Rivers of tears

We have had the pleasure of spending some time over the festive period with Zulu families. On Boxing Day we visited the house of Sophie, our cleaner. She had many of her family staying. This included cousins, nieces and nephews.

Family life is very different in Zululand. Far greater importance is placed on the wider family unit – cousins, aunts, uncles. In fact, these words don’t really exist in Zulu. Cousins are brothers or sisters. Aunts and uncles become second parents. From an outsiders perspective this can be difficult. Mary and I often find ourselves spending time trying to identify the core family unit of a patient/child. But we are beginning to realise that it is a pointless exercise. Clearly a cousin is a brother or sister if named and treated accordingly.

This closeness of the wider family unit is extremely special. It seems to defy geography. Increasingly, Zulus are living across SA. Of course the main driving factor for dispersal is the search for work. Ingwavuma grew up as a mining town. There are no mines in Ingwavuma itself. But men were driven to mines in the surrounding areas. Now these have closed. And little work remains outside of the schools and hospitals. Some families are unwilling to uproot. The result is either that the males do not work or that they leave the family for long periods of time.

The regular absence of men is one of the underlying causes of the spread of HIV. Though this hideous disease has many dire consequences it does seem to keep the wider family glued together when living far apart. Funerals of close family members happen with sickening regularity.* Afterwards the bereaved are scooped up and looked after by the wider family.

All of the above provides a long prelude to the main point of today’s ramblings – that Zulu must be a very poetic language. (I am learning it slowly. But at a very basic level. I am a long way off tackling a work of literature.) My assumption is based on the English spoken by educated Zulus. Sophie’s family are terrific. The adults have fought very hard to ensure the children are well educated. And their sentences are packed with similes, metaphors and analogies. Some of these are great. My favourite was said by one big sister to her little sister. Little sister had spent most of the day crying and running to her dad. Finally, after the umpteenth occurrence – older sister turned to us and said (with a serious face) ‘Don’t worry. She is fine. She has a river where she gets the tears.’ Not for the first time I burst out laughing.


* Indeed, such is their frequency that death becomes big business. All the banks compete to sell funeral plans (insurance to cover costs of a big send-off) to their customers.

Experiences of a Skunk

On Monday evening, I went for my first run since the half marathon. I went running with our cleaner Sophie’s daughter (age 14) and cousin (age 11). We only ran for 5 kms leaving me with energy unspent. This made me keen to join to join Nat (friend and fellow doctor) for exercise on Tuesday morning. (Our exercise routine involves me heading over to her house just after six and lifting weights, playing with fitness balls and running up and down a few stairs. We chat most of the time and it is great fun.)

My exercise meant that I was in need of a shower. (Indeed I had not managed to wash since the previous weekend.) On Tuesday morning after my exercise I stepped into the shower and turned on the taps. Little trickle. Then nothing. Not a drop. And out I got. With an empty jojo I was unable even to fill up a basin. Instead, I had to settle for using emergency cleansing wipes (a parting gift from Eimear). And then went to work to work 29 hrs in a row - great!. With my equally unwashed husband. Suddenly the double virtue of the ceiling fan became apparent. Not only would it keep us cool during the night but it would help to freshen the air. We put it on the third and fastest setting. And then kept our noses over our respective sides of the bed.

Having no water in the home is obviously unpleasant. But having no water at work is potentially extremely disastrous. It is impossible to conceive of a UK hospital operating without water. Here, we must continue to try to function, albeit operating an even more reduced service. For example, no water means no x-rays – as the machines that we use depend on water for development of the images. At a more basic level, it means the toilets cease to function. This, in a hospital caring for 250 very sick patients. To add to the unpleasantness, the Tuesday and Wednesday were days of 40 degrees heat.

Despite the dire situation, somehow, life seems to continue to function as normal. Nobody seems to have responsibility for sorting out the situation – there is no atmosphere of emergency. What makes the situation even more frustrating is that there is no shortage of water in the dam at the moment. We are in the rainy season. The problem is mechanical.

Fortunately, the water returned to us relatively quickly - by Wednesday. We were hugely grateful, not least because periods of two weeks without water usually happen at least once a year. Suffice to say that this year I won’t have to think too hard about my wish for 2011!

Press the red button

After an avalanche of requests, our blog is now going interactive. Now you all have a chance to help us solve our water problem. Let me explain.

In theory we should have no water problems at all. About 90kms from Ingwavuma, at Jozini, there is a giant lake/reservoir. And there is the infrastructure to pump this to us. But not a drop reaches us. There are various rumours that offer explanation. One is political – that the municipality want to shut down Ingwavuma. They want the population to move to Bhambanana (20 km closer to Jozini; but uglier than Medusa and horribly hot because not on the mountain).

An alternative explanation exists. This is that the municipality owes millions of Rand to the local electricity company. As a result they are unwilling to supply the electricity required to operate the pumps at Jozini. Being more swayed by cock-up over conspiracy, I think this is the more plausible.

This leaves us with two sources of water. The first comes out of our taps in our house. H20 for the hospital, and ipso facto (only bit of Latin I now know, other than agricola, so must be used) our house, is pumped up from the nearby Pongola river. This has two big drawbacks. Firstly, it is not very clean. This is because communities live upstream and likely contaminate it with… I’ll stop there. Anyway, we use tap water for washing and cooking. And, when desperate, we also drink it. After boiling it. Though it still tastes disgusting.

The second drawback is that occasionally, the water pumped is very muddy. This is usually a prelude to losing water for a couple of days. Despite being the rainy season, we are currently out of tap water.

And so we arrive at our second source of water – our jojo. Each of the properties at the hospital has a 50 litre container. These are about 12ft high and green. They collect water off the roof and store it in the tank. Giving us a very reliable source of ‘fresh’ drinking water.

Worry not. I have not forgotten about my promise of interactivity. I am getting there. Be patient.

Our house was painted two weeks ago. Unfortunately, the workmen decided to paint number 130 in the rainy season (it rains most days at the moment). They didn’t mention to us about their plan. And they didn’t discuss the wisdom of painting the roof. Furthermore, they didn’t remember to disconnect the pipe leading to the drinking water.

Well, the inevitable happened – 50 litres of water mixed with paint toxins.

The good news is that I have now emptied the jojo. The bad news is that the emptying process revealed that the bottom is covered in about 4-5 inches of mud with lots of dead insects and other ‘organic matter’. So the issue is what to do next.

‘Clean it’, I hear you shouting. ‘How?’ I shout back. One option is for me to try and get inside the jojo. Let’s call this the Roger Toulson/Sir Thomas More option (i.e. only to be contemplated by the lunatic martyr). It has a man hole cover at the top. But lowering myself down the twelve feet would be very hard. It would then take sometime to try and scoop the mud out and wash the bottom and sides. It is very hot. And the air is smelly.

Option two is to try and get a brush. But no long brush exists. So I will need to try and design something to do the job. Not easy. And highly likely to result in things falling into the jojo. So I foresee options two and one merging.

Option three is to try and find someone else to do the job. But now I find myself becoming a bit Gandhilike. Am I really happy with somebody else cleaning our latrine/ disgusting jojo?

Option four is to let the rain fill the tank again and resume drinking.

So now you get to offer advice. What should be done?

Mirror time

A mood of reflection has come upon me. And so below, is a top 10 list (not in order) of some of the small things that contribute to our enjoyment of living in Africa.

