Dancing to/on a different beat

It was cold and windy this morning. The policewoman on point duty looked like she was doing a little dance. Her arms and legs were moving rhythmically as she stood on the crown of the road. As we got closer, it became obvious that her shimmy was really an attempt to keep warm. Perhaps she was the syncopated majorette leading the Royal Swaziland Police Band, which is wheeled out at all major events?

The police in Swaziland don’t bear a strong resemblance to the police in UK. True, they sometimes wear flat-topped caps with a black-and-white chequered band and look smart in white short-sleeved shirts with epaulettes. But more often they dress like paramilitaries, with dark blue overalls, baseball caps and army-style black boots. Like UK armed response units.

When they are directing traffic, their hand signals are very stylised and stiff, a pastiche of a British copper. They are also usually friendly, so I have to avoid acknowledging them a wave when our stationary vehicle is directed to move. They are quite likely to wave back and cause traffic chaos.

The "Name and Shame" list of those caught driving whilst under the influence of alcohol. The headline writer shares my sense of humour.
The “Name and Shame” list of those caught driving whilst under the influence of alcohol. The headline writer shares my sense of humour.

At exhibitions and public events, the Royal Swaziland Police often have a stall to educate the public on their role. I picked up a few of their leaflets in Mbabane last month:

“Stock Protection” – How can you protect your livestock? Keep shepherds around your stock. Make sure your stock is locked into a strong kraal by sunset. If your stock is stolen, you will need indisputable evidence that it belongs to who claims it (sic). Full descriptions of the stock needed, eg colour, etc.

ROAD BLOCKS: Help us to make the roads safer for you. Roadblocks are intended to prevent accidents by lowering the speed at that specific point and to make positive contact with road users. People die on our roads because of: driver’s attitude, etc.

“What GUNS do to people” – Did you know? Because guns are designed to kill, the injuries they inflict are very severe, and so expensive to treat. If you want to defend yourself, why not try some alternatives such as self defence classes, carry gun sprays, personal body alarms, paralizers or shock umbrellas (sic). If you feel you are in danger, seek help. Anyone living with a threatening should seek support. Report all illegal guns, save yourself and your loved ones. Report any suspicious incidents which may lead to gun fire.

Yesterday, just before noon, there was a gunfight around the corner from the MSF office in Manzini. According to the press, it was a dispute over money.

“While everyone’s eyes were glued to the scene that seemed to turn ugly, one of the five men is said to have shouted that the …man in the Mercedes should do what he wanted to do. In fact, the man is said to have shouted “Shoot me if you can” little did he know that the man was fully armed as he had a 9mm pistol as his side arm.

In response the gunman also shouted “Sengidziniwe nguwe mine”. Within two shakes of a duck’s tail, onlookers said the passenger in the Mercedes produced a gun and shot at the man.”

Realising the seriousness of the matter, the four other men ran helter skater (sic) and this is when the gunman shot at the other two.”

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Dreams

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Some mornings, my father would say that he’d done a “second shift”. This meant that he had relived the previous day’s work in his dreams. It’s happening to me now. Perhaps it is because I am sleeping lightly because of the heat, so I wake up during the rapid eye movement phase, when dreaming occurs. Or maybe it is because my brain has such a lot to process from the preceding day. I think it is a little of both, exacerbated by the sustained effects of drinking a litre of coffee at the Forester’s Arms on Sunday.

The clinic has been busier than usual recently. I have seen so many people living with HIV who have complications that one pleural effusion blurs into another. Some sights are pretty ghastly, and those images are seared into my cortex as well as my camera’s memory card. Don’t worry, I’m not posting any horrific pictures with this blog. But the poor middle aged lady who kept complaining of a vaginal discharge, who had been unwisely treated as though it had been a sexually transmitted disease with antibiotics for over a year, did rattle me. The upper part of her vagina was rotten with cervical cancer. The unfortunate lady stank. So in my dreams I am treating her all over again. I can even smell her. And see her uncomprehending but grateful face when I tell her what’s wrong.

I diagnose and treat people in my dreams but sometimes I wake up with the feeling that I have missed something, forgotten to do order a blood test or an X-ray. Interestingly, I don’t dwell on my mistakes in my dreams. Maybe that is a psychological defence mechanism, protecting me from self doubt and recriminations that I could have done better. Perhaps it is because I am not aware that I have missed a diagnosis. People often shop around for medical care in Swaziland, so if my treatment didn’t work, the patient tries someone else, rather than coming back to confront me with failure. I continue in blissful ignorance.

