Keneas Mzezewa had dozed off for a nap that May afternoon, but was awakened at about two p.m. when he felt someone removing his loose-fitting pajama trousers. He lifted his head, still a bit groggy from sleep, and saw that it was Dr. Mike. The handsome American doctor had a syringe in his hand, and seemed about to give him an injection, so Mzezewa, eager to help, pulled down his trousers and turned on his side. Then the doctor plunged the unusually large needle into his right buttock. Mzezewa saw that after he finished the injection, the doctor concealed the used syringe in the pocket of his white medical coat.
"Good-bye," Dr. Mike said softly, pausing briefly to look back at Mzezewa.
Then he left the hospital ward.
Howard Mpofu, the director of hospitals for the Evangelical Lutheran Church in Zimbabwe, liked the new doctor the minute he met him, in November 1994, when he picked him up at the Bulawayo city airport. Michael Swango looked like the American athletes Mpofu had seen on television. He was blond and blue-eyed, taller than Mpofu, with a ready smile. According to the résumé the church had received, he was forty years old, but he looked younger. Mpofu tried to help Swango with his duffel bags, but the doctor wouldn't hear of it. He quickly hoisted the heavy bags and insisted on carrying them to the car himself.
On the ride into the city, Swango was garrulous, flushed with excitement at his new assignment. Mpofu asked why Swango had wanted to come to Zimbabwe to take up a post that would pay him a small fraction of what he could earn in the United States. After all, Swango was an honor student; he'd graduated from an American medical school and had completed an internship at the prestigious Ohio State University Hospitals, which meant he could go anywhere. "All my life," Swango told him, "I have dreamed of helping the poor and the disadvantaged." He said America had plenty of doctors, but in Africa, he would be truly needed. Mpofu couldn't argue with that.
When they reached the Lutheran church headquarters in central Bulawayo, they walked up one flight of stairs to the church offices, and Mpofu introduced Swango to the Lutheran bishop of Zimbabwe. To the amazement of the church officials, Swango knelt before the bishop and kissed the floor. He said he was so grateful to have been hired and to be in Zimbabwe at last.
The bishop seemed equally delighted. Indeed, he and Mpofu were overjoyed simply to have succeeded in recruiting an American doctor for one of their mission hospitals, let alone one willing to kiss the ground at their feet. Before Swango, the only European or American doctors the church had succeeded in bringing to Zimbabwe were Evangelical Lutherans from church headquarters in Sweden, and none of them stayed more than a few years.
Not many foreign doctors even from places like Eastern Europe and Asia wanted to come to Zimbabwe, the former British colony of Rhodesia, which lies between Mozambique and Botswana, just north of South Africa. Before the end of the white supremacist regime of Ian Smith and the holding of supervised elections in 1980, the country had endured a prolonged civil war. And after independence came the consolidation of dictatorial power by the mercurial Robert Mugabe, who, among other controversial pronouncements, has denounced homosexuals as "perverts" who are "worse than dogs and pigs." Since independence, the country has experienced the suppression of human rights, the collapse of its currency, a steep decline in the standard of living, and the emigration of much of its white population. Fully 25 percent of the adult population of Zimbabwe is estimated to be infected with HIV, the highest infection rate in the world. At times the country's hospital system has been plunged into turmoil, and there is a critical shortage of doctors.
With a population of about 650,000, Bulawayo is Zimbabwe's second-largest city, the capital of the province of Matabeleland, once a powerful African nation in its own right. For the most part, the local population speaks Ndebele, a linguistic cousin of Zulu, whereas the Zimbabwean majority speaks Shona. A debilitating civil war between the two ethnic groups broke out almost immediately after Zimbabwe gained independence, and though a truce was reached, simmering tensions persist.
