Sihlangu – the King’s Shield

P1030380Swaziland’s national football team is known as Sihlangu, the King’s shield. They managed their first ever away win against Guinea last month (the outbreak of Ebola had nothing to do with it) so confidence was high for the home game with Angola. We bought tickets in advance, but we needn’t have bothered. There was a car outside the gates of the national stadium, selling tickets from the passenger window. The tickets cost 30 Emalangeni, equivalent to about £1.60. A steal at ten times the price.

When my predecessor came to the stadium to see a local football match (she thought our MSF staff were playing another amateur team), there were twice as many policemen as players on the pitch. When she asked why, she was told it was for security. The players needed protecting from angry fans who were out for blood.

In a previous blog I showed a newspaper billboard which said that police were now doing body searches for weapons at the entrance to the stadium.

But we were not apprehensive. The mood of the crowd was good-natured and people were smiling. I felt very safe, even though a sizeable portion of the spectators were already drunk.

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We found some seats in the shade and watched the teams warming up. The Angolans looked impressive, from the top of their sculpted hairstyles to their neon pink boots. The Royal Swazi Police Band marched and played, then the teams lined up for their national anthems.

A man in traditional costume with a Swazi flag was leading the singing in front of our seats. He was also wearing a hard hat with a sign on top saying, “Hi Angola, we love you. But we want to show you the bullet from the feet.”

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Swaziland were outclassed in the first half. Their wingers kept sending high crosses into the penalty area, but the Angolan centre backs were about six inches taller than the Swazi strikers. The Angolans scored after half an hour and looked in complete control of the game. They scored again early in the second half after a defensive error, but instead of giving up, the Swazi players were spurred on. Sihlangu’s left winger gave the Angolan right back a torrid time, sending over low crosses from the byline. Swaziland scored, and the crowd went wild.

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A rather large, well-endowed lady behind me started screaming and jumping up and down. Her bosoms were bouncing off my head. She started calling out instructions to the team, “Pass it Choco!”, “Kick him Chief!”

The Swazis scored again seven minutes before full time, and their supporters went apoplectic. To my right, a man with a Chelsea jacket and visible bum-crack led the chanting. He was swigging from a two litre bottle of foaming, yellow liquid, whilst doing a pointing dance routine. If the game had lasted another quarter of an hour, Swaziland would have probably got the winner, but the final whistle went with the score at 2 – 2. It was probably a fair result.

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A black BMW SUV drove out of the main gates. Someone told me it was the Queen Mother, “the great She-Elephant”, who likes her soccer, apparently. As we left the stadium, we passed a few fans who were worse the wear from drink. A driver collected us and we joined the mass of vehicles jockeying for position to get back on the main highway. One impatient (and inebriated) driver was actually nudging the car in front, urging him to move forward.

A few days after the match, I came across a man suffering from bipolar disorder in the clinic. He was in a manic phase and believed that he had supernatural powers. He said that he had used his magic to help Sihlangu to win the match. I told him that I predicted the score correctly at 2 – 2. So my powers were better than his. He looked at me curiously, then said, “No, I don’t believe you. The Angolans had a powerful sorcerer helping them. That’s why it was a draw.”

He leafed through the back pages of the newspaper and showed me some photographs. “See that ghost player? He was on the pitch as an Angolan extra man,” he said. I looked and saw he was pointing at an out of focus player in the background. “And here is their accursed ball which was secretly used in the game,” he said pointing out another blurred image of a football.

It is inadvisable to challenge delusions, say the psychiatric textbooks. I am not sure I agree. But I increased his medication anyway.

The return match is on 2nd July in Angola. The Swazi players have incentives to win.
The return match is on 2nd July in Angola. The Swazi players have incentives to win.

Royal Wee?

The King has a fleet of black BMW Sports Utility Vehicles (SUVs). These sinister vehicles transport his family members around the country in style. The SUVs are topped with blue flashing lights and have darkened windows. They are usually accompanied by a sporty police pickup truck in front and behind, for the security detail and bodyguards.

One Saturday morning I was walking back from town when a black SUV passed me and pulled over at the side of the road. I could see there were pennants flying from mini flagstaffs on the front wings, but I didn’t know what these indicated. The two passenger doors opened and someone got out between them. At first, I thought this chap was going to clamber up the embankment and pop into Moneni SPAR to do a bit of shopping. But he stayed where he was, stationary, facing away from the car. I realised what was happening when I saw a jet of urine splattering against the roadside.

