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Care in the community
  1. I D Wacogne
  1. Ian Wacogne is a consultant in general paediatrics at Birmingham Children’s Hospital

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I think that she must be about 145 cm tall, perhaps 40 kg, and about 60 years old. She might have been taller before, but now her legs bow and her back is hunched over. She’s dressed in dirty, but not filthy, clothes which are nearly, but not yet, rags. However, none of these features are what you’d notice first about her. In fact, at first you don’t see her diminutive figure at all—you hear her, from a good block or two away, because she’s playing a drum.

The drum, supported by a strap around her neck looks fairly new and well cared for. Unlike the tin drum my grandad gave me for Christmas when I was five—thus endearing both him and me to my parents—this is a real drum, a cylinder with the same depth as diameter, real resonance and a deep, booming note.

The rhythm is strictly 2/2 march. No complex quickstep of waltz here; no pretentious 5/4 or fussy 6/8—just 2/2, because that is the way she is walking. As I say, you can hear her from a block or two away, giving you enough time to work through “What on Earth?...”, then “Maybe it’s...”, then “No it can’t be...”, and finally “Well, it really is!” When she gets really close you can tell that she’s also singing, if you can describe a monotonal “La, la, la”, in time with the beat of the drum singing.

If she spots you watching she’ll pause, smile a broad smile with not many teeth, and give you a burst of drumming at a faster rate—not, for the moment, constrained by her walking pace.

The deal is that you give her a few pence for her playing and she goes away. Except that she is so obviously enjoying her playing that you are reluctant for her to leave; it is such a simple—but noisy—pleasure. The cynic would have it that she is playing to be a nuisance, so that you give her money to stop disturbing you. Her eyes, her slurred speech, her apparent difficulty hearing, and her childish laughter tell a different story: That she’s probably enjoying this, probably a good deal more than you or I enjoy most of the things that we do. If you do a little dance with her metronomic beat, she’ll laugh fit to cry, as if you’ve just told the world’s funniest joke, or passed wind on live television.

This is a real live case of care in the community. Only here you get to choose if you are going to be a NIMBY—Not In My Back Yard—by paying just a few pence a day. You don’t worry yourself about where she sleeps, or washes or eats, because she seems pretty happy, doesn’t she?

An evil thought enters my mind. I see the consequences of (don’t) care in the community coming home to roost, in Downing Street in the late eighties, where those policies were engineered. I see a hundred, no, a thousand of these ladies wandering by each day, each with a voice in the shape of a drum, each pounding out their own happy rhythm.


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A drum isn’t the same as a voice in a democracy, but it can be a lot of fun as this lady has shown me. The lingering questions remain, however. Where on earth did she get such a good drum, and where can I get hold of a job lot?

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