It’s New Year’s Day and I decided to go out with the team to visit patients with drug resistant tuberculosis in the Mankayane area. I knew it was going to be an early start, so I went to bed early but the fireworks at the stroke of midnight woke me up. The driver arrived at 6:45am, which was a bit earlier than anticipated, but it didn’t take long for me to mount up. We picked up the nurse at KeKhosa, by the “Anointed Hands” hairstyle shop by 7am.

The weather was dull and grey, with low cloud over the hills outside Manzini. Our first patient lived a kilometre away from the road, down a rutted track. The view from the homestead was stunning. I suppose if you have a chronic, debilitating illness and can’t get up and about, a beautiful vista might help raise your spirits. While the nurse administered the injection, I chatted to some women chopping firewood. Two boys asked me to take their photograph, so I got them to pose next to the MSF logo on the back of the LandCruiser.

MSF runs the tuberculosis service at Mankayane Hospital. The clinic was closed, but we opened up to inject a patient whose own health centre was closed for the public holiday. I heard her scream when she was injected. Kanamycin and capreomycin are painful drugs to inject. I wondered about mixing the drugs with local anaesthetic, prior to injection. That would not help the initial pain, but it might reduce the discomfort after a few minutes.

The next patient lived some distance away from the hospital, well off the beaten track. We needed a four wheel drive vehicle with high clearance to get to his house. We had to cross a river, which because of the drought, we managed easily. We passed a general store in the middle of nowhere called the “Wonkhe Wonkhe Grocery & Hardware”. The patient’s home was perched on the side of a hill, with another spectacular view. He was feeling exhausted, so he asked me if I would take the horse into the field and do some ploughing for him. When I said that the last time I ploughed was in the 1960s, using a rotivator in our back garden. He offered to teach me, but we had more patients to see.

After leading the Israelites out of Egypt, Moses received the word of God from a burning bush. Canaan was the “promised land”, the “Land of Milk and Honey” of the Bible. In the village of Cana, just west of Mankayane, MSF supports a community of people suffering from drug resistant tuberculosis in Cana House. It was clean and tidy, with plenty of ventilation. A woman was preparing cook some spirals of sausage on a braai (barbecue) inside the house, so hopefully it would not be too smoky. For dessert, there was a New Year’s Day cake, which would be served with a dollop of thick custard, simmering on a Calor gaz ring.

The residents were delighted to see a docotela. I explained that I worked in Matsapha, but their new doctor, Yuan, has just arrived in Swaziland. I told them the news about their previous doctors, Khin and Srinu and showed them some photographs on my camera. Then the patients wanted their photographs taken. We would have been asked to stay to lunch, but we had to press on and see another patient on the far side of Cana, over the river (Jordan?).

It was interesting to visit the patients in their homes. It puts their treatment in context. The patients were very weak, with some of them not yet responding to treatment, but they were all able to smile and greet me enthusiastically. I think that they were happy that they were not being forgotten, sidelined as failures. They were grateful that someone cared about their welfare and wanted to visit them.

This aspect of MSF’s work is not spectacular and newsworthy, like treating Ebola victims in Sierra Leone, or providing emergency medical care where there has been an earthquake or a tsunami. There are no instant successes. It is a prolonged, tedious slog dealing with the “lepers of the modern world”, suffering from drug resistant TB. It is difficult keeping patients engaged in treatment, often when they are so disheartened and depressed that they feel like giving up. MSF is bringing new drugs to those who most need them and doing the research to find out if shorter, more intense treatment has better outcomes than the traditional regimens. No other organisation in the world is as well placed to do this research. It might not be a face of MSF which is well known to the public, but it is totally in keeping with its humanitarian ideals.

Siyabonga means thank you, in siSwati


By Dr Alfred Prunesquallor

Maverick doctor with 40 years experience, I reduced my NHS commitment in 2013. I am now enjoying being free lance, working where I am needed overseas. Now I am working in the UK helping with the current coronavirus pandemic.


  1. I hope when they eventually make the movie of your life and work they find an actor who reflects your humility. Happy New Year Doctor Cross. Stay beautiful. Mat, Ami, Isaac and Olivia Bella.

  2. I hope when they eventually make the movie of your life and work they find an actor who reflects your humility. Happy New Year Doctor Cross. Stay beautiful. Mat, Ami, Isaac and Olivia Bella.

  3. Your life is so amazing and fulfilling., your patients stories so moving that must make you wonder why you didn’t do this before .
    I wish my life could be all that.
    You are truly blessed., keep it up. Xxxxxx

    1. I did it for five years early on in my career, Amanda. I came back to UK, we had two children while I did GP training, then we went off again. But my wife was almost murdered in the Solomon Islands, so we came back again, and after being an adviser to the government on medical aid to Africa, I took up a job in Leicester as a GP, while my wife recovered.

  4. Yikes, Ian – a grim reminder of that day in the Solomons. Hope you don’t run into that kind of danger in Swaziland. Take care! Mike Strimling

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