For a brief moment I thought I might just pull out my camera and take a snapshot as I walked past. Would this be a national scoop? Would my photo be on the front page of the Swaziland Observer or The Times? I could see the by-line in my mind’s eye, “Royal Wee, by expat pee-parazzo”. But happily, common sense prevailed and I decided on discretion, rather than fame. My camera remained sheathed. And I remain at large, not confined to a Correctional Institute.

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I’m sure it wasn’t the king who had been caught short. The gentleman was very casually dressed. There were no flanking motorbike outriders, no muscular policemen in shiny black pickup trucks, front and rear. If it had been HRH, I could have offered him a throne at my place, just a 100 metres down the road, where he could pee in peace.

He climbed back into the SUV, the doors slammed shut, and with blue lights flashing, the vehicle pulled back onto the tarmac and roared off.

Asingamhlukubeti: Accelerating efforts to end violence against children

Things are often late in Swaziland. This year, even winter is late (the weather is glorious, cool nights and bright, sunny days). The official invitation to the Day of the African Child Commemoration arrived at the office just twenty hours before it was due to start.

One of our drivers certainly feels the cold in the mornings
One of our drivers certainly feels the cold in the mornings

A small team from MSF drove out to Swazi National High School to take part in the march to Kwaluseni Inkundla (community offices), thinking that we had plenty of time. We had just arrived at nine o’clock when the Royal Swazi Police Band struck up the music and marched out of the school compound.  Behind the police were the Siphumelele Primary School Drum Majorettes, followed by majorettes from the Kwaluseni Central and Infant Schools. Then came a mass of children, swarming out of the school gates like an angry amoeba on steroids.

MSF Banner
MSF Banner

The team joined the march with the MSF banner held high. Well, hand high. It was lost among the excited pupils who were milling around, trying to link up with their friends. The children behind us were pushing us in the back, stepping on our heels and making walking in close formation uncomfortable. It was like being caught up in a Zulu impi army, massing to overwhelm Michael Caine, Stanley Baker and the redcoats.

I stepped out of the march to take some photographs and video. I just can’t help myself. There were a few policemen trying to control the expanding mob of children, who were walking faster than the police band. They also had to deal with traffic trying to pass the march in both directions. Teachers with megaphones did their best to confine the marchers to one side of the road. I am glad to say that I say no violence being used.

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We passed a school where the children were penned into the school yard. Perhaps they were not coming to the event. They hung onto the wire fence and waved to their colleagues who were getting the day off. I took some photographs of the local shops.

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“Internash Proffetional Welding” – well, you know what he was trying to say, don’t you?

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“Classic Fast Food” with pictures of a burger, fries and cola on one side, and an ice cream cone on the other. In the middle, there was an image of a plate of food with white, green, yellow, red and brown blobs on it. Possibly pap with multiple relishes.

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“Lindo’s Fish & Chips Spazo” was a converted container painted Manchester City blue. It was up on palm trunk blocks at one end. There were a few ventilation holes at three corners and the makeshift roof looked like it needed some repairs.

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“Portugal Boy” (Blessed Iz Thy….Portugal Boy) was selling tea and takeaway hot chips.

The march took a sharp right turn and headed towards the main highway between Manzini and Mbabane. It was really important that the marchers didn’t stray out of the slow lane. We walked off at the next exit and took a break to load up on fluids. A gaggle of pre-school children holding balloons were waiting for us at the bottom of the slip road. They were ushered into a slot behind the police bass drummer and glockenspieler. They did a little dance to the music but it became obvious that they would not be able to keep up when the march restarted. So they were shuffled into the front of the march and the police band kept pace with them.

Marching down the main highway in the Kingdom, but in the slow lane
Marching down the main highway in the Kingdom, but in the slow lane

Some of the marchers were adults from non-government organisations, such as UNICEF and Save the Children. One lady had an interesting shoulder sack with a slogan which read “Bo Sugar Daddy, Na Bo Sugar Mama”. I think I understand the message it is trying to convey.

