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  ‘Yes, Mother.’ I bowed my head and sighed.

  As I rose to leave, I realised there was another important question I hadn’t asked.

  ‘Mother, who else is being asked to go?’

  ‘Sister Belinda has got experience of missionary work, but is now too advanced in years to take on the responsibility of the hospital so we have asked her to consider going to look after the House where you shall live. Also, Marie-Louise has been asked to accompany you and be your assistant.’

  I nodded. There was method in their madness and I knew straight away, she was right: there was no one else free to take charge. But still I did not want to do it.

  I spent the next few weeks in prayer but as sometimes happens when you really want Him to speak, God was silent. I had a horrible feeling He was silent because I wasn’t letting him get a word in edgeways; I didn’t want to hear what He had to say. So when I made the journey to the Chapter meeting I still didn’t know what answer I was going to give to the Community. Well, I knew what answer I wanted to give – a loud ‘No’ – but I didn’t know whether I would be brave enough to stand there and face the Community and let the word out of my mouth.

  Once again I found myself standing in front of the semi-circle of my peers, Mother Sarah Grace in central position.

  ‘Sister Catherine Mary, will you accept this mission and go to Malawi and run St Anne’s Hospital?’

  I opened my mouth to say no but ‘yes’ came out, and in front of me the Sisters’ faces broke into smiles. I have no idea how it happened. Perhaps the most obvious explanation is the Holy Spirit momentarily leapt in and took over my faculties of speech – that’s how it felt, anyway. But once the word was out of my mouth there was no going back. The meeting quickly moved on to practicalities and I was left thinking, ‘Hang on, can we just roll back and I’ll answer that again?’ In the weeks that followed I kept on plucking up courage to go and tell the Reverend Mother that I’d changed my mind, but I’d get to her door and my hand couldn’t physically reach up to knock. In the end I just had to accept, that whatever I felt about it, it was not just the Sisters but God Himself who wanted me to go.

  So as the boat to Cape Town sailed out of Southampton harbour and we left the coast of England behind (the first time, in fact, I had ever left the coast of my native land), the wind played havoc with my headdress and the tears (of grief, I think) rolled unchecked down my cheeks. A favourite passage from Corinthian which I adapted, came into my head,

  When I was a child, I spoke like a child, I thought like a child, I reasoned like a child. When I became a man, I gave up childish ways. For now we see through a glass darkly; but then face to face. Now I know in part; then I shall know fully, even as I have been fully known. So now faith, hope, and love abide, these three; but the greatest of these is love.

  I never saw Father Ian again. Soon after I had started training at Kingston I had received a letter from him, telling me he had been transferred to a new parish at the other end of the country. We continued to write to each other intermittently for years. But it was interesting: he never did marry and, of course, neither did I.

  CHAPTER TEN

  * * *

  THE TROUBLE WITH PARADISE

  The first year in Malawi I was full of enthusiasm; the second year I started to get tired; the third year I was on my knees, and the fourth year I could hardly put one foot in front of the other. You didn’t have to be a prophet to have predicted this – the clues were there right from the start. On my first weekend in Nkhotakota, I went for a little walk to get my bearings. I found myself around the back of the little missionary church, in a graveyard. It was poorly tended, with gravestones sticking through the long grass just enough to be able to make out the names on them:

  Lillian Smith RIP 1900–1930

  Poor Lillian! Thirty years old, two years younger than me. I wondered what had happened to her.

  Then I looked at the gravestone next to her:

  Paul Whetstone RIP 1911–1935

  Twenty-four years old. With a sense of mounting panic, I started scanning the rest of the headstones. I found several names of early missionaries, and not one living beyond the age of 35. There were no clues as to how they had died, but it didn’t look good.

  I walked over to Lake Malawi; it stretched over the horizon like a sea – a long thin strip of water over 350 miles long, the ninth-largest lake in the world. Nk’otakota was one of the 60 towns and villages that had grown up along its banks, and I could see in the distance the mud huts of the next village. The water twinkled blue in the early morning sunshine and there were men fishing in small boats.

