Friday December 5th
Today is drawing class day. Subila is going to help me and translate, so to tie in with her schedule we need to fit it in between the ward round and a visit from a class of girls from a local secondary school. I begin by introducing the materials I have brought with me, all of which seem new and strange to the women who crowd around me, full of curiosity. I show them graphite sticks, charcoal, chalk pastels and drawing pens. I draw marks on the paper showing them how they can use the materials and I demonstrate how to construct simple faces, and animals. My creative ingenuity is tested when it comes to drawing an elephant, but even so the women seem to think I am performing magic! They grab the sheets of paper eagerly and begin to draw. Most of the women are taking part – a few of them politely refuse with a slow shake of the head, and I can only respect their wishes. I am pleasantly surprised, and not a little impressed by the enthusiasm and the way nearly all of them take to drawing, most of all the way in which they are trying to communicate through their symbolism. This must give credence to the idea that visual language is a very powerful and universal medium. It is very noticeable that all of the women choose to draw ‘something’, and usually something they know such as a fish or a bird or an object they might use for cooking or washing. All things then from their imagination, and from their lives outwith the fistula ward. They love the colours, as I thought they would, and their drawings are lively, spontaneous and dynamic.
I notice one of the women studiously copying onto her own sheet everything that I drew earlier on mine, just to show them the materials. This seems an opportunity too good to miss so I draw some more things, asking her what she wants, and she copies, beautifully, everything I do. The drawings become more and more complicated – it is a game and she is happy and laughing. I end up drawing a colourful parrot in a banana tree and soon there are two colourful parrots and two banana trees! The class comes to a close as the schoolgirls arrive. The women bring me their work, we plan to have an ‘exhibition’ next week.
There are forty girls in all. They arrive and sheepishly line up against the wall of the seating area (banda). Subila disappears for a while, rallying the troops I believe and getting some literature together, so the situation becomes a bit difficult, even embarrassing. All the girls speak good English and Alison is telling them a little about obstetric fistula but all of the women, the living breathing examples of fistula patients, are left wondering what is happening and feeling perhaps, as I do, very uncomfortable. Eventually I suggest that the girls might like to tell the patients who they are and where they come from and this seems to break the ice a little, but it is not until Subila comes back, along with Caspar, the head of the Fistula program, that the tension begins to lessen. Caspar brings all the schoolgirls into the seating area and extra chairs are quickly found. It is a tight squeeze but everyone’s attention suddenly turns to Rainfrida, one of the women whose portrait I have drawn this week, as she stands up and starts to speak. Rainfrida is a woman of sixty years. She has been faecally incontinent from a rectal tear for thirty years and has suffered greatly. She is a however a strong woman and she speaks with conviction and a passion impossible to ignore. Within just a few seconds she dispels any idea that all these women, though some may be illiterate and all are downtrodden by circumstance, are certainly not passive victims. I cannot understand what this powerful spokeswoman is saying – Caspar says that she is talking about her own experiences – but whatever it is Rainfrida is certainly having an impact on the girls, they are listening intently.
The difference between these girls and the women patients seems vast. On the surface, the fine, fashionable clothes worn by all the girls, their jewellery and their Westernised, idealised appearance, enhanced in some by wigs of long straight hair, are sure signs of their wealthy and privileged lifestyle. Seen together with the patients, all alike and almost regimented in their blue hospital gowns, the disparity is profound. But the difference is not only in the outward appearance, it is in the eyes of the patients, often lowered, in the attitude towards their surroundings, and in their general way of being which, here in the hospital, seems to be one of submission. I feel their sense of abjection very keenly but equally I am very sure that many of them have simply retreated into themselves in order to maintain a reserve of strength. Their separate individualities maybe temporarily submerged within a sea of blue gowns but it resonates in each woman’s determination to recover – even at high emotional cost. They know that they now have a chance of living a normal life, that is the goal, and for the opportunity to achieve that after the horrors that many of them have already been through, a few weeks of being just another patient carrying a washing up bowl for your catheter bag must be at the very least a tolerable proposition.
After Rainfrida has finished there is a slight pause while everybody takes in what she has said, somebody starts to clap, hesitantly, and others, equally hesitantly, join in. Rainfrida looks satisfied. Caspar quickly lifts the mood with his enormous smile and excited manner, and then lowers it again by launching into a very long winded lesson on the causation and nature of fistula. He gets into his stride immediately, and doesn’t forget to remind us all that he spent seven years as a secondary school teacher. Soon he has the whole of the schoolgirl contingent rapt and following every word. The patients in the meantime are showing mixed emotions. Some just look bored, some confused and some are visibly upset, none look as if they feel part of what is going on and indeed Caspar is addressing most of his lecture to the schoolgirls. I am feeling very awkward and actually quite angry at the lack of tact and respect being shown here towards the patients. They know about fistula, they have a fistula! There seems no real need for this kind of ‘lesson’ to happen here in this situation. It is good of course that the girls should learn the things Caspar is telling them but surely it could have gone on before they came to visit the patients. There seems no advantage at all in going over it all, especially at this level of detail, in front of the women, but Caspar is on a roll and there is no stopping him.
Caspar finally finishes but now, and to make matters worse, Subila begins a second lecture! Admittedly Subila has more consideration for the patients position but still they are largely left out of the proceedings and as they are becoming increasingly dejected by it all I am becoming increasingly uncomfortable for them. I feel very protective towards them – perhaps wrongly so – but there is nothing I can do.
Its over, and now everything changes for the better. As it is Friday it is time for the regular discharge ceremony for patients who are leaving having recovered from their operation. This is a joyful occasion of course and the women now come into their own. Their singing is beautiful, with truly African roots and harmony. It moves me very deeply and I want very much to cry. I am surprised at how profoundly it affects me and Subila sees it in me. I say that I love the singing and this is the only encouragement she needs to ask the women to continue. They need no second request and the singing and clapping and drumming begins in earnest as the four leavers are presented with CCBRT kangas (a large colourful shawl) as a leaving present. The schoolgirls then present all of the patients with their own kangas that they have brought as gifts and the singing continues. Some are dancing now and Alison and I join in…the words are simple to pick up, even though I do not understand them. Subila tells me the song is a celebration of womanhood. Alison and I receive kangas too and I feel full of a kind of joy that I have not felt for a long time…if ever, if I am really honest.