Thursday Doors

mandelas-cell-doorThis is the cell door behind which Nelson Mandela was imprisoned for 18 years on Robben Island.

RnR @ the J&B Met

Two weeks ago, this was South Africa’s equivalent of Ladies’ Day at Royal Ascot. Every year there is a theme. This year’s was about mixing and matching – promoting J&B whisky with a contrasting soft drink. I wore my Swazi flag shirt matched with blue shorts. Don and I tried out for the most elegant couple, but for some reason, the paparazzi were nowhere to be seen, so we were not invited onto the centre stage.

It was fun hobnobbing with Cape Town Society. The gay men were the most stylish, even if not the most flamboyant. I liked the lady with an LP on the side of her head, the lad with an Indian feather war bonnet and the chap in the skirt.

We had rotten luck and didn’t bet on a single winner. In the fifth race, we fancied two horses equally, so we placed a “boxed exacta” – the horses to come in first and second – I think in UK we call it “reverse forecast”. They came in second and third. At least we didn’t lose our shirts (45p a bet) – not that anyone would take them off our backs.

 

Walking Safari in Kruger National Park

“Nothing but breathing the air of Africa, and actually walking through it, can communicate the indescribable sensations which every traveller of feeling will experience”

William Burchell, Travels in the Interior of Southern Africa (1824)

Yaybo!

We staggered out of our tents in Lower Sabie at 4am into the gloaming. The birds were already tweeting away when I made a quick trip to the ablutions block. By 4:30 we were standing by the open vehicle in the car park. The field guide looked us over and commented on our appearance. “You have to blend in with the scenery. That white baseball cap will make you stand out like a crowned crane,” he said.

Turning to me, he said, “Lose the shoulder bag.” This wasn’t just any shoulder bag. It was a thick, calico-cotton, Made-in-India, eco bag, with “Observer Food Monthly” written across it in bright orange lettering. I was using it to carrying water, sunscreen, sunglasses, binoculars and notebook. “We have a backpack to carry your breakfast. Stow your gear inside and carry it,” he said. “Yessir!” I was only too glad he failed to comment on my dusty, white cargo pants as I had nothing else to change into if they had been too visible.

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The senior field guide was a white South African called Travis. He was dressed in an olive-drab lightweight hoodie, with matching bush shirt and trousers and a khaki cap. His high-pitched effete voice contrasted with his macho outfit. He insisted on total obedience to his orders.

His assistant guide I will call Mr T. He rode shotgun. Literally. He was carrying a massive elephant gun. We climbed aboard the converted LandRover and set off for the walking location.

I was sitting next to two Czech medical students. The girl was wearing a tee-shirt bearing the message “Emergency DOCTOR”. A bit of a fib, really, but these walking safaris could be dangerous.

It was icy cold in the open back of the LandRover, so I tried wrapping myself in one of the blankets provided. The wind got beneath it and it was flapping all over the place until I sat on the edges. All the excited banter in the vehicle had been silenced. We were freezing.

Before the walk started, Travis spelled out the rules. No chatting. Constant vigilance. Single file. Keep up with the group. If threatened, point to the danger and say what animal is charging us. Shout out if you want to stop and take a photo or ask a question. Take nothing away but memories, leave nothing behind but footprints.

Meanwhile Mr T had gone on ahead, looking for predators.

We set off along a well-worn track and soon arrived at a midden – a rhinoceros toilet. They are messy creatures, rhinos. The dominant male deposits faeces in the middle and rubs it around with his feet. Less prestigious rhinos, such as visiting females, take a dump at the periphery. Travis explained it all by saying, “This is rhinoceros Facebook.”

Mr T came back and told us to avoid a dark smudge of excrement in the middle of the track. “This is porcupine pooh. If you get this on the soles of your shoes, I guarantee that you will be buying a new pair. It stinks for weeks.”

The next bit of bushcraft was a lesson on giraffe pellets. These are about the size of large hazelnuts, with a dimple at one pole and a point at the other. They fit together in the lower intestine like one of those cheapo key chains. “Try and crush it with one hand,” said Travis. “It’s just dehydrated roughage.” It was so compacted, I had to use two hands to break it. Do giraffes ever get constipated, I wondered?

Travis then told us he had seen lots of creatures ahead, but as we were walking in single file, no one else did. “The red-billed oxpeckers are flying about searching for large herbivores. They want their breakfast of ticks.” He saw a side-striped jackal, too.

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In the dried out river bed, an elephant had dug a waterhole with its tusks. Apparently elephants are sensitive to vibrations and can detect water under the ground. Judging by the tracks in the sand, lots of other animals were taking advantage of the muddy liquid.

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Travis pointed out a pearlspotted owl. It was being mobbed by canaries, but didn’t seem to care. Although it is small, it has a badass reputation and can take down other creatures twice its size. It doesn’t actually have eyes in the back of its head, they are feather markings.

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Community spiders share this tangled web accommodation strung out over the thorny branches of an acacia bush.