No to Sugar Daddy
No to Sugar Daddy

We arrived at the Inkhundla at 10 o’clock. There were four marquees set up around a dusty parade square. Swaziland TV were setting up. The public address system was working. The MSF team claimed a table in the NGO tent and set out our literature concerning sexual and gender based violence. The organisers wanted a senior representative of MSF to sit with the bigwigs in the tent with the best view and most shade. I jumped at the chance of being able to network with the bosses of other organisations.

The parade leaves the road and marches down a track to the parade ground
The parade leaves the road and marches down a track to the parade ground

I chose my spot carefully, so I could take photographs easily. I sat in the second row of plastic seats on one end, away from the Deputy Prime Minister’s table, and not on the cloth covered chairs for VVIPs. Some of the majorettes sneaked into the back rows but were evicted.

The senior psychosocial counsellor at Matsapha Police Station recognised me in my MSF teeshirt . Well, I was the only mlungu in the village, too. He introduced me to his boss, who complimented me on MSF’s work with survivors of sexual violence. She said, “But what happens after you’ve gone?” I replied that MSF would be here for quite a while yet. “No, after YOU have gone,” she repeated. “Oh, I am sure that MSF will replace me with someone who has my skills,” I answered. “No, if you leave Swaziland and a court case comes up two weeks later, how are we going to verify your evidence?” “In that case, you will have to subpoena me and I will come back to Manzini to testify,” I said. I discussed how the MSF medical officer could “stand in” for a colleague who has left, just the same as at the local hospital, where the medical superintendant vouches for the accuracy of medical reports done by doctors who have left. We are going to discuss this further.

After the obligatory prayers, the Regional Administrator said more than a few words and the show kicked off with Phocweni Primary poetry reading and Sibonile Preschoolers jiving about with their balloons. There were a dozen speakers, all but one speaking in siSwati, but I’m pretty sure they were all saying essentially the same thing. It is traditional, everyone needs to say their bit. Between the speeches, we had poetry, drama, music, costumes, modern and traditional dancing. Kwaito dance, Lutsango, Ummiso and finally, Sibhaca. Just like Sunday Night at the London Palladium (showing my age).

I'm totally special
I’m totally special

The modern dances involved lots of pelvic thrusting of both sexes. Their music was disco with a thumping beat, and very raunchy lyrics (though I am not sure anyone listened to the words). Police vans and vehicles bringing food drove around the performers to get to the Inkhundla building where lunch was to be served.

The dramas were about bullying, betrayal and unwanted pregnancy. From the guffaws of the school children in the audience, they were preaching to the converted. In mind, perhaps, but not in the flesh. There were some punch ups going on in the crowd between performances.

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The stars of the show were the young men from Swazi High School (probably in the Upper Fifth) who were on at the end. They were dressed in twee miniskirts (blue/yellow/red bands), white woolly leg and arm warmers, scarlet scarves, pink feathers in their hair and brandishing metal sticks. First of all, they positioned the drums, oil barrels sawed in half and covered in cowhide. Then the backing choir, wearing black western clothing, took up their places. Finally, the stars of the show arrived and sat among the choir.

Sibhaca involves synchronised dancing, stamping, stick thrusting and kicking as a group. Individual dancers come to the fore and do their thing, then return to the fold. One man threw some shapes, then pimp-walked up to the Deputy Prime Minister, licked his forefinger, stroked it sensuously down his shoulder, turned on his heel and sashayed back to the group. This drew howls of laughter. How could such a butch guy (even if he is a brilliant dancer) act so camp!

I didn't find his shirt inappropriate
I didn’t find his shirt inappropriate

At 1:30 pm, Senator Paul Dlamini, the Deputy Prime Minister, spoke to camera in both siSwati and English, giving the penultimate speech. The PA system didn’t pick up his voice well, and the hungry children became rowdy, with the smell of beef and chicken in the air. Despite an organiser interrupting the DPM’s speech to berate the children and commanding them to listen, the mob continued to rule.

The final speech was given by  the Chiefs’ Representative. It was a long vote of thanks. The speaker looked very distinguished with white hair and a beard, but his shirt had a print showing a lady in a bikini. He obviously not learned from the wardrobe mistakes of Matt Taylor who wore a top featuring women in lingerie during the European Space Agency’s live stream of the Philae landing last year.