Sometimes when there is no clear diagnosis and I can’t do all the fancy tests that would be done in UK, so it’s a question of let’s suck it and see. A trial of treatment. If they get better, then it is likely that my best guess was correct. If they don’t, think again. When it goes well, you pat yourself on your back. A little victory that makes work enjoyable. When it goes wrong, you justify your action by telling yourself it was worth a try.

Yesterday, I genuinely didn’t know what was wrong with one chap, who just kept on getting progressively worse, despite our attempts to cure him. I sent him to hospital because I had run out of ideas. I didn’t dream about him last night. My brain had already been wracked and found wanting, so there was no corner left to probe, no point in dreaming about him. Or, thankfully, he was no longer my problem. That is, until the hospital discharges him, having found nothing treatable.

Unlike “Who Wants To Be A Millionaire”, I can’t remove two wrong answers. I occasionally ask the audience if it is a local problem of management – “What would happen at St Elsewhere’s Hospital if I sent this patient there, do you think?” But my favourite decision making aid is calling a friend. I have a swarm of specialists in UK who pander to my needs and respond to emails with digital photographs attached.

Getting up in the morning after having “done a second shift” is tiring. I don’t feel completely rested, refreshed and ready to start the day. But after a couple of cups of strong “Five Roses” tea and some Weetabix, I perk up and by the time I get into the LandCruiser to go to the clinic, I’m fully charged.

Kombi Number One

New kombi slogans spotted recently:

“Never Mind”

“Facebook”

“God is in”

“It’s a long walk”

“Mr Nothing”

“Poor man’s friend”

The robots take a long time to change at the Nazarene Junction of the main road from Manzini to Mbabane. En route to the clinic one morning, we pulled up to the traffic lights just as it turned red. A red light in Swaziland does not indicate stop. It means, “Go on, then, just a few more.” But our MSF drivers obey the Highway Code and we duly stopped. A kombi drove up next to us and the driver got out of the vehicle, threaded his way through a couple of lanes of traffic, and walked a few paces onto a piece of waste ground. He unzipped his fly and started to pass urine.

This wasn’t just a quickie. It went on for about a minute. The nurse said, “It must be the first of the day for him. Always a long one.” He didn’t have prostate trouble, either. His stream was impressively strong. All of us in the vehicle were watching him intently. We were mesmerised. Was he going to finish before the lights changed, we wondered? Could he shake the drops off before the traffic moved off?

It was easy, never in doubt. He nonchalantly strolled back through the queues of vehicles, casually zipping up his fly on the way, totally indifferent to the stares of his captive audience. He opened the door, and swung into his seat, with at least ten seconds to spare before the traffic light turned green. Perfect timing, wonderful control. But, to parody Bob Dylan, “If you gotta go, go now…’cos the lights they are a-changing”.

This has absolutely nothing to do with the text
This has absolutely nothing to do with the text

Passing urine is one thing, but what about the other? I read an article in the Swaziland Observer which described how Nigerians dealt with the problem of public poopers. They add dried chilli peppers to the desiccated faeces and set the shit alight. This apparently causes the distant anus of the perpetrator to burn painfully, wherever they are. Works a treat.

Yesterday afternoon, while waiting outside the clinic for the vehicle to take the staff back to Manzini, I spotted a flatbed truck stacked with a load of toilet closets. Quick as a flash, I said, “Ah, it’s Toilets on Tour, a real bowel movement.” The staff of the ART clinic don’t always understand my humour. A nurse looked at me quizzically and asked, “Do you mean the mobile toilets, docotela? There must be a big funeral somewhere tomorrow.”

 

FIFA 2018 World Cup Qualifying Match

Last week, the Swaziland National Football Team returned home after drubbing Djibouti 0-6. Unfortunately, the Djibouti team got stuck in Kenya on their way to play the second leg at Somhlolo, Swaziland’s National Stadium. They made it with a day to spare, but it must have disrupted their concentration and preparation.

I must admit, I went to the match hoping to see lots of goals. I wanted to grab a good vantage point. It looked as though there were plenty of free seats in the central part of the South Stand, but when I got there, this area was reserved for VIPs. The very best seats were reserved for VVIPs, but hardly anyone was sitting there. I sat half a dozen rows from the back among a group of serious Chelsea fans. Well, they were wearing Chelsea livery, anyway. A few minutes later, the Royal Swaziland Police Band marched out onto the pitch. A fat sweaty copper ran down the side-line, opened his music case and hastily assembled his trombone. He just managed to join the band before they struck up.

