I saw a patient whose name was Serious. I asked him why his parents gave him this name, but he said he had never asked them. Very strange. I would definitely have wanted to know. Fortunately, he had nothing serious wrong with him.
We have had a few cases of mumps recently. I found out the traditional Swazi way to treat this illness was for the sufferer to go to a termite mound and shout out, “Take these mumps away from me!” Then the patient had to walk home without speaking to anyone. In contrast, Zambians with mumps would make a bundle of sticks, put it on their head, walk to a fork in the road, stay there until the sticks fell down, then walk home without speaking to anyone. It is all about unloading your problem, I suppose. Fascinating.
This photograph shows five generations. The little girl is with her grandmother and her great-great grandmother. I thought this was remarkable until they told me that on the other side of the family there are six generations still alive. This is the first Zimmer frame I have seen in Swaziland.
One of my beloved gogos was complaining about her backache (caused by a mix of osteoporosis and spinal arthritis) and she described it as being “like fireworks going off in my backbone”.
Another old lady in her 80s was having trouble with her arthritic knees. “I bet you were a good dancer, back in the day,” I ventured. She told me that she had danced for the previous King, Sobuza II, at umhlanga (reed dance), along with 10,000 bare-breasted virgins. He didn’t pick her to be his bride.
I can see many patients with trivial illnesses, such as having a headache for a few hours, or an episode of diarrhoea last night, and then someone with fungating breast cancer turns up (I am not attaching any photographs, don’t worry).
Today I saw someone who had nursed his brother in his final illness. Shortly after his brother died of tuberculosis, my patient developed pain in his testicles. He had been treated several times for non-existent sexually transmitted infections at hospitals and health centres. He even had an ultrasound scan which showed no abnormality. He thought he had contracted tuberculosis in his testicles. This is very rare; I have only seen it twice in 38 years working as a doctor. I examined him and his package was completely normal. It took a while to convince him that this was health anxiety, probably related to his brother’s death from TB. It can be difficult “re-framing” the problem in these terms, but he agreed to take notice of what was happening in his life when his testicles began to ache, rather than concentrating on his genitals. He’ll come back if he feels this has helped him.
A few patients later, I saw a man who had had “drop” (urethral discharge from gonorrhoea) for a month before seeking medical attention. He dropped his trousers to reveal a painful pair of gonads the size of a couple of tangerines. The infection had tracked inwards from his urethra, down his vas to his testicles, causing epididymo-orchitis (how many points can you get from that in Scrabble?).
The nurse running the under 5s clinic called me to see a 19 month old child with a lump on her arm after having been vaccinated against measles four weeks previously. Not surprisingly, the little girl developed a rash resembling measles about a week after the vaccination. We normally warn mothers about this. However, this mum had taken her child to another clinic, where the nurse diagnosed chickenpox and gave the child an injection of procaine penicillin, vitamins and paracetamol. The lump was the size of a ping pong ball and fluctuant – it felt squidgy and I thought there was some pus deep inside. I aspirated about 2ml of thick, yellow pus and started her on some antibiotics.
This is unusual, so I had a word with my supervisor who told me that she had seen tuberculosis present like this. I was so surprised that I went back to the clinic room and hunted through the sharps box to find the pus-filled syringe. Normally, this is against all the rules, but the sharps box was so full that the syringes were sticking out of the entrance and it was safe to find the correct one without getting a needle-stick injury. I took it to the lab and asked if we could do a Z-N stain on a smear of the pus to look for mycobacteria.
Finally, I thought a patient’s symptoms might be related to their employment:
“What work do you do?” I asked.
“Nothing interesting,” he replied.