Everyone left the VIP tent to get their lunch at the Inkhundla. I went over to the MSF stall and asked how it was going. Business had been very quiet. The children had been very excited by the performances and now that food was being distributed, they were queuing up to be fed. Half a dozen girls asked for some leaflets when I was there. Still, it was useful to do some networking with other agencies involved with sexual violence.

“Did you eat, Dr Ian?” asked one of the team.

“No, I came over here to find out how you were getting on.”

They had already eaten so they urged me to get some food. By the time I reached the Inkhundla, the doors were locked by the DMP’s security guards. The UNICEF ladies said the food was unpalatable anyway. We loaded up the vehicle and went back to the clinic.

Wami, Wakho, Wetfu

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The Devil’s Eye

These three advertisements appeared in the back pages of the Swaziland Observer this week.

Mama Meli & Koffi Specialist offers an array of powders to help you achieve your wishes. Goli stops your lover from cheating on you and Oli will capture the heart of your lover. The appropriately named Bingo powder will “boom your business” and make you a millionaire within a month. Saddest of all is oki powder which will help your in-laws love you.

Gogo Tasha specialises in relationships, or as the ad says, “men & women’s problems (big or small)”. She can bring back lost lover and “separate them within a day”. I presume this means separate the errant partner from their new lover. Ola Oil is used to attract white or rich people, but lala powder will make him or her build a house.

Dr Mac, the herbalist, charges £20 for a visit to his fancy consulting rooms in Manzini.

People in Swaziland often consult traditional healers before they come to the clinic. They believe there is an underlying cause for their ‘flu-like illness which is spiritual, rather than being caused by micro-organisms. This week, I asked a patient in the clinic why he was consulting and he told me with a straight face that his feet had been bewitched. I examined them and said I couldn’t find anything wrong. He looked really worried and said, “Now the spell is working it’s way up my legs.” I was tired and impatient, so I said, “Perhaps you ought to see a sangoma.” His facial expression said it all, as he rolled his eyes and got up to leave the room. What a waste of his time seeing a white doctor about cursed limbs.

Last month, I was called away from lunch for an emergency. Outside my consulting room a woman was sprawled across a wheelchair, her head lolling backwards at an alarming angle. Her husband was distraught. He said, “She was not feeling well this morning and at 10 o’clock, she said she had a bad pain in the back of head and fell down.” Or at least, that was what I thought he had said. We managed to drag her in the wheelchair up the steps and into my room so I could examine her. He said he thought someone had put a spell on her.

Performing a neurological examination on someone who is partly conscious is difficult, but when you can’t communicate with your patient in her language, it is really frustrating. You don’t know if the patient is not responding because they don’t know what you are asking them to do, or because their brain is addled. I called my translator for help, but instead of her coming into the room, she stood at the door. I relayed my commands through the translator to the husband who would shout in his wife’s ear.

There is a standardised scale of consciousness called the Glasgow Coma Scale, based on response to pain and commands. She scored 3 which is very low. On forcibly opening her eyelids, I could see the gaze was not conjugated. Her right eye was drifting off to the right. Not good. I thought she may have had a subarachnoid haemorrhage. There were no signs of meningism, such as neck stiffness, but these usually occur after six hours when there’s bleeding around the brain.

I asked my colleague for a second opinion as I started organising transport to hospital. She was very sceptical and said that this was hysteria. She asked the husband about any stresses and he said that they had had some arguments recently. She nodded and suggested that we give her an injection of a painkiller, which would give her “an excuse” to come out of her pseudo-coma. After half an hour, the patient became more conscious and her GCS score improved. My colleague said we should refer her to the Psychiatric Hospital, but the senior nurse said that the General Hospital would be better, as the psychiatrists would probably want to rule out an organic problem first. We agreed and she left in the ambulance.

Throughout all this, I noticed that my translator had vanished. I found her helping out at the drug resistant TB rooms. “Were you frightened?” I asked her. She said that she was concerned that the patient had been taken over by a demonic spirit. If our treatment had been successful in evicting the demon, it might contaminate someone else close by. “Could it possess me?” I asked. She laughed and said she didn’t think so; white folks are immune.