After the national anthems, the RSPB were led off by a majorette, twirling a long silver topped baton. Instead of marching with military precision, she was adding lots of funky moves to her repertoire, while beaming at the Swazi crowd. We cheered her to the rafters. She alone was worth the price of admission. That’s not saying much as it cost less than £1.50 to get in.

Djibouti kicked off, with their centre forward cheekily trying a long punt, hoping to catch the Swazi keeper off his line. It wasn’t difficult to see the Swazi keeper because he had white kit, with fluorescent green and yellow flashes. In the event, the kick was blocked.

The opening minutes were frantic. It was like watching a kids’ game, kick and run. The ball seemed to run in favour of the Swazi team. After just six minutes, the centre forward, Hlatjwako, got the ball in the net. The crowd went wild. It seemed as though we were in for another goal-fest.

The players’ ball control skills were lacking. They could hardly string three passes together. Tiki-taki this was not. Perhaps the poor quality of the pitch contributed to the errors. Sihlango, the King’s Shield, started to become cocky once they had the lead. But on 22 minutes, Djibouti got more players into the penalty area, and Liban scored. The crowd fell silent, apart from a dozen Djibouti fans (one of whom was cunningly wearing a Somalia shirt), who went crazy.

The crowd grew anxious. Obviously, it was time for a snack. Not content with a bag of nuts, Swazis wanted something more substantial, such as boiled corn on the cob. The lady next to me bought one. She ate it like a typewriter platen, starting at one end and gobbling down to the other end. I was half expecting a “ding” telling her to throw the carriage. When the game became more exciting, she nibbled faster. Just before the end of the half, Hlatjwako nodded the ball past Djibouti’s keeper to restore Swaziland’s lead.

At half time, the stadium’s loudspeakers screamed into life with some catchy Afrobeat rhythms. Half the crowd stood up to dance. After the humdrum first half, the spectators were certainly getting their moneys worth with the musical entertainment.

The players came out for the second half, but the dancing in the stands continued in true African style. In turn, one of the crowd of dancers would shimmy down the steps, throw some super shapes and then return to the group for another to take over. The action on the pitch was so scrappy that the spectators in wheelchairs on the side-line twisted around to watch the dance action in the stand. Even the TV cameras swivelled to take in the show instead of recording the game.

Neither team managed a shot on target in the second half. Sihlango seemed happy to sit on their slender lead. Whenever a wayward shot missed the goal, a man in front of me blew his vuvuzela making a loud raspberry. Swaziland’s “big number 9 shirt” squandered several chances, causing the rowdies in the crowd to make a rolling over gesture with their hands. They obviously wanted him to be substituted. Despite having scored both goals, he went off with ten minutes to go.

At 5:50pm, the final whistle blew. Bring on Nigeria’s Super Eagles in the next round. Everyone filed out of the stadium, apart from me. I had to wait 50 minutes for a driver to come from Manzini to Lobamba to pick me up. By then it was dark, and most of the stadium lighting had been turned off. But I got home in time to see New Zealand demolish France in the Rugby World Cup.

Spreading the Word Part 2

Fast forward a week from the previous post and I am back in Kwaluseni, but this time with forty-one female local leaders and opinion formers. There were only two dozen ladies there when we arrived at the community centre at 10am. We weren’t quorate by 10:30, but we kicked off regardless. After a prayer, we began with introductory remarks. Rather foolishly I tried to crack a joke. Swazis are very literal people and don’t normally understand my humour. Nevertheless, I said I wasn’t bothered so much about having fewer participants as last week, because that meant more cow hooves and head for the rest of us. Just as I said this, my translator’s cell phone chirped, and he stopped to take the call. My orphaned joke was left stranded in mid-air.

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Tumbleweed moment as my joke fell flat

The weather took a turn for the worse. A gust of wind rattled the metal windows and snapped the ripped tarpaulin over the outdoor meeting area. As the rain started to drive in from the north, I saw another group of ladies hurry towards the community centre to join the meeting. We had to rearrange the chairs and bring in a couple of benches to seat the newcomers. But the bigger group seemed to lend itself to more lively discussion. After two hours, we had exhausted the subject  of sexual and gender based violence. People were getting hungry. The rain had stopped and the sun came out as we filed out to get lunch.

