions. We all bunked down in the hut, taking the mattress off the bed and using it, and the box springs to sleep on.
The girl from Prince Edward Island, when talking to her counterpart from Vancouver, said about marriage, “When I become betrothed I will not have my fiancee ask permission of my father to marry me because my father does not own me.” I saw the rational in that opinion and reasoned similarly that my daughter is not my property so it is not for me to give permission, when the time comes, but perhaps offer only my blessing if it is requested. Enlightenment in darkest Africa!
Upon my return to the States I contacted the motherhouse of the Medical Mission Sisters and they graciously sent me a biography of Sr Martha with a copy of her notes on central Africa. She had developed a syllabus for training health personal and hoped to initiate a preventive health program by instituting a fluoride delivery system. Tragically her early death interrupted those plans and the dental mobile van she and her brother had assembled in Minnesota prior to her African mission had now succumbed to the heat, trails and sand of the African wilderness.
Here again I found myself pushed to new commitments by the selfless example of a nun. I thought it sad that her legacy should drift from memory so I planned to resurrect the concept of preventive care by shipping a supply of fluoride to Swaziland via Johannesburg in amounts sufficient to treat 10,000 children for a three year period. The concept was the same as that which we initiated and seen work effectively in Antigua a few years before. The major problem that lay before us however, would be in getting the material and the clinicians out to the isolated villages where the program would serve those less likely to have access to dental treatment. The purchase of a sturdy vehicle would satisfy that requirement and we resolved to do just that. It was at this point that I felt great satisfaction in knowing that at long last, Sr Martha, as the first women to graduate from Georgetown dental school finishing number one in her class, who drove across central Africa relieving pain and suffering, had a dream that I could help bring to fruition.