The last time I had a bit of bother with the law was over 40 years ago, when I was arrested for cycling down a one-way street in Cambridge. I was a medical student and should have known better, the policeman told me. So I was rather taken aback when a stern police officer sought me out in Kakumbi Health Centre one afternoon earlier this month. I had signed a document I should not have signed, and this was very serious.
A young man had attended the clinic with his face covered in dark, dried blood. He told me that he had been hit with a bottle the previous evening. He gave me a piece of paper which was an official request by the police for information. What were his injuries, were these consistent with his version of events and what were my reasons for corroborating (or not) his story.
I had filled in the form, patched the young man up and arranged follow up for another injury which I had detected (traumatic perforation of the eardrum). I signed and franked it with the health centre stamp, and gave him the form. But health centres in Zambia don’t have medical officers (Kakumbi is the only one in the country which does), so a health centre stamp is not permitted.
“All your colleagues working here before have made the same mistake,” said the very large, khaki-dressed policeman. “It is against the law for you to sign this paper.”
“But I am a legally registered doctor in Zambia,” I unwisely replied. “I have my Practicing* Certificate, too. Surely I can sign where it says ‘Signature of Medical Officer’?”
“Don’t argue with me about this!” he insisted. His moustache bristled with indignation.
“So what do you want me to do when you send me patients with this form, asking for a medical report for the police?” I asked him, politely.”Why do you not refer them to Kamoto Hospital directly?”
“I can’t! They have to be seen at the health centre first. Then it is your job to refer them to Kamoto Hospital so the doctor there can sign the form legally, verifying his findings with a hospital stamp.”
“Do you want me to examine and treat them before I refer them?” I asked. It is 55 kilometres to Kamoto Mission Hospital, and some might not make it alive. I saw one man a few days ago who had been almost scalped by an assault with a grass-cutting sword. He had lost over a litre of blood. Although I sutured the laceration to halt the bleeding, he was almost in shock when I packed him off to hospital in a public bus.
“Of course you must treat them. But don’t stamp the medical report with a health centre stamp. If you can get a stamp from Kamoto Hospital, you can use that if you like. That would be legal. But if the medical evidence is contested in court, you will be required to return as a witness, to ensure that justice is done.”
Getting a Kamoto Hospital stamp for me to use on police reports sounded like a typical Zambian way to circumnavigate the bureaucracy. However, he had made a fair point about being requested to appear as a witness in court. But thinking about it, I would be happy to return to Zambia to give evidence if the court were paying my travel expenses. Since I qualified in 1977, I have only been requested to attend a court to give evidence about a medical report I had done once. And that was in 1979, so I reckon it would be pretty unlikely.
I am only too glad the officer hasn’t seen the other report I wrote for the police earlier this month. This concerned an altercation between a female witch and a male witchdoctor. She said she had been slapped in the face and had become blind in one eye as a result. Her left eyelids were a bit swollen, but the eyeball looked normal, the pupil was reacting to light, and when I moved my finger quickly close to her eye, she blinked. She would not allow me to look into her eye with my ophthalmoscope because it was too uncomfortable.
Only once in my career I have seen a patient with hysterical blindness, but it is really very strange to have just one eye affected. She insisted on a referral to hospital, which one of the nurses arranged. Waste of time and resources, I thought to myself, but what the nurse had done was legal and proper, following the official protocol.
In the clinic last week, Daillies remarked that the old man I was examining was the husband of the witch. I couldn’t resist it. I had to ask him what it was like being married to a witch. He denied she was a witch but he did tell me that the “evil eye” spell had worn off, and she could now see out of both eyes.
She returned today to tell me that she was still blind in her left eye. “But your husband told me that your sight had recovered,” I said.
She glowered at him with both her good eye and her bad eye. “I must have made a mistake. I don’t understand the doctor’s English accent,” said the husband.
So I repeated the examination. And this time there was a clear corneal ulcer. I have found a stack of fluorescein paper tests which have gone out of date (but do they ever actually go out of date?). This showed up an impressive central scar. She could still see, of course, but her central vision had been affected. Her cornea had probably been injured when the male witchdoctor hit her. I wonder if he was trying ward off the gaze of her evil eye.
Luckily for me, she had decided not to take the matter further with the police, so my original report had not been submitted. I hope she isn’t able to read and understand the bit where I wrote about “hysterical monocular blindness”. Or I might be on the receiving end of some sorcery.
* Yes, I know, it should be practising, but it says practicing on the certificate.