“You have risen me up from the dead!” said the delighted gogo. I hadn’t a clue how I had done this. I try to do my best for my patients, but I don’t do miracles. She saw from the look on my face that I was perplexed. “You cured my sugar, docotela,” she said. “Don’t you remember?”
Well, I had diagnosed and treated her diabetes after she’d been unwell for months. But now I had to get over the message that diabetes was for life, and would always need treatment. It is true that some people can change their lifestyle so radically that they can become non-diabetic (take a bow, father), but this is rare. Some Swazis find the concept of needing to take medication continuously for a chronic disease rather strange. Doctors are powerful, their “muti” (drugs) should be able to defeat the disease. Once the hypertension or the diabetes is controlled, they think the job’s done and there is no need to continue taking medication, especially when they feel well.
A few days ago, a young lady, who was carrying a baby on her back, gave me a beaming smile when she encountered me in the clinic corridor. “Your special muti has made me a new person. I feel great on the new tablets,” she effused. This isn’t normal Swazi behaviour. People often avoid eye contact with their “betters” and would not normally approach their doctor in such an outgoing, disrespectful way. I smelled a rat. Could this woman be one of the fifty or so patients whose medication I had switched from NVP to EFV? Is this the beginning of euphoria leading to mania?
I might well be suspicious. Yesterday, I saw a woman in clinic who had become acutely disturbed a week after starting EFV. She had stopped sleeping, was pacing around all night, could not stop talking and accusing her neighbours of plotting against her. She had even trashed her room (“She has become a vandal, doc!”). She escaped from the clinic, pursued by her relatives, whom she called “demons”. I ran after them and caught up with her when she sat down in the driveway of a housing estate after being denied access by security guards. She was lustily singing hymns and rolling her eyes. She told me I could not treat her because I was in a different century. I offered her some medication, but she dashed the 10mg haloperidol and diazepam out of my hand.
I left her with the security guards and went back to the clinic. We informed the police who were empowered to take her to the National Psychiatric Hospital. They didn’t have a vehicle available, so we sent our ambulance to pick up the constables and transport them to the patient.
‘All the world is queer save thee and me, and even thou art a little queer.’ Robert Owen
A man in his 40s came to consult me about his failing memory. I fell into the trap immediately. “How long has this been troubling you?” I asked. “I don’t know. I can’t remember,” he replied. He reached into his plastic bag and pulled out a sheaf of loose medical records. I saw an A4 pale green card, only used here by the National Psychiatric Hospital. “Can I have a look at this?” I asked. It showed that he was taking a small dose of carbamazepine, which is the standard treatment for bipolar affective disorder ( what used to be known as manic depression).
“Do you go to see Dr Violet, the consultant psychiatrist?” I asked. He couldn’t remember, even though he had been given a prescription just four weeks ago. He said he was running out of tablets, so I gave him another prescription, wrote on his psych records and asked him if he would remember to take the medication. “I hope so,” he replied.
“My faith healer has told me that my baby’s umbilical cord is too thin, so I must have an operative delivery,” said the anxious young lady in front of me.
“How did he diagnose this? Does he have an ultrasound scanner?” I asked.
“No scanner, he just put his hands on my bump,” she replied.
“Why have you come to me? Why didn’t your healer refer you directly to the hospital for the delivery?”
“I don’t know. He told me to come to you. But you must send me soon, to stop my baby from dying,” she said.
I examined her. She was 17 and about 32 weeks into her first pregnancy, abandoned by her boyfriend and berated by her mother. I couldn’t find anything wrong with her pregnancy, so I sent her to our psychosocial counsellor at the antenatal clinic. Unfortunately, no one could persuade her that the baby was growing normally. I gave in and referred her for an ultrasound scan.
A week later, accompanied by her mother, she came back to clinic with the result. It was fine: cord seen, normal diameter, normal pregnancy. Her mother sat beside her with her arms folded under her ample bosom. She started to answer all the questions I directed at her daughter, so I had to find a way of shutting her up. “Ok, ma, tell me what you think about the situation,” I said.
This unleashed a non-stop diatribe – she should never have taken up with that useless boy, she knew about contraception but didn’t use it, now she’s pregnant, HIV positive and going to be a single mother. Her chances of having a career are over, she’s going to be a professional baby mother from now on. This pregnancy has always been ill-fated. She has vomited for most of it, despite using western and traditional medicine (drinking lemon juice and water then eating orange peel). Probably been vomiting her HIV medication, too.
I felt I had to intervene. This poor lass had had a rough time, I said that she needed some support.
“That’s why we took her to the Zionist pastor, who specialises in helping pregnant women. He has got a big reputation. He helps everyone.”
“Is he the one that uses Nigerian ‘holy water’? ” I asked.
“No, we went to him as well, but it didn’t work.”
“Right, you have had your say, ma. Now I want to hear from your daughter.”
She was in tears, of course. A frightened girl whose dreams of romance had been dashed. I tried my best to salvage some of the good bits. The baby was normal. The HIV medication would greatly reduce the risks of the baby being infected. There was still the chance she could continue her education and pursue a career, with help from her family. She dried her eyes and said she would come back and see me in two weeks.
The nurse seeing outpatients had gone for her hour-long lunch break and the queue was stretching down the corridor, so I stepped in. My first patient was a large lady weighing well over 100kg. Someone that Alexander McCall Smith (author of The No. 1 Ladies Detective Agency) would describe as “traditionally built”. We discussed her headaches and sides pain for a while, then I noticed her legs. The right leg was distinctly fatter than the left. “I have pain in my left leg, it can’t walk properly, it feels weak. Look, it doesn’t look strong,” she said. As she was so large, I examined her while she was sitting down. I told her I thought that it was the right leg which had the problem, but she insisted I was wrong. With a lot of heaving, I managed to get her up onto the examination couch. I was sure the problem was an old deep vein thrombosis in her right leg.
I called in a senior nurse to help me. Perhaps I was losing something in translation. He chatted to her for a while and told me that indeed she had been to hospital when this first happened. The doctors had told her that there was a blockage in the veins. But this was so long ago that she had forgotten which leg had been affected. Her thinking was that a large fat leg must be stronger than a thinner leg.
On the front of her medical records book it said that her religion was Zionist. This Christian sect draws its inspiration from the Old Testament. As part of the service, the congregation en masse walks round and round a central post in an anti-clockwise direction. I had a sudden brainwave. If she has a weaker left leg, it would suit her when walking anti-clockwise around the pole at church. I couldn’t resist asking her if she circumambulated at church. She said she was too tired to do that, she just sat and watched from her pew.
Borderline 