1. The double handed wave as a greeting
2. Regular monkey sightings on the roads
3. Umbrellas to shade from the sun
4. Woolly hats even when +40 degrees
5. Babies being carried on mother’s backs tied up in a towel
6. Slogans that adorn the local taxis – often uplifting, but sometimes cautionary, such as ‘Trust nobody’
7. The freedom to pick the nose without fear of social embarrassment
8. The celebration of fatness as a sign of good health e.g. ‘Oh sister you are looking lovely and fat today’
9. The regular use of ‘yes’ to answer ‘either…or’ questions
10. ‘High fives’ between ladies when one of them has told a particularly funny joke.

Fast and Furryous

Saturday we engaged in a completely different Safari experience. To explain, you must know that Hluhluwe-Imfolozi Park consists of two interconnected parks – hence the double barrel name. Having spent much more time in Hluhluwe, we decided to visit the Imfolozi side this weekend. There, the terrain is slightly flatter and the bush is less dense. This is meant to make it easier to spot cats.

Unfortunately, we arrived later than planned at the park. Getting through the gate at 1700, we had to exit by 1900 or face a fine. We calculated this allowed us one hour smoking out animals on the Imfolozi side. We would then make the journey across to our accommodation (just outside the park on the Hluhluwe side). The guide at the gate told us that our plan was entirely feasible.

But she was wrong. Only after turning for Hluhluwe did we calculate the distance versus the speed limit – 40km/h. At 1830, we still had 30 kms to travel. And so we had a dilemma. Pay a fine or go faster. For any Kwa-Zulu Natal wildlife inspectors reading the blog, please stop now.

For we did not opt to pay the fine. Instead, we drove at slightly faster than 40 km/h. Not a lot faster. But the light was fading fast. And lots of the nocturnal wildlife began to seek out the warmth of the tarmac.

The consequence was a truly exhilarating experience. As I raced up and down and round and round the windy bumpy roads, Mary navigated. While also pointing out the animals whizzing past on right and left. (Read the following very fast to recreate the experience.) ‘Take the road to the left, zebra, impala with baby, rhino lying down, 5 km to the, lots of impala, watch out one on the road, well missed, think of how many dung beetles we are killing, whoa look a hyena.’ This continued for half an hour.

Fortunately, dung beetles were our only likely road kill (though they themselves are quite a fragile species; in fact there are 350 species of dung beetle; and I like them very much; so hopefully most managed to take evasive action). Our nearest misses on the road were two impala. Not the most precious of the parks wildlife. Indeed the wildlife management of the park sometimes have to cull the population to keep a sustainable population. However, I’m not sure they do this by driving round fast at night in Ford Fiestas.

Thankfully, the ultimate conundrum did not present itself. Again we saw no leopard. So we didn’t have to stop the car to take any photos. This meant we reached the gate at 1910. Using all our Zulu charm we escaped without a fine.

Our Sunday driving was less eventful. We did though finally manage to see the elusive black rhino. They are in great threat of extinction (low thousands in population) and hard to see because they like to hang out in the deeper undergrowth. Our mother and baby were very shy and quickly disappeared. Hopefully they found a good hiding spot.

Stab wound to the chest

I am sorry that I have not written a blog in ages – so much has happened since I last wrote – but Henry has done a very good job at keeping you updated of our going ons!

It was five weeks ago today that I won the Ingwavuma Women’s half marathon. (And the enormity of the achievement is beginning to sink in. It has been a whirlwind of media engagements and award ceremonies. I have been nominated as the local newspaper’s woman of the year.) Regretfully, I am still missing one toe nail. So, I have not run since. It is without doubt the hardest physical challenge I have ever undertaken! (Not counting my double gold weight lifting medals from the Moscow Olympics.)

A week later, were on our amazing holiday with Eimear. We managed to pack in lots into our two weeks and a bit time together including game parks, turtle tracking, hiking in the Drakensberg mountains and pony trekking in Lesotho. It was really amazing!

I then came back to 12 days on the trot – 7 of the 12 days involved me being on-call. There is something very comforting to me about being able to work as a doctor at Mosvold. It is ridiculously busy (especially the past week as we are down 4 doctors who are on holiday) but very humbling. There are so many moments at work when I laugh and think I should definitely write a blog about this – the snake bites (not so keen when the family hands me the puff adder in a spar bag – luckily it was dead), the many fractures involved when the umkhulu (grandfather) is chasing a goat or the newborn babies handed to me under a massive blanket. Then there are the sad moments – too many rape victims and too many young people dying of HIV and/or TB. Lastly, there are the scary moments. This happened to me on-call last Sunday. I had just got home for supper (Henry Oliver had once again rustled up a scrummy meal – using only organic ingredients) and was finishing up when I received a phone call from OPD to say that a patient had been brought in with a stab wound. Fortunately we don’t get many of these in Ingwavuma. And we get almost no gun shot wound victims as the people are too poor to purchase firearms. Anyway, it was my first case and I ran to the hospital. Once there – in a sweat – I quickly assessed my patient and saw a hole in his left chest. I sealed it with a finger. (Help! Did I remember to remove this? Too late now!) I then got some gauze. I was excited and terrified but the nurses continued at their slow and steady pace. The man was talking to me and after an x-ray which revealed a haemoperitoneum (blood in the chest), I inserted a chest drain and sent him to male ward. He went home a few days later.

With a weekend off, we are down at Hluhluwe-iMfolozi Game Park in search of cats. Henry will write on Monday with details.

Being incredibly tired, I have just fallen asleep before finishing this blog. But it is ok. I can trust my husband to post it on our site without making any infantile additions. Night everyone.

Adieu, Adieu

On Thursday (the penultimate day of term) we had a farewell function for our grade 7s. They are all moving onto high school. The event was also used to welcome new grade 1 students (4-5 year olds). All parents were invited.

In anticipation of the event each of the top 3 grades were expected to use the final week to prepare a musical/ dance performance to entertain the parents. I decided to work with grades 6 and 7 on putting together a ‘concert’. Living out a long held dream, I became choir master.

Flicking through my ipod for songs to perform, I settled on starting with some Sound of Music. Initially the children were subjected to learning three songs – ‘Doe, ray, me’, ‘Raindrops on roses’ and ‘Climb every mountain’. They got the hang of the first two. And we worked up actions to go with each. ‘Climb every mountain’ proved beyond us – perhaps because the choir master was unable to demonstrate how to hit the high notes. As a result it was cut.

Trying out some pop music, the children took to ‘Let it be’. So we added it to our repertoire. We then worked on two Zulu songs that I had heard performed by the Drakensberg Choir – ‘Shosholoza’ and ‘Umkhoti’.

Delighted with our efforts, I went to tell the Principal about our readiness. ‘You have made excellent choices for the traditional songs’, he told me. ‘The parents will enjoy them. Umkhoti is a lovely song. It is about family celebrations at a wedding. The family are singing about their delight that the new wife will be able to do all their washing, cooking and cleaning.’ ‘Wonderful’, I replied.


The excitement of the children on Thursday morning was very obvious. Indeed it could be measured in hair length, as most of the girls had added long braids. Both grade 1s and grade 7s were dressed in academic robes (these are passed round all the schools in the area). The 3-4 year olds looked ‘omuhle kakooloo’ (very sweet).

