Strelizia Gorge

How lovely the gorge looks now that spring has sprung. Wildflowers are beginning to bloom. The dried grass is getting greener following the start of the rains. I love the Fire-Ball Lily and the Grassland Tree Ferns, nestling in the valley where there is a bit more moisture. These photographs don’t really do it justice.

I am a veteran walker with the NHSS (Natural History Society of Swaziland) so I was volunteered to be the sweeper. The backstop. The man at the back of the group that kept us all together. The group leader also knows I am a doctor, so I could deal with the stragglers if they had medical problems.

All went well for the first hour or so, but the sun was getting hotter and a large Swazi man sat down beside the path, sweating profusely. This was his first walk with the group. “How did you train to do this walking, Doc?” he asked me. I told him that I didn’t train, I just walked. “But how long have you been doing walking?” he asked. “Since I was a child,” I said. “I enjoy walking for fun.” “Howww! This is fun? I’m dying, Doc!”

I asked him about his fluid intake. He had drunk a whole camel backpack of water. He was drenched with sweat, his autonomic nervous system desperately trying to cool him down. I asked him about any medical conditions, but he said he was fit. Well, perhaps that was a matter of opinion.

Two of his friends came back to support him. One said, “I’m sweating more than him. I had 10 bottles of Sibebe beer last night. Not the small ones, the long necks,” he said. “It is pouring out of me now.” That is 7.5 litres of 5% lager.

I herded them up and we pushed on up the hill to the next bit of shade. Two small boys wearing ragged tee-shirts and no shoes strolled past us. “Here’s 20 Rand, boy, get me a cold drink,”said the largest man. We were probably 5km from the nearest Spaza Shop (also known as a tuck shop, where coolish drinks might be available).

“How far is it to the waterfall, Doc?” he asked me. I told him that I’d not done the walk before, but it was at least another 2km. “Howww! In this heat? Tell me it is closer.” His pal said, “Let’s just think of it being half a kilometer away. We’ll walk that distance, then stop for 15 minutes, and tell ourselves it’s just another half kilometer after that.” Interesting motivational philosophy.

By now I couldn’t see the rest of the group. I said that I would have to go on ahead to contact the leader and let him know that we were having problems, but I would definitely be coming back for them. One of the group told me not to worry. “We’re farm boys, Doc. We’re Swazis. We can handle this, it is our country.”

The leader had stationed walkers at strategic points on the path to guide us. I crossed a gully and walked up a muddy track in the forest to find Eric, our leader. He told me to send the fat man back to where we had left the cars, with one of his friends. Good plan. Why hadn’t I thought of that? I returned to the stragglers, who had managed another 100 metres before collapsing under a tree fern.

“No, I’m not going back. I can do this, just give me time,” the big man said. I encouraged him to go slowly and steadily, rather than trying to rush until his energy gave out. We were so far behind by now, that I needed to go on to scout out the route, as we were out of visual contact with the main body of walkers.

I waited at the next fork in the path to make sure we went the correct way. While doing so, I took these photographs. The lads asked me, “Seen anything interesting, Doc? What’s that flower called?” So much for being Swazi farm boys!

Eventually, we reached the waterfall and the lads could cool off in the mountain stream. On the way back, I chose to go the difficult route, under Tortoise Head Rock, and someone else had to be the sweeper.

Conversations in the Clinic

I am fascinated by how Swazis name their children. I can understand the delight of having a new baby. Names such as “Happiness”, “Lucky” and “Precious” make perfect sense. But what about calling the most recent addition to your family “Futhi” which means another girl or even “Sanelisiwe” which translates as we have had enough girls.

Another great name is “Velaphi” meaning where are you coming from? as in an unexpected arrival…the husband might not have been around nine months ago.

Names can be male or female. I met a married couple in the clinic whose names were Andiswa and Andiswa. To avoid further confusion, they called their child Bongiswa.

I saw a pregnant lady with pica, a disorder characterised by having the desire to eat strange stuff, such as coal or soil. She had been eating red ochre, which is commonly used for dressing wounds or for husbands to daub their new wives, demonstrating their ownership. It is actually iron oxide, and perhaps it was a traditional treatment for anaemia. This wasn’t her concern. “Can it cause fibroids?” she asked me. “I don’t know, but no one knows what causes fibroids so the answer is probably not,” I replied.

Part of my remit is to improve how we manage non-communicable diseases, such as diabetes and hypertension. In line with practice in UK, have introduced an annual check up for diabetics. This includes a few blood tests and an examination targeted at feet and eyes. As I was winding up the consultation with one ancient gogo, I came over all patient-centred and asked her about concerns and expectations. She wasn’t having any of that new-fangled stuff. She said, “I want you to hurry up, I’m hungry! I’ve been starving for that blood test since last night.”

A 29 year old lady was complaining of lower abdominal pain. “Are you single?” I asked. What I heard was, “Yes, I’m desperate,” but she had actually said, “Yes, I’m stress free.”

This led on to a discussion of relationships with men. “Men, they ask you where you live, they visit you in the evening, but the next morning they read their newspapers and go back to their wives.”