A few days ago, I saw the same patient in the waiting area outside the clinic. She had been treated for acute bacterial meningitis in hospital and had made a good recovery. I’d recognised her because her right eye continued to deviate laterally. In the politically incorrect days of my medical training, this was known as a “venereal strabismus”. I’d always assumed this referred to an acquired squint as a sign of neurosyphilis. But perhaps this “wandering eye” allowed an affected person to make furtive, amorous glances at someone they did not have to face.

Emlembe, Swaziland’s Highest Peak

On Sunday, I climbed the highest mountain in Swaziland. I should confess that I didn’t clamber up all 1,863 metres of it. We drove in four wheel drive vehicles on rough tracks through the Mondi forest to 1,425 metres and scrambled up from there.

We left the vehicles at an abandoned COIN camp formerly used by the army. This stands for COunter-INsurgency. This is such an incredibly remote place, one wonders why the camp was built here. South Africa surrounds Swaziland on three sides. If SA wanted to invade, they would not have to march over Emlembe to do so.

We walked for thirty minutes uphill before arriving at the Devil’s Bridge, a sliver of land between two hills, with deep canyons on either side. It is only a few metres wide and is eroding fast.

Once we crossed over, there was a strenuous, steep climb through highveld grassland to the peak. Our route took us along the border with South Africa, which was marked by a rusty barbed wire fence. On the top there was a metal watch tower on the Swazi side. The ladder to the top was hanging by a single rusty bolt.

On the South African side there was an isolated concrete hut without a roof and an empty flagpole.

The views were stupendous across the Makhonjwa Mountain Range. This contains the oldest preserved, accessible rocks on the planet. There are others, but they are in Greenland. And there’s no bus service there.

Looking south into Swaziland we could see the Maguga Dam, Silotwane in Malolotja. The former asbestos mining town of Bulembo was laid out below us. It became a ghost town when the mine closed, but after some chicanery a Canadian church foundation converted it into a massive orphanage for 300 children. They make excellent honey which tastes delicious. You can spend the night there at a guest house which is really, really quiet. Almost oppressively quiet for some people. The golf course at 1,200 metres is still playable.

Looking north, we could see the rocky peak of Gobolondvo and I could just make out Driekoppies Dam near Matsamo and the Lebombo Range to the east.

We came down faster than we went up.

Another week in the clinic

My interpreter was not available this morning, so I struggled when seeing patients. When I ask for patients in the queue who speak English, I get a completely different clientele. They are usually middle class or students. It is almost like doing general practice in UK.

We have half a dozen student nurses from Good Shepherd Hospital on work placement at the clinic. One nurse helped me out by translating when she was not dressing wounds or giving injections. Unfortunately she wasn’t very good. She told me one patient was HIV positive and taking anti-retroviral therapy, when just the opposite was true. Luckily the patient knew enough English to correct her.

She called me to the treatment room to see a boy who had fallen from a tree and managed to impale his arm on a broken branch. It was very satisfying to remove a long splinter from his forearm under local anaesthetic.

This is not the boy who fell from a tree
This is not the boy who fell from a tree

MSF don’t like me to do minor operations in the clinic perhaps because it is “mission creep”, taking the project further away from its core business of HIV and TB treatment. But I find it hard to resist fixing minor surgical problems. After all, I have a degree in medicine AND surgery. The patients like it, too. It is simple stuff, such as lancing a boil, resecting a wedge of ingrowing toenail or suturing a wound. It isn’t neurosurgery.

But there can be obstacles. Sometimes there are no sterile instruments, so I have to improvise. A few weeks ago, I struggled to remove a chunk of glass embedded deep in a man’s palm just using my fingers and the flat edge of a scalpel blade. This was not ideal. I knew we had some sterile packs in the Family Planning room. They usually contain instruments (forceps) which we use to apply acetic acid (vinegar) and iodine to the cervix. Instead of Spencer-Wells forceps to hold the cotton swabs, there was just a tenaculum to grab hold of the anterior lip of the cervix. I couldn’t use it to grapple for a fragment of glass, embedded in scar tissue, deep in a hand. But I got it out eventually.