The event itself was terrific, if very long – 4 hours! Though I understood very little, I was entertained throughout. One cause of great amusement was the loud speaker system. It was far too loud. A long sermon by the local priest was particularly deafening and many in the audience looked in visible pain.

The performances by the different grades were very impressive. However, many were curtailed mid flow by the two senior female teachers. Acting like x-factor judges they would shout ‘enough, enough’ in Zulu and usher the performers out the tent.

Our ‘set’ was not interrupted. But I’m not sure the locals were that impressed by Frauline Maria. Polite applause accompanied our exit from the stage.

After the event I was invited for supper with the elders. Worried about my ability to stretch my Zulu, I sat down with trepidation. Fortunately, I was more than able to contribute to the silence. I filled gaps between mouthfuls with lots of inane grinning. Then I was able to excuse myself for photos with the grade 7s.

And so the school year finishes tomorrow. We start again in January. Tomorrow I shall try to post family Christmas presents. Then I’m off to try and fix the car.

Mary is on call this weekend. I’ll let you know where we decide to go next weekend.

the three amigos

Four days on ponies. Average duration of ride to be seven hours. Three nights in village huts with no water or electricity. A bring your own food requirement. One rider suffering from a slipped disk. A second rider very nervous about her very weak shoulders. The last of the trio recovering from flu. None with any horseriding experience. Large Lesothan mountains to scale. No turning back policy insisted upon by the Lodge.

Guiding for the adventure would be the very short-tempered Pelan. His fuse would be blown by any small mistake from a rider. (He regarded horses as being identical to bikes. In other words, they behave rationally at all times. Axiomatically, the rider should be blamed for any horse intransigence.)

Given all of the above, what could possibly go wrong? Well much obviously could have gone ‘Lesotho mountains up’. But not much did. Instead, we were able to enjoy our characterful horses and our majestic surroundings.

Each of the riders quickly bonded with their horses. Eimear on Esanu, Mary on Baafor and Henry on Strike. And each immediately adopted their own horse behaviour management policy. These differing approaches were to be stuck to steadfastly.

Eimear put all her faith in a ‘loving’ technique. All of Esanu’s foibles were embraced. None needed correcting. Esanu’s favourite trick was taking the route less travelled. Eimear explained this away as ‘Esanu knows best’. (I’m convinced that these would her been her first words had Esanu ever unseated her. Thankfully, he never succeeded.)

Mary adopted a ‘reasoning’ strategy. She did not try to hide Baafor’s shortcomings – such as disobedience. Instead she would try to coax him into recognising the error of his ways. ‘Oh Baafor. Please don’t do that. Ok Baafor enough. Fine, this is the last time I’m telling you.’ And so it continued. Her efforts to communicate with Baafor were made significantly more difficult by Pelan’s attempts to shout repeatedly at her with instructions on what she should be doing, ‘Go left. You are meant to be left. Take the left path. We are going left. Not right. Up. Not down. Not through the tree.’

Lastly, Henry adopted the carrot and stick approach. With the carrot substituted by kind words. And how well the (aptly named) Strike responded. Any visual sight of the stick and Strike immediately charged forward. The girls disapproved of my style both on animalitarian grounds and also because the threat of stick for Strike acted as equal encouragement to their horses to move quickly.

While the horses kept us thoroughly amused for our whole journey, we also managed to notice the mountain scenery. For good reason is Lesotho known as ‘Little Switzerland’. The peaks enveloped us as we travelled from hut to hut. In winter they are snowcapped. In summer they are green and blue. All year round they are decorated with many waterfalls.

Each night was spent with a local tribe. With almost no signs that life had changed since 100,000 BC, we felt transported. After cooking (no small challenge) we would spend the rest of daylight hours mingling with the community and watching the animals. We were ‘in bed’ in our hut by 8.00 – in time for the local donkey to sing us to sleep.

By the end of our 4 days we all felt very sad to be leaving the horses and the mountains. As we rode closer to the main lodge the occasional satellite dish told us we were re-entering the modern world.

Visiting the Bergs

On our last night in Ithala a large spider sat beside Mary's bed. The girls debated how to kill it. I insisted that it be left in peace. The following day we visited a chemist to pick up lozengers for Eimear's throat. The pharmacist immediately asked Mary when she had been bitten by a spider. Seemingly, the spot on her fae was a gift from incey-wincey. 'Not to worry', she was told, 'the egg will hatch quickly'. Since then I have been enjoying excellent sleep in the kennel.

On Wednesday we arrived in the Drakensbergs. I drove like a maniac to get us from Ithala in time for a concert by the Drakensberg Boys' Choir. They had been highly recommended to us by another traveller. They did not disappoint. The concert comprised two parts. The first half was a mix of pieces by the great composers interspersed with some classical adaptations of pop songs. The second half was all traditional African songs. I have never been so moved by a performance. It provided great hope for the possibilities of the rainbow nation.

Apart from the boys' choir, the Drakensbergs are famous for two reasons. Most visitors come to walk in the stunning mountains. Others are drawn to the area by the history. In among the peaks are battlefields from the Anglo-Boer Wars. Not 100km from our accommodation was the place where Winston Churchill was captured and also the bloody fields of Spion Kop. My intuition told me the girls probably wouldn't want to spend much time visiting these. I will return another time.

Instead, we hiked. Two days of walking in the Ds was relatively painless for me; the girls had a wonderful time. The second of our ambles was in the direction of Tugela Falls - the second highest waterfall in the world. This created some excitement for me. A waterfall of that height must be spectacular. Except that it wasn't. Our walk ended with a partial view of two sections. Very underwhelming. I think only continuous falls should be allowed to count in the record books. Time to start a petition.

Much more exciting was a set of canopy zip wires running threougth a nearby section of forest. Eimear and I both spent a morning swinging high above the trees. My antics hanging upside down gained me the name 'infeme' from the locals - meaning baboon.

Tonight we have scheduled one more game drive. We discoverd that there is a lodge nearby containing lots of cats. We are trying to arrange for Eimear to see a lion during her visit. This will be the last chance.

Tomorrow we have a long drive to Lesotho. Plenty of time to listen to our Dberg choir cds.

Pursuit of the yellow jersey

Some quite extraordinary experiences with Mary and Eimear in the first half of our two week break. Thus far we have spent the time viewing animals. We have visited both Huhluwe and Ithala Game Reserves. In both we have seen an abundance of life (but no cats and no leopards!)

Though Ithala has much less game than Huhluwe, it is situated in a very mountainous area. Dramatic cliff faces provide the backdrop for viewing the animals. This made our days their as memorable as our time in Huhluwe. The absence of animals also forced me to take more notice of the birds. I am starting to be able to get slightly (but not much) beyond saying - 'small bird', or 'colourful bird' or 'big bird'.

Our camp in Ithala was open to the animals. They made full use of their rights of access - especially the monkeys and baboons. These close relatives prowled round our accommodation trying to find a way inside. Once, Eimear very gently ushered one out of the kitchen (done with such Irish charm that the beast didn't take anything with him). Shameless burglers, each time we left our accommodation, we watched the apes 'casing' our rondavel. (Theft, it seems, is an alien concept for them; the moment Mr Monkey takes something he considers it his.)

In between our safari trips, we spent a night at Kosi Bay. Mary and I have been there before but wanted to return with Eimear to go turtle spotting. November to December is when they lay their eggs. Kosi Bay - with short beaches and high dunes is the preferred location for loggerhead and leatherback turtles to bury their soontobeborn. To borrow from a London gangster movie - it was emotional.