Bulawayo residents complain that the city has been neglected by the national government because of continuing ethnic discrimination against the Ndebele. But a result of that neglect has been that the colonial-era architecture and city plan have been largely unmarred by the building boom that has swept Harare, the nation's capital. Even the cars generally date from the fifties and sixties, owing to years of international economic embargo during white-supremacist rule and the collapse of the Zimbabwean dollar following independence. Many people in Bulawayo seem to prefer the atmosphere of faded gentility, especially the fifty thousand or so remaining whites, most of British descent. These days few live lavishly; there is little conspicuous wealth. But they praise the city's unhurried pace (nearly all businesses seem to close by three p.m.); the nearly ideal climate of the high African veldt, in which even summer temperatures almost never reach ninety degrees; the gracious residential neighborhoods of walled villas and jacaranda-lined streets. Most white people still return home for a lunch prepared by black servants. They congregate at the Bulawayo Golf Club, the oldest club in Zimbabwe, with manicured fairways and a swimming pool, and the Bulawayo Club, an imposing beaux-arts mansion downtown.
By contrast, the orderly grid of colonial Bulawayo is surrounded by scores of "settlements," in which thousands of black people live crowded into small houses and shanties along dirt roads that seem to have been laid down at random. Many commute into the city on aging, diesel-fume-spewing buses, and the central bus terminal is a colorful and chaotic mass of shouting passengers, piles of goods and luggage, buses, taxis, bicycles, and handcarts. There is an almost eerie sense of a time warp in Bulawayo. In the award-winning 1988 film A World Apart, it stood in for 1960s Johannesburg.
Swango spent his first night in Zimbabwe at the Selborne, a colonial-era hotel whose wide verandah overlooks the city's bustling central square. The next morning, Mpofu picked him up for the drive to the church's mission hospital at Mnene. Mpofu had made the six-hour drive many times, and he was accustomed to the dismay of first-time visitors as the pavement gave way to a dirt road so rough that a four-wheel-drive vehicle or truck is required. Yet Swango voiced no complaints as they ventured ever farther from what most Americans would consider civilization.
Mnene a cluster of buildings can't be found on many maps. It lies in the region of Mberengwa in south-central Zimbabwe, in what in colonial times were known as the tribal lands of Belingwe, in the heart of the bush. Inhabitants identify themselves by the name of their tribal chief; the land is still owned communally, and the local people's life of subsistence farming has changed little for generations. There are no towns to speak of, scant electricity, almost no telephones. Most people live in extended family units in clusters of mud-walled buildings with thatched roofs. The landscape is often stunningly beautiful: verdant valleys give way to distant panoramas of mountain ranges. Drought and malaria are constant threats, in part because the lower elevation makes the climate more tropical than it is on the high plateau where most of the white population lives.
The region is served by three hospitals, one of them also called Mnene, all founded in the early part of the century by Evangelical Lutheran missionaries. Mnene Mission hospital, a cluster of one-story whitewashed buildings with corrugated metal roofs and wide verandahs, is set atop a hill with distant views and refreshing breezes. The buildings look much the same as they do in a photograph taken in 1927, when the hospital was built.
When Mpofu and Swango finally arrived, Dr. Christopher Zshiri, the hospital director, hurried out to greet them. He introduced Swango to Dr. Jan Larsson, a Swedish missionary doctor who was the other member of Mnene's medical staff, and showed Swango to his quarters, a spacious bungalow with a verandah, adjacent to the hospital. Zshiri is a native Zimbabwean. Under the country's system of socialized health care, he reported to the provincial medical administrator in Gweru and was paid by the government, even though nominally he worked for the Lutheran church. Even more than the others, Zshiri thought it was almost too good to be true that they had managed to recruit an American doctor to a place like Mnene.