Last week’s cow head and hooves had been stewing in a massive cast-iron cauldron for hours. The sturdy lid bore the name “Falkirk”. When I took a peek inside, I was disappointed. The hooves were still hairy. An off-duty community policeman helped to serve up the portions. At least, I think he was off-duty. He still had handcuffs and a baton attached to this belt, even though he was not in uniform.

I tore off a strip of plastic wrapping to hold my share of the cow. I could see it was a knuckle, with rubbery straps of ligament attached. There was no actual meat. I chewed and sucked, but couldn’t find a way into the joint. It tasted and smelled dreadful. The two psychosocial counsellors with me pretended to be excited by the cow, but when it came down to it, they didn’t eat any. My share went into the back of the LandCruiser and proceeded to attract a cloud of flies.

Back at the clinic, I did my Lady Macbeth impersonation, scrubbing away at my hands trying to expunge the reeking odour of stewed cow bones. Like her, not very successfully.

“What did you think of the cow hooves, Doctor Ian?” the staff asked.

I replied, “Well, in England, we call this offal. And this offal was awful.”

Spreading the Word on Sexual Violence

How do you change hearts and minds? Well, we certainly don’t have anyone “by the balls”, as Chuck Colson (a presidential adviser to LBJ) said, so we will have to rely on persuasive argument. Rates of sexual and gender based violence (SGBV) in Swaziland are shocking. Recent studies by UNICEF and the Centers for Disease Control in Atlanta (2015) say that 37.6% of children have been sexually assaulted in the Kingdom. A sixth of women reported that have been forced to have sex.

Gender based violence is basically women being abused. It does not just happen in Swaziland. The figures for other African countries (Uganda 46%, Tanzania 60%, Nigeria 81%) are much higher. Oppression of women, whether by sexual domination or physical aggression, is all about wielding power.

We use the term “survivors” rather than “victims”. Some might feel that insisting on using “survivors” is just playing with words. But to me, a survivor is someone who has kept going after an awful event, they are recovering, putting the past behind them. On the other hand, a victim is the name for someone who is still in trouble, suffering and defined by what happened to them. Survivor is active, victim is passive.

The MSF clinic at Matsapha has a dedicated unit for SGBV. To avoid referring to it as the “rape clinic” we call it “Room 72”. This is a reference to the need to get help within 72 hours of a sexual assault to get effective, preventative medical care. Where needed, we give emergency contraception, drugs to prevent survivors from developing HIV (“Post Exposure Prophylaxis” – PEP), a cocktail of antibiotics to deal with potential, common sexually transmitted infections, and vaccinations against hepatitis B and tetanus.

I analysed our statistics recently. Our clinic has seen 62 cases of sexual violence this calendar year, aged between 2 and 50. Almost all the survivors are female. Just three out of 62 are male. Two thirds of the survivors are school-children, aged between 7 – 19.

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We spend a lot of time, money and energy on health promotion. It was sound sense to target maidens attending the Umhlanga ceremony to raise awareness of our services. We have a dedicated toll-free number available twenty-four hours a day, with a trained psycho-social counsellor offering advice. We hand out bright blue business cards, written in English*, to advertise the clinic. Larger postcards, written in siSwati and English, explain in greater detail why it is essential to get treatment as soon as possible. We have newly designed posters to hang throughout the district.

I want to target schools, both Primary and Secondary, in the surrounding area. We have plans to hold debates for older pupils, and use storytelling, poems, drama for the younger ones. But this needs approval from the Ministry of Education. I have had very fruitful meetings with officials from the regional office, but we now have to pitch the idea to the national Director of Education in Mbabane. It isn’t easy getting an appointment.

In Swaziland, health promotion campaigns start with the traditional leaders in the community, the chiefs and indvuna. These are usually older men. The meetings can drag on for hours, as everyone wants to have their say, even though their opinions are almost identical. As the dialogue is in siSwati, I find it really difficult to follow the action, even with a translator scribbling notes for me on a pad. Nevertheless, they are powerful “opinion formers”, so convincing them about the need to prevent SGBV is an important part of the campaign (regardless of the fact that virtually all perpetrators of SGBV are male).