The process begins with the turtles (we only saw loggerheads) allowing themselves to be washed ashore. The giant shelled creatures then 'walk' approximately 40-50 metres and park themselves high on the dunes. If satisfied with the sand quality, they begin preparing the site. This includes digging a hole approximately 80 cms deep for their eggs. If disturbed at this stage, they return to the sea.

Having designed their nesting spot, the female begins firing ping-pong sized eggs - sometimes six at a time - into the sand. This lasts around 20 minutes. Once finished (they usually deposit 100-200 eggs), they tip sand gently over the hole using their back 'flippers'. With their remaining energy they struggle back into the sea - visibly exhausted. So amazed were we by the spectacle, we have already booked ourselves in for hatching time in February (Eimear has pledged to return).

Our next destination is the Drakensberg Mountains. Here 'we' plan to do lots of walking. The only complicating factor is that our schedule has begun to take its toll. Eimear has taken an involuntary vow of silence - having lost her voice. My stomach is doubling up for a vuvuzela having eaten some dodgy impala pie. And Mary is tired from her long hours of work. I have pointed out to Mary that even Tour De France cyclists get a rest day. I'm not sure if this will make much of a difference.



ps - I must thank Tricia for sending Mary's sun hat. Not only does it look very fetching but she also now resembles a character from an Agatha Christie drama. I am enjoying doing regular Hercule Poirot impressions.

Eimear’s arrival

Tomorrow I head down to Durban to pick up Eimear from the airport. We are then on holiday for two weeks. We will let you know about our adventures. Of course top priority is to see a leopard.

Race Day

Race day. And what a relief. Opening the curtains early in the morning we were delighted to look out upon a relatively cold and grey scene.

Arriving at the race registration point we were quickly joined by sixty-two other athletes. This too provided great relief. It meant that we had the biggest ever field for the event but not too many for our free t-shirt supply. Of the athletes, fifty-one wanted to run the 10k race. Nine men, including ‘yours sadistically’, opted to run the 21k race. Suffice to say that none of my competitors were Caucasian. Equally madly, Mary opted to run the 21k race (one of two females).

I made a breathtaking start to the men’s race. For about 25 metres I was the clear leader. And then very shortly I was at the back. Having run the distance several times in recent weeks I felt relatively confident about my ability to cope. I had run the second half of the course several times so knew what to expect. Typically, the part I hadn’t seen was Himalayan. For the first 10.5km the race went almost entirely uphill.

Well, I completed the race. The winner finished in 1 hour 30 minutes. I finished in 1 hour 55 minutes (sixth out of nine). I managed to run the entire race except for the last hill. By the time I got over the line I had nearly lost the power of speech. I sounded like Lord Prescott at his most incoherent.

Meanwhile, my wife was battling it out against the other female runner. Behind for most of the race she overtook in the last stages and triumphed. Having just about recovered at the finish line, I was able to watch her complete the last few metres. Her time was 2 hours and 21 minutes.

After the race we held an awards ceremony and bbq. Everyone seemed to have a good time. And I got to present Mary with a newly made statuette of a giant golden female lady made out of coat hangers. (My description doesn’t do it justice; it is a terrific trophy and sits on the kitchen table.) Embarrassingly she also scooped the amazing prize of a weekend for two in a luxury hotel. (She has yet to confirm who she will be taking!)

Since the race we have both been in agony. Despite many hot baths we are still walking like clowns on stilts. Mary has the added enjoyment of badly sunburnt shoulders. But they are receiving expert treatment from her doting husband.

Manic Friday

Despite meticulous preparations for the half marathon, last Friday was chaotic. Knocking off at 1300 from school, I had prizes, food and drink to collect.

First stop was collecting the prizes. A number of local companies made very generous late donations. This included a voucher for 300 bricks (worth £300 apparently; not sure how many Godfather Robert could get for that) from Nyawo Stone. This became top prize for the men’s race. Tiger Lodge, a 4/5 star hotel stumped up an all inclusive weekend away. This became top prize for the winner of the women’s race. Lesser prizes included the previously mentioned red wheel barrow, and also a river cruise and picnic. All told, we now had a prize list fit to grace a 1980s British TV game show (Blind Date, Big Break, Blockbusters – you pick).

Laden with prizes I began my food stops. First, I collected 60 loaves of bread, 12kgs of chicken and 200 bottles of fruit juice. Then I picked up the water sachets. Except I couldn’t. Because they had been forgotten. By the supermarket delivery man. Somewhere in Durban. Time now was 1700.

Feeling an A-team moment, the half marathon committee met. Without any cigars, I set out the problem. How could we purify a lot of water very quickly and where could we find lots of small drinks bottles? Authentically (as the A-team), we had a quick solution. All we needed were several giant containers, sodium hypochlorite (bleach) and a water source. Using the hospital’s resident dietician we added the appropriate percentage of bleach to containers of water. We then decanted the contents of 100 of our juice drinks into yet more containers and refilled them with H2O. Job done. Once again, Colonel Decker had been thwarted.

The rest of Friday was spent sorting out logistics such as ensuring we had enough vehicles to transport the athletes to the start line on Saturday.

Working on Isolation Ward

This week is my fifth week of being the doctor in charge of our Isolation Ward. It is where the sickest patients in our hospital are resident. Most of the patients have HIV and are in the last stages of the disease so are very sick. They come in marginally better than dead and my job is to try and keep them alive. I first check to see if they have TB (the most common cause of serious illness here). Once confirmed, most patients go home. A few cannot (for instance the amount of blood they have is so low that they are too weak to walk, etc). Some of these I transfer to TB ward. Others I keep an eye on. At the moment I am monitoring a nine year old boy who is so sick and thin from stage 4 HIV that I cannot send him home. On my first day, I thought that he must have a multi-drug resistant (MDR) TB and this past Friday, I found out he did. I should transfer him but he feels safe with the nurses and me and we would all like to keep him (it is very sad – he has no family visiting him – often the case – children get abandoned here). I also have a 21 year old man who came in completely breathless on my second day on the ward. I carried him to x-ray myself where I discovered that one of his lungs was not inflated and the other was riddled with what looks like TB. Surprisingly, he is HIV negative and every day, we chat and I try to help him with his homework (the resilience in these patients is amazing).

Unsurprisingly the mortality rate in my ward is very high. The most difficult patients to treat are those with a combination of MDR TB and HIV. Fortunately, the medical manager, Dr Heese, is a TB expert and always available. I enjoy discussing and solving occasional cases with him.

Henry and I leave for holiday with our friend Eimear in two weeks time and I will miss the ward. By the time I return there will be many different faces – equally sick. And so it goes on.

The joy and fun of running near the sun

The ‘world’s most spectacular half marathon’ event, is now under a week away. Huge excitement is building in Ingwavuma. Or at least it is in the Toulson household.
We have had plenty of dramas so far. We have had villainy in the form of Ithala Bank. (They promised to be one of the sponsors for the event. And then they broke their word. Despite threats that we would change the name of the race to, ‘Running against Ithala Bank’, they have not changed their mind. We plan plenty of negative publicity on the day.) We have had near catastrophe as we faced the prospect of no race t-shirts. (These are being picked up today in Durban.) And we have had lots of generosity. For example, the local supermarket and the nearby DIY store are both giving us cash. The DIY is also stumping up our ‘wow’ first prize – a very handsome red wheel barrow. We are assured that it is highly sought after.