I have seen some tee-shirts with interesting logos in clinic recently. As I was performing an intimate examination I looked up to see “Look but don’t touch”. Another young man had a tee-shirt inviting you to choose between petrol and milk. “What do you choose?” I asked as a conversation opener. “Petrol,” he replied immediately. “Don’t you like milk?” I asked. “But I am taking this medication (tetracycline) and the packet says I cannot drink milk or milk products with it.”

Now that Manchester United is at the top of the Premier League, more patients are wearing their merchandise. This lady obviously is a fan of Wayne Rooney, the team captain.


I was impressed by another gogo who was wearing a fluorescent yellow Adidas running shirt. I had asked her to do more exercise, but this was taking my advice too far. I was less impressed with her running shoes, though.

When I googled this logo, I found it was not a spelling mistake as I had imagined.

More conversations:

ME: This kind of problem is often related to stress. Are you aware of any stressful situations in your life at the moment?
HIM: Since the day I got married I have had stress.
ME: OWW! (This is a Swazi expression indicating shock and surprise)

ME: Your blood pressure is good, but your sugar is still high. Your weight has increased by 7kg this year. Are you taking your high-high and diabetic medication regularly?
HER: My stomach is getting big, docotela.
ME: Why do you think that is happening?
HER: Because I am eating all the time. I even wake up in the night and I am hungry, I eat and then I drink lots of water.
ME: What do you eat?
HER: Salads, mostly.
ME: Lettuce and tomatoes? That shouldn’t make your tummy get fat.
HER: I eat salads of potato, mayonnaise, boiled eggs, pasta.
ME: Okaaaay. Well, that would explain it. Are you eating because you have hunger pains at night ? (I ought to explain, hunger pain relieved by food or milk is a symptom associated with duodenal ulcers, which are common here.)
HER: I don’t have any pain in my stomach at night, but I do in my legs. I feel there is something inside my leg, moving about like a worm, making the legs prick and burn. It feels like the worm is causing ulcers inside my leg. I think if I feed the worm by eating it will not move around so much and cause me pain.
ME: (Thinks – please don’t ask me for de-worming medication) Sigh.
INTERPRETER: Docotela, do you think she should take Herbex?
ME: What is Herbex?
INTERPRETER: It is advertised on the TV. “Herbex attacks the fat”.
ME: I think she should just eat less.

The young man looked anxious. I dealt with his presenting complaint and asked him if anything else was bothering him.
He said, “Yes, I have a child.”
“Is the child sick?” I asked.
“No, he lives with his mother,” he replied. “I have to pay 400R (about £20) maintenance every month.”
“And how much do you earn?” I asked.
“1200R a month.”
“So a third of your money goes to your baby-mother,” I said.
“Yes, children are expensive. And just wait till I have to find school fees. Aish!”

This is a common problem. Look at this article in the Swaziland Observer:

Straight Outta Compton

It was much too hot to walk this afternoon so I went to see Straight Outta Compton at the cinema. When I arrived, the cinema was half full, virtually all young Swazis who were busy WhatsApping and scoffing pop corn.

Many of the audience came in late, some fifteen minutes after the film had started. People kept leaving the screening in order to get more drinks and snacks. During the “boring bits” where the plot was being developed, smart phones lit up across the cinema, as the audience checked for messages on their Facebook pages. It wasn’t like this when I last sat in the Odeon in Leicester.

Spoiler alert!
At the end of the film, Eric “Eazy-E” is in hospital, suffering from a chest infection. The specialist doctor comes into his room and tells him he has HIV. He says, “The normal CD4 count is 500-1500; your count is 11.”

At this, a section of the cinema audience scornfully jeered. I don’t think this was a reaction to the flawed genius getting his comeuppance. I genuinely felt that the young people in the audience were relating to Eric’s predicament. In 1993, being told you had a CD4 count of 11 was tantamount to a death sentence. In 2015, it just means that you are late starting the anti-retroviral medication which will provide your rescue. Eric was just unlucky to have contracted HIV ten years too soon.

Before anti-retroviral medication became widely available in Swaziland, it is estimated that HIV/AIDS was responsible for the population falling from 1.4 to 1.0 million. Nowadays more and more people living with HIV are taking medication which is keeping them alive. We start at least a hundred patients on HIV medication every month at the clinic.

Swazis know that effective medication is freely available. If you take the drugs correctly, your immune system will recover and the virus will be suppressed, you are going to live. Unlike Eric “Eazy-E”.

Strictly Come Swazi My Favourites

This man’s back was ramrod straight. He looked impeccable. His partner was petite, nimble and gorgeous. They looked really professional.

I must admit I used to slip my tongue between my lips when I was concentrating.

This boy was the only one singing along to the Swazi National Anthem. But I caught him lip-synching.

Great jiving, just like Nicky and Mike Drucquer.

Purple haze – very refreshing to see dancers who are not built like stick insects.

My final selection of photographs from the competition. I am sure that you will breathe a sigh of relief. Back to what’s been going on in the clinic in next week’s post.