Last week I attended a meeting of men at Kwaluseni Community Centre. It was scheduled to start at 9am, but the participants took their time to arrive. Eventually, we commenced at 10:30am. I was pleasantly surprised to see some younger men in the group, as well as the usual mkhulus (grand-dads). After introductions, I tried a trendy approach, asking the participants what they knew about SGBV, did they have any experience of it, what did they think of it.

This led to a wide-ranging discussion for twenty minutes. “Rape is the fault of those young girls wearing provocative short skirts,” said one older man. Another man questioned the parenting style, “because fathers and brothers must be involved when it comes to how the women dress.”

I just had to respond to this. “So if I park my car and leave the keys in the ignition, I might be foolish. But if you give in to temptation and steal it, you will still be breaking the law.” This triggered much nodding of heads and mumbling.

“Some people are so poor that the whole family has to sleep in one room,” said another.

Finally, a younger man spoke up, “Is this meeting supposed to be a free for all? It’s wasting time. I want to hear from the doctor and nurse what services they provide!” That was a bit of a shock for the old ones, who are used to chewing the fat around the campfire in the evenings.

I took the floor and told the meeting about the services we provide in Room 72. “Did you already know this?” asked the psychosocial counsellor. Most of the audience had no idea that anti-retroviral medication taken within 72 hours could prevent HIV infection.

The discussion moved on to the rape of young children. The men could not understand this, and thought the perpetrator needed help as they must be mentally ill. “Those people need Jesus, to make them behave like humans.”

I spoke about young children being sexualised by older children who had downloaded pornography onto their smart phones. One man in all innocence said, “Yes, when I am watching a porno DVD, my children come into the room to see it, too.”

“We can’t control our children now, because of children’s rights. It’s a crime to beat a child, so how can we influence their behaviour?”

“We have moved away from traditional solidarity in the village and now people act like animals. Not so long ago, the whole community helped to raise children. Now you cannot criticise a neighbour’s child without offending the parents.”

“But some men do harm under the influence of alcohol. How can we stop men from drinking?”

I spoke about the Umhlanga slogan “Discipline to correct, but not to hospitalise.” The maidens understood that physical discipline was needed to make them behave, but this must not be so severe that children needed medical attention. The psychosocial counsellor told me that the audience were shocked by my making this observation. They said that they were fed up with being told what they must do by visiting dignitaries, and it was refreshing to hear from someone who understood their culture. Gulp.

“You should have invited women to this meeting,” said another youngster. “We will be holding another meeting with the women next week,” said our psychosocial counsellor. “But we wanted to speak to you as respected members of your community so that you could influence the behaviour of other men.”

The audience formally thanked us for coming and said that they appreciated the good work we were doing. The men filed out to get their free dinner – cow tripe and intestines, with maize meal pap. Uncharacteristically, I declined to join them.

I noticed that there were two plastic bags on a chair behind reception. One was filled with cow hooves, the other was a cow’s head.

“That’s the meat for next week’s meeting,” said our community educator.

“So the men are eating the insides. We will be eating the outside corners. Who gets to eat the good bits in between?” I asked.

When no one could answer me, I remarked, “I suppose the cow had its head and legs on for ten years. Another week won’t make a lot of difference.”

“Don’t worry doc, I think they have a refrigerator here.”

* English has a much larger vocabulary than siSwati, so it takes fewer words to express the message.

African Pygmy Kingfisher

This post is dedicated to my uncle, Leslie Beresford Cross, who died twelve hours ago from metastatic cancer.

Today is going to be a wonderful day. It has been very warm and humid recently, but at six o’clock this morning the sky was powder blue and the temperature was delightful. I wanted to have breakfast on the verandah, but as I opened the door, I could see a tiny bird under one of the white plastic chairs. It was an African Pygmy Kingfisher, waiting for the sun to rise over the hedge and warm it up.

Remarkably, it was very calm and not spooked by my arrival with tea and Weetabix. I slipped back inside and brought out my Panasonic LX-100 to take some photographs. It has a zoom lens, but only 75mm, so I had to get close to get these pictures. A delightful start to the day. Uncle Les would have loved it.

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This bird is quite tiny, just about 12cm in length from long red beak to tufty tail. Probably the natalensis subspecies, because the underparts are not so rufous. The dark blue crown distinguishes it from the dwarf kingfisher.

The bird was not interested in the bits of sausage I put down for it, kicking one chunk away with a red foot. They prefer to eat spiders, grasshoppers, worms and cockroaches.

As the sun came up, the bird flew off. I am set up for the day, now.