Plenty still remains to be done before the weekend. Prayers are being said daily and, increasingly, with Islamic frequency (by Mary Muezzin). Remaining headaches include, planning without numbers (anywhere from 4 to 400 people could turn up); arranging transport for the competitors; sorting out the water stations and organising the braii (bbq) for after the race.

Time is also being set aside for prayers to hotus and humidius the twin Ingwavuma weather gods. The course designer, a certain M. Nature, has said she is hoping to, ‘test the participants (she preferred not to use ‘athletes’) to the fullest. Flat is dull. I prefer hills and spills’.

Mary, due to work restraints has trained less than me. She is debating whether to do the 10 or 21k race. I am confident I can get round the 21k course and may even be the first white man home (no others have yet declared themselves). However, the willingness of the bookies to offer a price on my victory owes largely to the remote possibility of a Foinavon scenario. At 100,000-1 I have yet to attract any money. The bookies are though shortening the odds on two Olympic standard runners in the field.

I will, of course, let you know within how many hours I finished of them. And Mary will report on her race experience. Now time for more prayers.

Celebrating Henry’s Birthday …

Although I treated Henry and me to a lovely weekend at Kosi Forest Lodge two weekends back, I still wanted to make a bit of a fuss on his actual day. I could not bring him to Fancy Stitch for lunch as I was away in the bush attending two of our ten clinics. So, instead we had a pudding party. These are regular events here at Mosvold. As the name suggests, they involve everyone bringing a pudding. I made a chocolate cake with candles for the birthday boy. It was a great evening with loads of people from all different ages from our community here in Ingwavuma. We played the name game which was great fun. Outside entertainment was provided by a magnificent lightning storm. At one point we began to doubt whether Henry would see much of his 31st year as one of the forks hit a tree not 10 metres from our house. A few verses of ‘favourite things’ (Sound of Music) helped settle the nerves. Gradually the storm subsided.

Wheels of misfortune

We planned to spend the weekend diving in Sodwana Bay. However, car problems intervened.

Leaving later than planned on Friday night, darkness quickly descended upon us. Driving from Ingwavuma to Sodwana in daylight is difficult. It involves lots of swerving to avoid potholes and cattle. Driving at night requires lightening reactions (think skiing at night by torchlight). Mary gave a clear warning the need to drive slowly. Then she fell asleep. She was awoken not many minutes later with an almighty thud. Henry had hit a wide and deep pothole travelling at c. 90 km/h. Result = burst tire, broken wheel rim + angry Mary.

As a form of penance, I got out of the car and began to change the tire. Worryingly the spare looked almost equally flat. We drove the rest of the journey extremely slowly and, mercifully, we managed to get to Sodwana. There we were able to inflate our ‘spare’ tire.

Having dived in Sodwana Saturday morning, we set about trying to buy a new wheel. We were reliably informed that we would need to go to Huhluwe – a distance of 80km. Off we went. The atmosphere in the car was remarkably cordial. Again Mary reiterated the importance of not driving too fast. Another pothole accident would leave us with three tires.

Guess what happened next. No, we did not hit another pothole. Hooray Henry. Well done. Except… with all my focus on the road, I hadn’t spotted the petrol gauge. Half way towards Huhluwe I suddenly did notice our fuel ‘situation’. In a colour, it was ‘red’. Then how to tell Mary. I longed to be back a week in time faced only by a black mamba.

Having uttered a prayer to the patron saint of petrol stations (St Shell?) I briefed Mary on the situation. Silence descended. At a loss for better ideas I decided that we would have to drive on until the car conked out. 4km later the car was conking its heart out.
And then a wonderful moment. The last revolutions of our fuelless car brought us into the tiniest of towns. Surely they must have petrol. Please St Shell!

Hallelujah. No they did not have a petrol station. But they did have a lady selling ‘green’ and ‘red’ containers of petrol. Which did we want? As on ‘Who wants to be a millionaire?’ we decided to consult the audience. The locals surrounding us thought we should go for green. And so we did.

Now how to get the green petrol into the car. Our petrol vender had a ready made solution. Out came a broken vuvuzela. It acted as an excellent funnel.

Five minutes later we were continuing our journey. I felt more content than Lawrence must have done after crossing the thingamy dessert to attack the Turks.

In Huhluwe we found a tyre place (of sorts). We then headed for an evening game drive at Huhluwe National Park; we stayed the night in a local backpackers and enjoyed a game drive in the morning. Still no leopard. But we had a contented cat (albeit minus a few lives) at the steering wheel.

Ntabayengwe Netball tournament

Apologies for the absence of blog articles over the past week. There is now much for you to catch up on. The first big news item concerns the rip roaringly successful Ntabayengwe Netball tournament. This was a four team contest consisting of four local schools, including my own. Each school entered two teams – one under 11 and one under 13. Tournaments create great excitement in the schools and mean a half day of lessons. They are taken very seriously by the teams involved. They train hard during the week of the event.

I helped prepare the Ntabayenge teams, assisted by Miss Ngobese. Miss Ngobese is a formidable woman. She, like all the female teachers at the school is traditionally built. She walks everywhere with a stick in her hand to remind pupils of the perils of transgressing. And she has a ferocious bark (to match her bite). I am happy to say that she is always sweetness and light with me.

In advance of the tournament each coach was asked to check the ages of their players to ensure fairness. This was not entirely straightforward. It took some time to find a register with all the details of our pupils. Then there were issues with the credibility of the data. For example, one of our sets of identical twins apparently had birth dates two years apart.

Sadly, the information that we could find told us that two of our star players were ineligible. The Principal and Miss Ngobese were not amused. ‘But they must still play’, they told me. ‘Nobody sticks to the rules’, they assured me. ‘The other teams will all be playing older girls. It will be madness not to play Zethu and Nondumissu.’ I stood firm and insisted that ill gotten victory would taste sour. My colleagues were utterly unconvinced.

Our tournament began spectacularly well. We were 8-0 up by half-time in our first U13 game. Our brilliant forwards were scoring almost every time they shot. At the interval I was keen to bring on both of our weaker reserves. Miss Ngobese was horrified. ‘We must not make any changes. The reserves are very weak players. They are very bad. They will make many mistakes.’ Insisting on the changes, our two reserves, now brimming with confidence, entered the action.

We did not lose the match. But we only drew the second half. Miss Ngobese felt absolutely vindicated in her half-time assessment. She was not entirely happy with me. Worse was to follow.

Our second Under 13 game pitted us against Mpontshini Primary School. As foretold by my colleagues some of their players looked distinctly ineligible. Indeed a couple of them had the physique of NBA (USA basketball league) superstars. Our girls were obviously much smaller but I still felt we could compete.

By half-time we were a number of goals to the bad. Several of our team were arguing with each other. Miss Ngobese looked livid. I tried to lift their spirits with lots of inspirational platitudes. I insisted that we were as good as them. That we just had to believe. That we mustn’t criticise each other. Unfortunately my words were immediately drowned out by the following exchange:

Miss Ngobese: We are not good.
Principal: Yes. I smell defeat. I smell it very strongly.

Sadly the Principal’s nostrils were aromatically accurate. But we won our last game. And the Under 11s performed excellently. Still an air of post tournament tension existed in the staff room. I couldn’t help hearing reference to the giraffes from Mpontshini. I escaped as quickly possible for the weekend.