A few days ago, a young man told me that the cleanly-sliced cut on his neck had been done by a screw when he was doing some DIY. My inbuilt lie detector hit the red line. I wonder why he refused to go to the local hospital accident and emergency department? Did he want to avoid the police? This was a sharp knife or razor wound. Again, we had no sterile forceps to hold the needle to suture so I was forced to use my fingers. The curved needle was less than a centimetre across, so this was tricky. I normally use a plastic surgery technique to tie off sutures, but this needs forceps, so I had to tie the knots using my fingers. Remember those hours we spent learning to tie one-handed knots in medical school, Hattie Lupton? Well, my fingers still remember how to do it. My brain doesn’t. When I tried to think it through logically, I failed. My fingers just went into automatic mode. Maybe it is a bit like riding a bike, you never lose the knack.

Wherever I work, I seem to attract pus. A man limped into the clinic with a swollen thigh, caused by a deep abscess in his quadriceps muscle. I lanced it with a blade (no holder), but had to delve my finger deep into the wound to break down any loculations (pockets) of pus. It needed a gauze wick to prevent it healing before the pus had drained, so I had to insert this with my finger as well, because no forceps were available. Two days later, he was walking much more easily when he came for a dressing change. You just make do with the tools you have available.

Another chap turned up to my consulting room waddling as though he had soiled his trousers. He had. There was a large ischiorectal (inside his buttock) abscess which was leaking pus into a makeshift nappy. He had had a previous abscess some years ago which took months of hospital treatment to resolve. This time the pus took the easy way out, through the track of old scar tissue. I’m not very squeamish, but when he said he could feel the pus squirting within his buttock cheek, from one location to another, when he sat down, I felt a bit queasy. The pus was freely draining now. He may need further surgery, but our immediate difficulty was how to apply a dressing in such a tricky location. I leave these problems to the nurses, who know this stuff better than I do.

You always have to be on the lookout for TB and HIV in the clinic. These infections are constantly on my clinical radar. A man told me that he had had bloody diarrhoea for a month. I noticed that his belt had an extra hole poked into it, because he had lost so much weight. His test for HIV was reactive and he went on to start treatment.

Lumps in the neck are quite common. There are many causes, but HIV and TB are most common here. Usually they are firm or rubbery lymph nodes, but once they get “squidgy” (that’s not the technical term we use), I stick a needle in and aspirate the juice. Within a couple of hours, our geneXpert machine will tell us not only if there is any TB DNA present in the sample, but whether it is sensitive to rifampicin or not. I was rather hesitant to do this when I first arrived because there is “a lot of clockwork” by the angle of the jaw. Jugular vein, carotid artery and facial nerve, to name a few. I’m more confident now, but careful not to be too gung-ho.

Tuberculous cervical lymphadenitis used to be common in Britain a few centuries ago. It was given the name “scrofula” and could be cured by the touch of a monarch.

Of course, you get sad cases where patients turn up late. One lady had suffered from post-coital bleeding for three years, thinking it was because she was using injectable contraception. I discovered a bleeding ulcer on her cervix, which is very likely to be cancerous. There isn’t a national cervical screening programme here. Even when we do find suspicious patches on the cervix, the waiting list for colposcopy at the local hospital is six months. Women living with HIV have a much higher risk of developing cancer of the cervix, so we would like to offer them annual screening. At present, only one nurse in our clinic has been trained to do this. She would have to screen 11 women every day to reach this target. But she has other duties to carry out and we don’t have a dedicated room to do the procedure. This is a problem we can tackle using a “QI” approach – Quality Improvement, not Stephen Fry’s Quite Interesting TV programme.

When you are living with HIV, you can get strange cancers. The most common is Kaposi’s Sarcoma. I see about one new case every couple of weeks. Last week, I saw a lady with a fleshy growth on the corner of her eye which my colleague assured me was likely to be cancer of the conjunctiva. I hope that the surgeon sends the specimen for histology so this can be confirmed. My “eye expert” (Mr John Sharp) in UK tells me that these are really tricky to treat, requiring “excision, double freezing/thaw cautery, topical mitomycin C and alcohol application”. If I was doing the surgery, I’d need some alcohol application afterwards, too.

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I have developed a reputation for diagnosing strange neurological conditions. The main reason for this is that I discuss these patients with retired professor, Steve Brown, who lives in Cornwall. I send him videos, photographs and case histories via email. Although we might not be able to cure the patient, with Steve’s help, at least we can begin to understand what has happened and formulate a management plan.