Zshiri and Swango soon became friends. Zshiri couldn't get over how talkative Swango was, always eager for conversation and filled with curiosity. After his arrival, Swango had garnered glowing reports from patients and staff members. He was soon known to everyone as "Dr. Mike." It was true that he lacked experience in general surgery and obstetrics, two areas most in demand at Mnene. After a month at Mnene, Zshiri sent him to Mpilo Hospital in Bulawayo, where Swango spent the next five months gaining additional clinical experience. The doctors at Mpilo wrote glowing recommendations, and Swango was far more confident and proficient when he returned to Mnene in late May. He was seen as a nearly tireless worker, able to complete forty-eight-hour stints without sleep. He even worked extra shifts, giving up his free time. Of course, at Mnene, there was little else to do. Even the indefatigably cheerful Swango finally complained about the isolation, asking Zshiri if the church could possibly provide him with use of a car, since he couldn't afford one. Fearful that Swango might decide to leave, Zshiri wrote church officials a letter asking whether there wasn't some way they could accommodate him.
Swango often made extra rounds to check on his patients, sometimes at night or during afternoons when he was otherwise off-duty. So when Dr. Swango arrived in the surgery recovery room one May afternoon in 1995 to check on Keneas Mzezewa, the only patient there, no one thought it unusual, even though Swango had already completed his rounds that morning, and technically Mzezewa wasn't his patient.
Mzezewa had recently had his foot amputated by Dr. Larsson. A farmer in the Mberengwa area who was also a part-time laborer at the nearby Sandawana emerald mine, Mzezewa had come to the hospital the previous week complaining about severe pains in his leg. A tall, slender man with a wide smile, Mzezewa had reacted calmly to the news that his infected foot would be amputated. The doctor reassured him that he would be fitted with a prosthesis and should be able to lead a normal life once he returned to his farmstead. The operation had been uneventful, but Mzezewa had been kept in the recovery ward for close monitoring, which was routine in amputation cases. Dr. Larsson had been pleased with his progress, and mentioned to Zshiri how well Mzezewa was doing.
That afternoon Mzezewa was awakened from his nap by the new doctor, Dr. Mike. Before the doctor gave him the injection, Mzezewa noticed, he neglected to swab the skin with disinfectant. Mzezewa also noticed that when Dr. Mike put the used syringe in his jacket pocket, the needle's cover fell to the floor near his bed.
Still, it seemed a routine visit. Despite the large size of the needle, Mzezewa didn't mind the pain. He relaxed and lay back on his bed, prepared to resume his nap. But as the drug given him by the doctor spread through his body, he began to feel a strange loss of sensation in all his muscles. With mounting alarm, he realized that he couldn't turn over and couldn't move his arms or legs. He wanted to speak or cry out, but his jaws, tongue, and throat wouldn't respond. Then the room, brightly lit by the afternoon sun, grew dim. Soon all was darkness.
Mzezewa didn't know how much time passed while he lay there, alive and conscious but paralyzed and terrified. But then the darkness began to lift; he could see, though he still couldn't move his head. A nurse's aide entered the recovery ward and came over to his bedside. She held a thermometer and told him it was time to take his temperature. Mzezewa's mind was racing. His heart beat furiously. He wanted to cry out, but he couldn't make a sound. He could hear the aide, but he couldn't move; his muscles wouldn't respond. She asked him to move his arm so she could put the thermometer in his armpit. He lay motionless. She asked him again. Suddenly the aide looked alarmed, and ran from the ward.
Moments later, Mzezewa regained his voice. He screamed and began shouting to attract attention, though he still could not produce recognizable words. A nurse came rushing into the ward, followed by the aide. She came and stroked his hand, trying to calm him, asking him what had happened. But he was still unable to speak. Two more nurses arrived.
Slowly Mzezewa regained his voice. "Dr. Mike gave me an injection," he finally gasped. The nurses were puzzled, for while Mzezewa was taking oral painkilling medication, he was not scheduled for any injections. In any event, injections were administered by the nursing staff, not by the doctors.
Then Swango himself came into the ward, coolly appraising the commotion. Mzezewa looked terrified. The nurses fell silent.
"Did you give him an injection?" a nurse finally asked. "What was it?"
Swango seemed mystified. "He must be delirious," he said. "I didn't give him any injection."
© Copyright 1999 James B. Stewart
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