Friendly Animals

So my surprise weekend destination was Kosi Bay. It is about an hour and a half driving time from Ingwavuma and is a place of many treasures. These include: dense, fig, mangrove and raffia-palm forests; wildlife such as hippos, crocs and 250 species of bird; some of the quietest and most beautiful beaches in SA; stunning coral reefs for snorkelling; a fascinating local tribe called the Tonga (no relation to the Pacific Islanders*). Mary had booked us in to a very Kosi forest lodge.

The Nature Reserve consists of four interconnected lakes. We spent both days exploring these – the first on a motor boat, the second in canoes. Despite the presence of lots of hippos and crocs, our guide insisted that we could swim in the lakes. He assured us that we would be able to see if any hippos were in the vicinity. As for the crocs, they were most definitely ‘friendly’. This meant that the guide had never heard of them having eaten any of the local fishermen. Mary needed no further reassurance. She was in the water. Her reluctant husband followed. Re-entering the boat after our swim, a helpful German couple that had stayed in the boat pointed out a hippo about 50 metres from our swimming area. Danke.

The Tonga people live a subsistence lifestyle. We were able to watch their methods for catching fish. Without sliced bread the Tongan’s use another expression – the best invention since fish traps**. This is how they work. Narrow channels connect the lakes. The water level in these is about 4-5 feet. A straight line of sticks are planted into the water over a distance of c. 50 metres. These sticks are approximately 6 feet in length and are planted close together. Thick algae quickly grows creating a ‘wall’ through which the fish cannot pass. Instead they are forced to swim alongside the algae until they reach the end. Here sticks form a three-quarter circle. A one way revolving door occupies the final quarter of the circle. Following their natural course a large number of fish swim straight into the trap. Along comes Mr Tonga to spear the fish. Each family builds/maintains/works a trap.

The couple that ran Kosi Forest Lodge were snake enthusiasts (or more particularly, he was). They had a large number of snake books. Given the likelihood that we will come across some (SA and KZN in particular is home to all of the continent’s most dangerous reptiles), I thought I should try to get some advice on the different types and the ones to avoid. Chris quickly revealed that he kept a couple of ‘baby’ pet snakes – one a very nasty puff adder. He assured us that we would be won over by its beauty. Willing to be persuaded, we both examined the intricacies of ‘puffy’. Without doubt the colours and mosaic like patterns on its back were very impressive. Less appealing was its regular and loud hissing noise.

Our walk to the canoe on Sunday took us through the beautiful forest. Mary and another girl led the way. On our canoe trip we saw some extraordinary birds. These included the very rare palmnut vulture – the only vegetarian vulture (unlikely to be a source of kudos among his vulture friends). We saw the Jesus bird (named because it walks on water) – a favourite with the Tongan people. And we saw many, many others. On our return walk the guide led us back to the car. We immediately struck up loud conversation with another couple. After 20 minutes of walking our guide suddenly reared backwards, threw a hand in the air and turned to look at us looking utterly terrified. In 10 seconds the danger had passed.

What had caused the guide to stop us? As Mary had seen (I didn’t because I was a few metres further behind), we had nearly tripped over a black mamba – South Africa’s most deadly snake. It is very rare to come across them. They contain sufficient poison to kill over 30 humans. They are also the fastest striking snake. And they are extremely nervous characters. This means that they attack if they think they are being threatened. They rear up and can strike at chest height. Fortunately, Jerome had been alert and we were able to return to the lodge with a good story.

On our drive back we came across another adder. Indeed we ran it over. Not sure we will have dented the population numbers greatly. Anyone still keen on visiting us? Suze?


* Just imagine the confusion if the two did meet. Immediate conflict would surely ensue over naming rights. Historians would have to write about the Tongan wars in which the Tonga defeated the Tonga for the right to be called the Tonga.

** Not completely true.

Jiminy Cricket

As regular readers will know, I am not a big fan of South African radio. My particular poison is South Coast Fm ‘Durban’s number one radio station’. The music is dreadful and the djs are moronic. However, today they managed a droll moment. Occasionally they comment on a news story. This morning they drew attention to the fact that SA comes 38 out of 39 on a list of countries recently assessed on a range of security issues. The country was only ‘beaten’ by war torn Liberia. The dj casually thanked all his compatriots that contributed.

Today we had afternoon sport at school. Of choice, the kids would always pick to play football. But they play ‘soccer’ after school everyday anyway. In one of the school outhouses, we have some rugby balls and the essential bits of cricket equipment. So, feeling like a missionary, I have been trying to put them to use. Today’s cricket session began with me demonstrating four Comptonesque strokes with the bat. All then copied. Having learnt the art of batting, we moved on to bowling. Technique issues were quickly covered. And all the vital messages were hammered home – ‘line and length’, ‘corridor of uncertainty’.

Now we were ready to play.

Well it wasn’t the prettiest spectacle. Environmental factors created issues. As examples, the breeze kept blowing over the wicket behind the batsman; cattle made certain fielding positions difficult; the heat of the sun led to some very poor umpiring decisions. Nonetheless all tolerated the novelty of not playing football. And there was exciting controversy at the end of the match as both sides claimed victory (almost every player had a different view on how many runs each side had scored). I was happy to call the game a draw and none accused me of match fixing.

We have been busy this week with preparations for the half marathon. More to follow about this next week.

Tomorrow we are going away to celebrate my birthday. I know nothing about what the weekend involves. One small clue is that I was meant to be taking my malaria pills. I forgot. Hopefully this won’t lead to an unwanted present.

Karate Kid

Mary had a very busy weekend on call. I spent the weekend at the hospital escaping only to go to one of the smaller safari parks called Ndumo on Sunday. I didn’t see a leopard. I did see some giraffes, lots of antelope, a baby baby* monkey, and some big big* lizards.

We have stepped up our half-marathon training regime. We are now trying to do some longer runs. Running through the nearby areas creates lots of interest. Often people ask to join in. Last Thursday, Snethembu (18 years old) ran with us.

On Friday, Snethembu arrived at our house at 16.30. We had mentioned that we might go running again. In anticipation, he was all kitted out. But not in athletic gear. Instead he was wearing a Karate/judo suit. On his feet he had a pair of crocs, with the heel straps broken. In his hand he had his mobile phone – ‘music to help us go faster’. Concerned at Snethembu choice of attire and footwear, I suggested he might need to change. He found my reasoning very weak and so off we went.

We didn’t get very far before Snethembu’s knee started hurting. Insistent that he didn’t want to stop, he began to run in a crouched position with one hand on his knee. Minutes later, Snethembu’s phone began to ring. It was his pastor wanting a long discussion about an upcoming conference. Quite unfussed, my running companion began a long conversation.

I am due to be running again with Snethembu this afternoon. I am slightly intrigued about what he will be wearing this week.

* A better way of exaggerating something when speaking English to the Zulu people is to repeat the key word. If Mary needs something done ‘now’ in the hospital, she must ask for it to be done ‘now, now’.

Feeling cold & singing songs

The weather has been distinctly unafrican this week. No sympathy expected, but it has been cold and wet. Today it even started hailing. All the children immediately ran outside the classrooms. So began 10 minutes of wild excitement. I found myself joining in.

