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.

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