  I remembered reading in an encyclopedia borrowed from the library in the Mother House that Lake Malawi had more species of fish than any other freshwater lake in the world. Steamboats went backwards and forwards, some probably off to Mozambique on the other side. They reminded me of the film The African Queen, which I had seen as a teenager. Then, Africa seemed impossibly exotic and remote. Yet here I was like some 1970s Katharine Hepburn. No sign of a Humphrey Bogart to corrupt my missionary work, though, I chuckled to myself.

  Down near the beach an impromptu bazaar had appeared. Large pieces of driftwood had been used to set up stalls of fruit and colourful materials. Children were playing while women haggled. The smell of Africa – damp, rich earth mixed with tropical flowers like hibiscus and frangipani – overpowered me.

  How could somewhere so close to Paradise hide such mortal sickness?

  The answer was there in front of me – diarrhoea, vomiting and malaria were rife among the people. As I looked at the tiny waves whipped up by the gentle breeze, I remembered why none of the children were actually in the water. Beneath the pretty blue lurked bilharzia, parasitic worms that, while rarely fatal, result in lifelong illness and all sorts of damage to your internal organs. There was danger in paradise, as if the more beautiful the landscape, the more deadly it could be. In a way that was exactly the reason why God had sent us here, but at what cost? It seemed that others who had come before us, doing His work, had paid the ultimate price.

  Despite this nagging fear lurking at the back of my consciousness, it was amazing how quickly I left smoggy, cold London behind and became acclimatised to my hot, exotic new home.

  It had started on the boat over. Sister Rachel had made us some new habits that were more appropriate for tropical Africa. And gosh, how ridiculously exciting that was – a new outfit for the first time in years! We were allowed to have a say in the design and we decided on pale blue habits with short sleeves and skirts ending just below the knee, and shorter, lighter white headdresses. (Of course our crosses of St John and girdles were eternal.)

  As we sailed over the equator and the weather heated up, we abandoned heavy old home clothes and put on our new habits. One day, as we sat outside on stripy deckchairs, becalmed and sweltering in the South Atlantic Ocean, Sister Marie-Louise exclaimed, ‘Lord preserve us! Would it really matter if we took off the undercap?’

  Sister Belinda and I looked at each other.

  ‘No, no, I don’t think it would – not if we all do it. Shall we?’ I asked.

  ‘I’m game,’ Sister Belinda said. So we retreated to our rooms and emerged like butterflies from a chrysalis, lighter and transformed, never to put them on again.

  The transformation continued once we got off the ship at Cape Town and started our ten-day train journey north across Africa to Malawi. I gazed out of the window at landscapes that seemed to have come straight out of a picture book – an idea that wasn’t helped by reading the whole of The Lord of the Rings. It had just come out and looked reassuringly thick, the kind of book that you might be able to read several times, which considering I was a bit like a guest on Desert Island Discs who can only take one book besides the Bible and the complete works of Shakespeare (books would be few and far between in Malawi and I didn’t have much room in my suitcase), Tolkien it was. And although it’s not supposed to be religious, it is about good versus evi
l, and I could see Christ in there, so it proved to be a good choice. But which seemed more unreal, the book or the view from the window? I wasn’t sure.

  When we arrived in Malawi, the jolly Bishop put us up in his colonial house for a few days while we recovered from the journey, and then we set off on a long jeep ride deep into the centre of the country, to our final destination – the small clusters of settlements known as Nkhotakota.

  Our little patch in Nkhotakota was like an African version of the square back in Poplar. The hub of the community was a large quadrangle, with an enormous tree at its centre. On the one side was the missionary church, with the graveyard behind; at right-angles to it was a primary school and opposite this was the hospital. Down a dirt track was another square with more buildings – houses for the various volunteers and missionaries, and our new home, which we would rename St John’s House. Again, in the middle was a large tree that had apparently been planted by David Livingstone in 1859, when he stayed there resting on his journey to find the source of the River Nile. Everywhere there were flowers and mango trees. At first glance it really was quite beautiful.