I decided to focus on personal health issues in my life orientation classes this week. In most respects the children have little control over this. For example, having a varied diet is a luxury beyond most. They are forced to drink some very unclean water from the tap (though this is cholera free). They all have to exercise, as few have cars. None need worry too much about drugs – too expensive (even tobacco; the exception is marijuana which is grown locally).

The obvious area to target is infectious disease. Apart from having a very high HIV rate, South Africa has the highest TB infection rate in the world. Better still, KZN has the highest rate in SA. Hence there is a TB sponsored ward in Mosvold. In the spirit of increasing awareness, we came up with our own TB song. It must be sung to the tune of ‘Doo dah, doo dah’

‘The TB Song’

We must know about a thing called TB, TB,
We must know about a thing called TeeeB,
It can make you ill, it can even kill,
You must know about a thing called TeeeB.

There are many signs that you have TB, TB,
There are many clues that you have TeeeB,
Coughs with blood, pains in your chest,
You must see a doctor, to have a test.

There are other signs that you have TB, TB
There are more clues that you have TeeeB,
Feeling tired, losing lots of weight,
Go and see a doctor before it gets too late.

If you are always sweating think TB, TB
If you are always sweating think TeeeB,
And if you don’t want food, you never want to eat,
You need to see a doctor, you’ve got TB to beat.

The good news is that TB can be cured,
The good news is that TB can be cured,
6 months of drugs taken every day,
This will make sure, your TB goes away.

Some skill is required to make it fit the tune but we all had fun making and singing it. I think the HIV/Aids song might be more difficult. We will need some possible rhymes for e.g. abstinence, fidelity, unprotected sex and circumcision. I’ll let you know what we come up with.

Due to the poor weather, and the fact that Mary is on call, this weekend is likely to be uneventful.

Hornlessness

This weekend we went for a big food shop at Richards Bay. Not much to report except that we fixed the air conditioning in the car. Mary and I celebrated as if a leap of leopards had just passed by and posed for our camera.

Unfortunately, the car developed another problem on the return journey. Trying to honk a cow off the road, our horn packed up. For the rest of the journey we had to halt and wait for umpteen cows, goats, hens etc to complete their evening crossings - unhurried. The beautifully cool air belting out and Bob Dylan’s idealistic whine meant we retained great inner peace throughout.

He came, he saw, he pointed

On Friday I completed a second week at Ntabayengwe School. I am developing a role for myself. I teach English, Social Sciences (history and geography) and Life Orientation (personal health and social issues classes). I teach years 6 and 7. On average I teach 3-4 lessons (each an hour long; there are 5 lessons in a day). I also take sport.

As well as teaching my scheduled lessons I also act as permanent ‘cover’ for year 6 and 7. They often are without a teacher. This will be for one of three reasons:

1) A teacher is away. We only have about 9 teachers. One, a young male is on sick leave. The headmaster and I visited him on Friday. He is very unlikely to return. He has Tb and almost certainly HIV. We found him living in an isolated hut, wasting away. He said he had no appetite. Nobody was caring for him. It was one of the loneliest situations I have ever witnessed.

2) A clash in the timetable requiring a teacher to be in two places at once.

3) Late cancellations. Sometimes, a teacher will decide to take a lesson off. Today the principal wasn’t keen on teaching African art and culture period 3.

I cannot be critical of any of the staff. Most work very hard and are paid appallingly. I asked the headmaster about the average salary for a teacher. Embarrassingly, he presented me with the payroll. It showed that most get paid approximately £1000 p.a. Food prices are comparable to the UK. This makes it barely a living wage. I now understand why they have been on strike!

Two things caught me by surprise during the week. The first was a big downpour. This came while I was teaching. And then suddenly I wasn’t. The rain landing on the tin roof made it impossible for the class to hear me. For a couple of minutes I tried shouting over it. I continued until I realised that most of the class were laughing at me. Then I gave up and we all became spectators at the window.

Later the same day the Principal entered the classroom. He arrived to give a motivational speech to the class. Suddenly he stopped and pointed at the eldest student (about 20 years of age) called Caesar. He sits on his own. In front of the whole class he said, ‘That is Caesar. He is retarded. He will not go on to Secondary School. I am trying to find him a special school. Do you understand?’ I did and so did the rest of the class.

Gogo and the goat!

My last patient during my on-call shift (29 hrs) was a medical first for me. As those following the blog will know, I have had many novel experiences in my short time at Mosvold. This case was the first time I have dealt with a goat related injury.

In came a gogo this morning with a relative (you are never quite sure who the relative is) and explained to me that her right shoulder hurt. I asked her what happened (in Zulu!). She explained that she was sleeping two nights ago when a goat entered her house. All our patients sleep on the floor at home. The animal walked through the house and onto the patient. She woke to the shock of a goat morning kiss. I found this very funny but no one else did so I kept quiet. I took a look at her right shoulder and noticed a large bump. I sent her for an x-ray and back she came with a clear cut right sided fracture of her clavicle. Poor Gogo!

She’ll be back in action in two weeks. She is now investigating goat security measures.

Nuts!

‘How does a squirrel keep his nuts dry? By swimming on his back.’

This is one of dad’s favourite jokes and last night at midnight it popped into my head. Fortunately, it popped out again quickly. For last night was not the moment to be attempting to retell it in Zulu.

Presenting in front of me was a six year old boy with his Gogo and neighbour (who looked very awkward) to explain to me that the boy had been bitten by a dog. The location of the bite quickly became clear – the scrotum. Unfortunately, the clinic had covered the man’s dignity with tape and no gauze. My first challenge was to try to get this off without causing him more pain. I decided to apply lots of sterile water and then pulled it apart (still very painful). This revealed that both testes were hanging loose. Although I do not have male genitalia (you will be pleased to know), I felt his pain. We do not have many options (and none are good) for strong analgesia. I did my best and cleaned out the wound. I tried hard to pop both testes back in place but to no avail. As a result, I had to transfer him to our referral hospital for specialist care.

NB. This somewhat emergency situation was not taken seriously by our ambulance crew. I asked them to pick the boy up at Mosvold at 4am so that he could be on the surgeon’s table by 8.00 am (it is a 3 hr drive to our referral hospital). They reassured me this would be done. It was not. None of the EMRS drivers could be convinced to disturb their sleep. On discovering this I gave our Ops Manager a full and frank opinion of our emergency service team. The boy finally left our outpatient department at 7.30am this morning.

Ingwavuma Superman

How to solve our significant problems in house number 130? This was the issue facing us on Monday afternoon. Having reached the end of our tether with the on-site maintenance team, we felt desperate.

Fortunately, help was on its way. Enter, Ingwavuma’s very own comic book hero – Mr Vilikasi – Hospital Manager. Vusi arrived at 130 having received our distress call. He immediately wanted to know the long story of our accommodation woes. We were delighted at the opportunity to vent our frustrations.

Mr V is a man of authority. He is highly respected in the hospital and wider community and very competent. If people truly look like their pets then Vusi is also a man to be feared. For in his garden somewhere, there lurks a significantly sized rhino. Most rhinolike, he has a permanent friendly upward curve on his mouth.* He originally began working life as a nurse. At some point he moved into administration. Talent often seems to act as a barrier to career success in SA. Somehow this able man managed to reach the top of Mosvold hospital (no mean feat given the incredible levels of bureaucracy).

Vusi listened very patiently to our story. He then gave a very heartfelt apology and promised to resolve the situation. With the speed of a rhino on a charge, he set about finding solutions to all of our problems. Since his intervention, we have had two new boilers put in (the house next door had been sharing ours), new pipes, a new shower and new taps. Praise be to Vusi.