Our next stop was a large pit. It may have been dug initially by an aardvark, but now could be home to warthogs, snakes or porcupines, all living together communally. Rather worryingly, there were lots of bones scattered around the edge of the pit. Travis was careful where he stood. “Sometimes, the inhabitants shoot out of the burrow in a panic, so it is best not to get in their way.”

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We marched off and Travis noticed something. “Did anyone pick up a warthog tusk? Put it down immediately!” Another tourist asked if he could take a porcupine quill. “No! Remember the rules.”

Travis went on to tell us about a tourist whom he had heard eating an apple. When the munching stopped, he heard another noise. “Did you just drop that apple core?” The tourist said that it was biodegradable, but Travis maintained that its seeds could pollute the environment. I felt guilty even though I hadn’t done anything.

Eagle-eyed Mr T claimed to have seen some rhinos far away on a ridge below the horizon. He said he had once spotted elephants three kilometres away. Not even Travis with his Nikon binoculars could see the pair of rhinos he was pointing out.

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We spotted some hyenas, a family of giraffes, a harem of impala, another jackal and then stopped for bush breakfast. Travis invited questions while we ate trail mix and drank fruit juice. “I really want to see an ardwolf, what are my chances?” I asked. “There has only ever been one confirmed sighting in Kruger, so your chances are pretty slim,” he replied.

By now it was 7:30am and the day was starting to heat up. We marched back towards the vehicle, stopping occasionally to learn about insects, fungi, plants and rocks. We stopped. Our way ahead was blocked by a herd of about 500 meandering buffalo. Travis had a brief conversation with Mr T and decided that we would walk abreast, not in single file, straight towards them. “They will part like the Red Sea did for Moses,” he said.

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And they did.

Most of us had heard tales of hunters being ambushed by wounded buffaloes, or having to climb trees to escape a charging bull. But we did what we were told, and the buffaloes scattered. A couple of males returned to scrutinise us as we walked by, but they didn’t bother us at all. It is all about who has the biggest cojones. Figuratively speaking.

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That was an exhilarating end to the walk. We were all buzzing when we climbed aboard and drove to Lower Sabie. Travis even booked another tourist for speeding on the way back to camp. It is always impressive when someone from a completely different walk of life impresses you with exceptional knowledge, making their world more understandable.

Soka Uncobe: Male Circumcision in Swaziland

Soka Uncobe is the slogan of the Male Circumcision (MC) programme which began in 2008 in Swaziland. A Task Force led by the Ministry of Health aimed to integrate male circumcision into the services of all hospitals and health centres. Its ambitious target was to circumcise of 80% of men in the 18-49 age group by 2013. Another programme came on stream in 2011, aiming to circumcise 50% of all male babies born in hospitals by 2014.

Mass campaigns are very costly. After the initial push, health facilities were encouraged to integrate MC into their routine work, saving lots of money. The organisers naively thought that this could be done without disrupting normal health services. This thinking is very reminiscent of the NHS, where additional work is dumped into primary care on the assumption that its capacity is limitless.

To boost the flagging programme, MC champions were appointed in the Parliament, schools and Chiefdoms. Twenty-six doctors and 83 nurses have learned the new WHO-approved surgical method. Only 2% of operations resulted in significant adverse events, such as excessive bleeding, infection and damage to the penis. In South Africa, I read a newspaper article which claimed that 22 males had had their penis amputated following complications of circumcision, but I have not heard of any cases in Swaziland.

The programme didn’t work. After an initial rush to cut (the low hanging fruit?), the numbers have been falling recently. Only 70,000 men have had the operation, just 28% of the target of 80%. Barely 5,000 infants have been circumcised. As a result, the targets have been adjusted to 80% of males aged 10-29, and 55% of the 30-34 age group, by 2018.

Older men have not been excluded, but will not be priority cases. The circumcision of newborn males will continue after this “catch up phase”. Another cadre of health workers (45 doctors and 78 nurses) has been trained to circumcise babies using the Mogen Clamp.

P1010335I went to a Centre of HIV and AIDS Prevention Studies (CHAPS) event last month which was promoting MC in the private sector. Circumcision is free for the patient, but the private doctor collects a bounty of 700 Rand (£40 or US$60) for each case. The equipment is provided free of charge and there may be some assistance for private clinics to expand (staff, equipment, rooms) to take on more circumcisions. This is presented as a good business proposition, a money-making venture which will also improve the facilities and reputation of the private clinic. Private GPs must undergo rigorous training at an approved centre and perform at least ten circumcisions. USAID is providing most of the financial support.

The whole point of male circumcision is to reduce transmission of HIV to men. Removing the foreskin to expose the tender skin of the glans penis makes it tougher. The soft skin becomes keratinised, so it is less likely to get damaged during sex. Broken skin gives viruses a portal of entry. By my way of thinking, less broken skin should also reduce transmission of HIV from infected men to non-infected women during sex, but this has not been shown to be the case. Whilst men are recovering from the operation, they are more susceptible to HIV infection through the surgical wound. The official advice is “six weeks off games”, but most men I have spoken to would find that an impossible restriction on their sex life.