  However, on closer inspection it became clear what we were up against. The new St John’s House had only the most basic furniture. Luckily, we had been warned and we came with trunks full of linen and cutlery. The roof was made of corrugated iron and leaked. One night there was a terrific downpour and I dreamt I was being rained upon. I woke to find a trickle of drips pouring onto my forehead. Marie-Louise was sleeping in a little bed on the other side of the room and seemed to be dry, so I pushed my bed across the room next to hers. But as the rain continued, we both started to get splashed.

  ‘Botheration! This is no good,’ I said. ‘Let’s go and see if we can slip in with Sister Belinda.’

  So we scurried down the corridor and opened the door to Sister Belinda’s room, only to find her sitting bolt upright in bed, holding an umbrella over her head! Luckily, there was an easy solution which involved offering a small amount of pocket money to some of the local lads, who were only too happy to spend a day on our roof.

  The hospital itself was a greater worry: the wards were made up of tiny beds or mats placed tightly next to each other on the floor, so that there was barely any room for us to get between them. It had space for 60 patients, but there were always more than 100 women needing treatment. During the day it was so hot (generally over 100°F) that the verandah was full of heavily pregnant women sitting or lying, all trying desperately to keep cool.

  There was only one labour ward, which consisted of four walls and two iron beds with rubber mats. There were some bowls and disinfectant in a kidney dish, a pair of forceps and some scissors and clamps; the only light was a Tilley lamp. It had to be held in the right position, otherwise we would have had to deliver babies in the middle of the night in total darkness (and the African night could be very dark). This meant that there always needed to be two of us up, one to cross-match the blood and the other to be down at the business end.

  It has to be said that this was not necessarily a bad thing; generally the mothers who arrived at the hospital were those who needed emergency care. No matter how experienced, I always found it helpful to have a second opinion and support if things went wrong. And they did go wrong. To my horror we did lose mothers and babies from the start, women and children who would not have died in the East End of London, because we just didn’t have the equipment or the expertise to deal with some of the extreme emergencies we faced.

  The most obvious problem was that we didn’t have an operating theatre. If an emergency Caesarean was needed, the mother would have to be transported at great risk to the main hospital, which was a ten-minute drive. But we only had one method of getting them there, which was the old Land Rover, and if that was already off at the hospital, or on an errand, or even acting as a mobile clinic going round the local villages, we would face an agonising wait.

  We had two men helping us in the house – Anton, who cleaned and drove the Land Rover, and Henry, who cooked. Jobs were scarce in Malawi, so we were encouraged to employ local men with families who badly needed a steady income. Anton and Henry were both devout Christians, with lots of mouths depending on them to be fed, so they were immensely grateful for the full-time, secure jobs we gave them. Nothing was ever too much trouble.

  Henry was smaller, more inscrutable and intense. Anton, on the other hand, was tall, lanky and funny. He became my right-hand man. Driving me from emergency to emergency, singing hymns (sometimes changing the words), giving a running commentary and gently teasing me (he insisted on calling me ‘Reverend Mama’). Meanwhile in the hospital we had the help of a Dutch doctor who regularly visited and a rich American volunteer called Eloise. Two years before she had come out for a short eight-week placement, but ended up staying for eight months, then went home and then came back indefinitely with her baby grand piano. Every evening she used to play it with the french windows open and sometimes we would go and sit on the grass in the quad and listen. I used to watch Sister Belinda (the former concert pianist) listening impassively and wonder if it was torture for her. One day, I said to her, ‘Go on, why don’t you ask Eloise if you can have a go? I’m sure she’d be delighted.’

  I regretted it immediately. Sister Belinda looked hurt and vigorously shook her head.

  ‘That was my old life. It has no place with me now.’

  I wanted to argue with her. Why on earth not? Just because we have started a new life, does that mean we have to reject everything of the old, even the most creative, positive bits? But I sensed at that moment it was more important to respect Sister Belinda’s approach to her vocation, so I remained silent.

