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.”
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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.

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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.
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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: http://www.observer.org.sz/news/76217-how-much-does-an-average-married-guy-spend-on-his-mistress.html

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