I didn’t need his help to diagnose cerebral palsy in an eight year old child with a spastic, tiptoe gait last week. The child didn’t walk until aged four, but perhaps because she was HIV positive, no one had made the diagnosis. We do have a physio/occupational therapist working at the clinic, but her work is exclusively with TB patients. Luckily, there is a Cheshire Home about a kilometre away from the clinic where the child can get help with rehabilitation.

This next patient was either very lucky or extremely unlucky, depending how you look at him. First of all, he was involved in a road traffic accident. He was a passenger in a kombi which left the road and hit a tree. His arm was crushed, but it was also bitten by an angry snake which was apparently living in the tree. It took eight hours before he was transported to hospital and his arm started to swell alarmingly. The swelling squeezed the forearm muscles in their sheaths, stopping their blood supply. Surgeons cut open the fibrous tissue confining the muscles (called fasciotomy) to prevent Volkmann’s ischaemic contracture. But the radial nerve in his arm had been damaged, causing wrist drop.

Massive amounts of protein leaking from the crushed muscle caused his kidneys to fail (what I used to call acute tubular necrosis, but it is probably termed acute kidney injury nowadays) and he required renal dialysis for a short while. To cap it all, he needed split skin grafting to cover the gaps caused by the cytotoxic effects of the snake bite. His nerve is recovering and his kidneys are doing well. After all this misfortune, he is lucky to be alive.

Some readers have commented that they like to hear what I am doing in the clinic. I apologise if this post is rather gruesome and medical. It describes part of MSF’s work in Swaziland – this is how your charitable contributions are spent. I don’t spend all my time walking in game reserves and attending music festivals.

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Bring Your Fire – Bushfire Festival 2015

The Bushfire Festival is a must-see. It one of the biggest in Southern Africa, with over 25,000 people attending over three days. Admirably, the profits go to charity. It was really well organised. What could go wrong when the master of ceremonies is called Anacondza?

The first act I saw was Nomsa M, a chunky Afro-Jazz singer, with buttercup-yellow dressed backing singers. Not only could she belt out the songs, she could even manage a high kick, way above head height. She sang in siSwati, so I hadn’t a clue what the songs were about. She got the festival off to a great start on the main stage.

Next up was 123, a Turkish indie band, fronted by Dilara, singing like an angel in English. I was fascinated by Secil playing vibraphone. She resembled someone who had been classically trained, wearing serious-looking spectacles and a cardie. She never looked up from her vibes. The band covered Thom Yorke’s Eraser, but not very successfully. They didn’t go down too well with the Africans in the audience.

Haja Madagascar and the Groovy People play Afro-trance music. Their music is based on traditional Malagasy music, such as salegy, bahoejy, antosy and kilalaky. Salegy is funky style, with electric guitars, accordion and call-and-reply vocals, boosted by underlying heavy bass and driving percussion. It has a syncopated, rapid polyrhythmic beat, in 6/8 time, accenting the 3rd or 7th beat. I thought I could detect a North African, almost Arabic influence. It was quite difficult for me to keep in time clapping along with the beat. I’d never make a drummer.

Kilalaky music also has a compelling, rapid 6/8 time, accompanied by synchronised line-dancing, with follow-my-leader. It is supposed to drive dancers into ecstasy (shades of whirling dervishes, Sue Lock?). Researching this online, I read about villagers stomping out footprints in the dust, either to disguise cattle raiders’ tracks or to give aggressors the impression there are lots of people in the village. There is a folk tale that when a king heard Kilalaky, he couldn’t control himself got up to dance, so everyone had to follow suit.

Haja played some “spiky guitar riffs”, accompanied by a South African playing a swooping bass, a Mozambican drummer and Swazi backing vocalists.

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Away from the main stage, True Vibenation were playing in the House on Fire Amphitheatre. The band was made up of Zimbabwean-born twins, now based in Sydney, with a great saxophone player who rapped, hip-hopped and dubstepped when he wasn’t blowing his horn. They really got the house rocking, playing within touching distance of the audience. They even used a “human drum machine”. When the power went down for 15 seconds, they kept the act going and were cheered to the rafters when the lights came on again.

For a few songs I listened to Poni Hoax, French electronic rockers with a classical training. They were loud and frantic, an acquired taste, perhaps.

It was past midnight by now so I didn’t stay for full Shortstraw set. These indie rockers from Jo’burg apparently “deliver infectious summertime music, making for ideal festival vibes”. I should have stayed for another well-known South African group called Freshly Ground, but I was exhausted.