Unfortunately, MC does not protect men who have sex with men from HIV infection, but the reasons for this are unclear. Most American males are circumcised but the incidence of HIV infection is higher than in UK, where few males are circumcised. MC may provide some protection against herpes, but not against the commonest sexually transmitted infection I see in Matsapha – gonorrhoea. I have heard that some wily men who have HIV want to get circumcised as they think new girlfriends will regard them as low risk, and not insist on them using condoms.

In 2000, the London School of Hygiene and Tropical Medicine suggested that circumcision was associated with reduced risk of HIV infection. Three years later, the Cochrane Collaboration examined 35 studies and didn’t think the case was proven. To settle the matter, WHO/UNAIDS commissioned three randomised controlled trials in Africa. The trial at the Orange Farm district of Johannesburg in South Africa reported that circumcised men were 60% less likely to contract HIV. Trials in Kenya and Uganda showed similar findings, and were stopped on ethical grounds.

Even putting all the data from these three trials together (over 11,000 men were involved), the results are still not clear in my mind. The studies showed the risk of contracting HIV for circumcised men is at least half that of uncircumcised men over a year. But what about in ten years from now? One meta-analysis examined the trials and stated that to prevent one new infection of HIV, 72 males would need to be circumcised. WHO and UNAIDS mathematicians modelled the same data and came up with a different figure of between 5-15 circumcisions per HIV infection avoided. This is very cost effective compared with the price of anti-retroviral drug therapy. However, condom use is almost a hundred times more effective than male circumcision at preventing HIV infection. And of Circumcisioncourse, circumcised men would need to continue to have safer sex to maintain the protective benefit.

The local newspaper ran a story about circumcision interfering with an arrangement for warriors to collect urine (the imvunulo) when they are taking part in long ceremonies wearing traditional dress. I am not sure how this contraption works, but I doubt the foreskin is essential for its use. Circumcision used to be part of the rite of passage of becoming a warrior in Swaziland. I heard that the custom fell out of favour because the King needed as many warriors as he could muster and too many men were “on the sick”, recovering from the traditional procedure.

P1010690 On rare occasions, voluntary medical male circumcision (VMMC) turns out to be neither voluntary nor medical. In this newspaper article, a woman discovered her paramour taking a WhatsApp message from another woman. Was it his wife or another girlfriend? We will never know. Hell hath no fury like a woman scorned. She bit off his foreskin during oral sex. Ouch. No chewing gum jokes, please.

The slogan used toP1010496
promote MC in Swaziland translates as “Cut and Conquer (HIV)”. Perhaps this has given the wrong message to many young men who feel that once they have been circumcised, HIV has been defeated and they no longer need to use condoms. Our health counsellors blame the Americans for thinking up a snappy slogan and not consulting lots of Swazi men to find out what they understood by Soka Uncobe. “Cut and Reduce Your Risk Of HIV, But You Still Have To Wear Condoms” isn’t such a slick catchphrase.

Much better is Zambia’s slogan: “Shield and Spear”.

Statues

Some people in South Africa are getting angry about statues; there is a campaign to remove all symbols of colonialism.

The statue of Cecil Rhodes at Cape Town University had to be removed from its plinth because of protests from the Economic Freedom Fighters (EFF). This group objects to any symbol of colonialism which they view as the cause for the country’s present economic problems.

In Port Elizabeth, the Horse Memorial, erected in 1905 after the Second Anglo-Boer War, was damaged by the same group. The kneeling soldier holding a bucket of water for the horse to drink has been pulled off the base. They left the thirsty, bronze horse still standing, commemorating all the gallant animals that perished during the conflict. This inscription is written on the plinth:

“The greatness of a Nation consists not so much upon the number of its people or the extent of its territory as in the extent and justice of its compassion.”

The Boer War Memorial statue in Uitenhage’s Market Square was “necklaced” – activists set fire to a car tyre draped over the soldier’s shoulders. They used a sledge hammer, but could not bring down the statue. This triggered a newspaper cartoon showing a replacement statue, depicting the brutal necklacing and beating of a man.

Security guards have been trying to protect the statue of Paul Kruger (the President of the South African Republic from 1880 to 1900) in Church Square, Pretoria, after EFF activists splashed it with lime green paint. He fought against colonialism and the British imperialists.

Even the statue of Mahatma Gandhi was defaced with white paint in Johannesburg. And he was arguably the most famous freedom fighter of the twentieth century.

Is nothing sacred?

Jacob Zuma was also portrayed in the controversial painting, "The Spear"
Jacob Zuma was also portrayed in the controversial painting, “The Spear”

Apparently not. In Cape Town, a small statue resembling President Jacob Zuma was erected on the hill, Lion’s Head, overlooking the city. It depicted a short, fat, naked man, with a large pink sex toy in its hand. Zuma has a reputation as a philanderer. When he was on trial for alleged rape, Zuma stated that he protected himself from HIV infection by having a shower after sex. The statue was cut in half and destroyed.