  On my first day I was bewildered by the sheer mass of people and weight of things that needed to be done. There was an extraordinary line of women and young children winding all the way out of the hospital and up the road, with more coming and joining from all directions. They didn’t seem to be pregnant. I asked one of the nurses what was going on.

  ‘Oh, that’s the vaccination clinic,’ she said.

  ‘Vaccinations? But these children are quite old, some of them look about five.’

  ‘Well, we’re a maternity hospital.’

  ‘Yes, exactly. What are these people doing here, they don’t look pregnant?’

  ‘Well, part of the job of the maternity hospital is to look after the health of the babies until they are five.’

  ‘Hang on, in England a baby is a baby until about the age of one year and then they become a child! And anyway, a baby is only the responsibility of the maternity hospital until they are six weeks old and then they are handed into the care of the health visitor.’

  The nurse shrugged.

  ‘In Malawi, maternity hospitals look after the child until they are five.’

  That was a bit of a shock. It meant we were responsible for the health of all the children in the area until the age of five – a huge job for any unit, but especially in an area where so many children were vulnerable to disease and malnutrition. ‘I will not be scared, I will not be scared,’ I repeated over and over to myself, and I made a mental note to send off as soon as possible for a book on basic paediatrics from the London School of Hygiene & Tropical Medicine.

  The responsibility of being in charge of all this was feeling a bit overwhelming. But I decided the best place to start was to make an inventory of the equipment in the hospital, if only to see what was missing. I found myself weeping as I examined the medieval-looking forceps; I was filled with the admiration for the missionaries we had replaced, having to work under such conditions. As I was wiping away my tears, a woman came running in and tugged on my sleeve.

  ‘Uko.’

  ‘Uko?’ I repeated.

  She nodded and said again in Chichewa, ‘Uko.’

  I turned to our volunteer, Eloise.

  ‘What does she mean?’

  ‘Uko, over there.’

  ‘Over there?’

  ‘Yes, it’s what t
hey say when someone is trying to get here and has collapsed. We call it the “Failed to walk” phenomenon.’

  ‘Dear God!’

  ‘Well, they end up having to walk miles. There aren’t any cars out in the villages, you know.’

  ‘Well, of course, but what am I supposed to do about it?’

  ‘You send someone out in the Land Rover to find them and bring them in.’

  ‘OK.’

  I turned to the woman and said: ‘Uko, where?’

  She nodded and pointed in the general direction of the hospital door. Eloise laughed.

  ‘That’s the best you’re going to get, Sister! They don’t do things like maps or directions.’

  ‘Dear God!’ I exclaimed again, ‘How on earth does anyone ever survive here?’

  ‘Well, they do, Sister, they generally do. You’re just going to have to relax, go into Malawi gear and up your praying.’

  I studied Eloise carefully and decided I liked the cut of her jib.

  ‘OK. Eloise, would you be kind enough to take this lady and go and find Anton – I think he’s in the house. See if he can drive around with her and locate her friend and bring her in.’

  ‘Righty-ho, Sister.’

  Half an hour later Anton returned with a labouring, but grinning lady in bright clothes. And that’s what struck me going round the wards – the stoicism of the women. They were calm and uncomplaining despite the heat and lack of facilities, always terribly respectful and grateful. During the day I witnessed five babies being born, and rarely had I been present at such quiet births. Were they experiencing less pain? It’s impossible to know, but my hunch is that, having grown up without a pot of painkillers ready to hand, they were just better at dealing with it.

  I also felt there might be something psychologically deeper going on. They were deeply religious, with a depth of faith that would put most of our woolly Anglican churchgoers to shame. It was humbling. But also during our first month, the other Sisters and I were taken to see a traditional ceremony for a first time mother-to-be. I suppose it was the Malawi equivalent of an antenatal class that extended into the labour itself. It took place in a secret location outside the village. The only people allowed to be present were women who already had children (they made an exception for us on the grounds that we were ‘medical staff ’).