Saturday morning kicked off with the Austrian band, Sweet Sweet Moon. The cello and violin duo made heavy use of the reverb pedal, producing an interesting sound. Most of the previous partygoers were still in their sleeping bags, so the small audience were treated to a more intimate performance.

Bashayi Bengoma are a band of traditional musicians, playing a variety of local instruments. They performed to an appreciative audience in the amphitheatre. Most of the women were playing an instrument called a makayane, a bow with a gourd attached to the staff. Apparently, women put their breast inside the opening of the gourd, sucking it in to create a seal to get a better tonal sound. They then beat the string with a baton. An elderly man was a demon on the concertina and another man tried to get a piece of wood to whisper. Even with three microphones around him, I still couldn’t hear it properly.

Then there was a hiatus, with some mediocre bands playing: Transito, “a Mozambican band producing tight Afro-centric grooves”; Tiale Makhene with Malawian guitarist, Erik Paliani; BCUC (Bantu Continua Uhuru Consciousness) playing some funky music.

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I really enjoyed listening to South African Bongeziwe Mabandla, singing melancholic melodies, folk and traditional, in isiXhosa. He writes his own songs, about the father who left and never returned, or failed love affairs. It was entrancing. His big, bald bass player had dreadful facial acne scarring. I took lots of pictures for my library of medical photographs.

American singers, Sweet Honey in the Rock, were festival headliners. They sang some Miriam Makeba (RIP) songs accompanied by a lady doing sign language at the side of the stage. It was great to see her changing her signing gestures according to the rhythm and feeling in the songs. It looked really neat. She is the odd one out on the end.

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Black Jesus Experience is an Australian jazz take on Ethiopian music. The main singers were accompanied by an ageing brass section (complete with Fu Man Chu wispy beards and ponytails behind balding pates). The Ethiopian singer was brilliant, but when this segued to an Aussie doing hip-hop rap, I was less impressed.

It had been a long day, so I left and had an early night. Dr May needed some help driving to Manzini, so I road shotgun.

Steith Ulvang started the show on Sunday morning. He sang a passionate set of folk-inspired indie tunes, playing intricate keyboards. He was accompanied by Buddy Ryan (not the football coach) on double bass. Some young girls in front of me got really carried away singing along. Apparently they knew the words. I liked how he explained the origin of his songs. For example, he describes how he encouraged some German tourists to hop onto freight trains while he drove their classic car to the West Coast. And they loved it.

Amandla Freedom Ensemble was the first genuine jazz group at the festival. There is a strong tradition of jazz in South Africa, and the group is developing this theme by incorporating indigenous music. I love this quote from Jazz Times about the group:

“Mlangeni’s Amandla quintet wraps elliptical melodies in three-part horn harmonies, rich with impasto, swinging like broken chandeliers. The Soweto native’s compositions pull from church hymns; traditional rituals learned from his uncle, who was a sangoma, or healer: American postbop; the Ornette Coleman Quartet; and the bounding, interwoven cycles of Eastern Cape music.”

Cool.

Grrrreat.

NICE!

(Apologies to Louis Balfour of the Fast Show on TV)

The Parlotones are another rock group from Jo’burg, now relocated to Los Angeles. Kahn Morbee, the lead singer, is famous for his bizarre face makeup. They played at the World Cup 2010 kickoff festival and opened for Coldplay on their tour of South Africa. Their music really got the audience rocking.

The sun was starting to set when The Soil took the stage. They are an acapella Afro-soul group. Wikipedia informs us that “The Soil currently consists of three members. Buhlebendalo Mda (Soil Sister), Ntsika “Fana-tastic” Ngxanga and Luphindo Ngxanga (Master P). Ntsika and Luphindo are biological brothers. During interviews, they usually refer to God as the first member of the group.”

While one person is singing, the other two provide backing using their voice as an instrument and “boombox” techniques. The crowd went wild. Most of them knew the words and were singing along at the top of their voices while they danced. Everyone seemed rather boozed up. I sat down on a borrowed folding chair and could have murdered a cup of tea. I had a little rest before calling it a day because, like Cinderella, I had to leave the festival before dark. It was truly an unforgettable experience.