However, the restoration process, has not all been plain sailing. Today I returned from a day of teaching to find our kitchen floor covered in two inches of mud. Worse still was mud sprayed across our bedroom. Standing back, it looked rather like an art work – Jackson Pollock meets Tracy Emin. Mary, on seeing the scene, looked rather like the Munch scream character. (How had this happened? Somewhat frustratingly, the workmen had not closed the hatch for the ceiling before taking out the boiler. It was full of mud due to the collection over time of sediment from the water supply.)

Tomorrow will now be laundry day. Meanwhile the workmen will be painting the ceiling to the kitchen. We’ll let you know how the drama unfolds.

Don’t condomise – circumcise!

There is an approach in South Africa when it comes to sex education and HIV awareness called ABC. This stands for Abstain, Be Faithful, Condomise. Given the HIV rate continues to increase (at least here in KwaZulu Natal – KZN), the government has set up circumcision camps. This involves a doctor from each hospital every month or two spending a full day or two carrying out circumcision after circumcision.

The only one requirement in getting a circumcision is that the man needs to be HIV negative. This is because there is one study that shows that men who are circumcised have a lower rate of getting and giving HIV during unprotected sex.

Yesterday, a sixteen year old boy came to OPD to request a circumcision so that he can have lots of sex without a condom and not catch HIV. The doctor who saw him in OPD was not impressed and took the opportunity to educate him but also booked him in for the snip. Today, I carried out the operation. I did it all by myself and felt it went quite well (if I can say so). I had seen it carried out once before – a good five weeks ago. It is very much a see one, do one, teach one culture when it comes to medicine.

It did make me think that the new SA approach should be ABCD – Abstain, Be Faithful, Condomise, Don’t condomise just get a circumcision.

Unfortunately changing attitudes towards sex is a very slow process. It is not helped by the example set by some in authority e.g. the President, Mr Zuma. Zuma was acquitted of rape prior to taking up office. He ran as his defence that the woman was wearing a short skirt and so was provoking him. Enough said.

Rats

This weekend we headed back to Sodwana Bay for more diving. It was a last minute decision. The plan had been for a group of us to go to Cape Vidal; this then changed to Mozambique. Logistics made both of these impossible. Feeling the power of Ringo Starr’s lyrics, we decided we most wanted to be in a little hideaway beneath the waves. So we drove back to our favourite scuba haunt, whistling tunelessly all the way.

We spent Saturday on the beach. We read, built sandcastles, and frolicked in the sea. Two things threatened my enjoyment of the waves. The first was my oversized swimming trunks with built in extra gravitational pull. Through a mix of luck and technique I managed to avoid any pornographic scenes. The second was getting ear ache from spending too much time under water. My bathing suit battles meant the Maginot Line defences in my ears were broken time again by the sea water. Combat has been raging since.

Sunday we were blessed with perfect conditions for our dive. We had 30 metre visibility, calm water and little surge. Our main concerns were that I could avoid too much ear pain and Mary could avoid vomiting. Thankfully neither of these interfered too much during our time in Ringo’s world. And by great coincidence, the first thing I saw on descending to the bottom of the ocean was an 8 legged friend. Unfortunately Mr O immediately decided to scarper. (I didn’t even get time to say, ‘How do you do? How do you do? How do you do? Etc.)

Despite the quick disappearance of the host, some of his guests decided to stay. Perhaps the most timid of these was a large potato bass. He was discovered hiding under a big rock.

When we got back to the surface I began to feel some pain in my fustilugs. Before I could alert my wife she was vomiting again. This time Mary hadn’t felt sick during the dive. It was resurfacing, that brought up breakfast. The other divers were very grateful for Mary beckoning so much sea life to the vicinity. She was encircled by hungry fish all keen on a share of the regurgitated food.

On our way back home we stopped off to buy some things for our new ‘home’ – number 130. We spent £26 buying crafts to decorate the ‘cave’ (nickname for our new abode).

We arrived at the hospital to find our kitchen flooded and water dripping steadily through a number of spots in the kitchen ceiling. The on-site plumber immediately recognised that there was a problem. After not much more time the cause was identified. We were told that, ‘The boiler is f…... It is most definitely f…… There is no doubt at all. The problem is the f…… boiler. I can tell that it is f…..’

We now have to wait for ‘a week’ for the new boiler. Previous occupants of the house told us before moving in that we would be able to hear giant rats running through our rafters at night. With a big hole in the kitchen ceiling we will now be able to assess their friendliness. Hopefully they won’t be singing to Ringo’s tune ‘We like to be under the ceiling, in Mary and Henry’s kitchen’.

Uthi lizokhithika?

School holidays have meant another week of inactivity for me. My time has been filled mainly reading.

After work Mary and I have been training for the half-marathon. I am trying to convince my wife that it is unnecessary to greet every single person that we happen to pass (there are many). I am having little impact and feel mean spirited to boot. Those that greet us, do so in a mixture of Zulu and English. Sometimes this can be very funny. Yesterday a teenager bowed slightly and said, ‘Good evening, my lady’ as Mary ran past. Henry Higgins would have placed him in the Home Counties. Even I find it impossible not to wave and talk with the children we pass.

We are in the process of moving house. We are having to vacate our current property (Mandela’s mansion – no 110) for an English family that are coming over. We always expected to move. We were meant to live in no 130 from the start. Convincing promises were made that it would be ready a week after our arrival. Suffice to say we are about to move in and little has been done to it. Today an army of pink ladies were sent in to clean it. I arrived just as they were leaving. Then began a very sensitive negotiation process. On the one hand I needed them to feel the warmth of my thanks for the job they had done. I managed to convey this very well – smiles and laughter all round. On the other, I wanted them back inside to do all the things that had been missed; the bath still looked like it had just been used by a particularly dirty rugby team. Not as successful on the second part. Eventually one pink lady agreed to perform a ‘polishing’ job. Another exercise in the art of the possible. Hopefully Mary won’t be too aghast when she sees it later.

Our vocabulary in Zulu isn’t improving much. It is a very difficult language to learn. Take, for example, the sentence for ‘I am speak very little Zulu’ – ‘Ngisazi kancane kakhulu isiZulu’. Not exactly a longhop. Then I have difficulty learning the phrases that I most need. Annoyingly, much less useful ones tend to stick. I can now say ‘uKhisimusi omuhle!’ meaning ‘Happy Christmas!’. Pronunciation is an absolute nightmare. I have no handle on the clicks at all. Furthermore I get a bit angry when I’m corrected by somebody repeating the noise I have just made but suggesting a difference. Our language issues aren’t helped by our tiny Zulu phrasebook. This was clearly written by an owakwelinye izwe (foreigner). Among the essential phrases section is, ‘Uthi lizokhithika?’ meaning, ‘Do you think it will snow?’ Not bloody likely.

Anyway, on a more cheery topic, we are likely to go to Cape Vidal this weekend. This is meant to be a stunning part of the coast, good for e.g. whale watching. I’ll let you know what my inkosikazi (wife) and I get up to.

Hlane

As foretold, we visited Hlane over the weekend. It is Swaziland’s biggest game park with more life than ‘a tramp’s vest’ (thank you Stereophonics).

We had a terrific time. Although we are on the border of Swaziland, we have to take a circuitous route to get onto the nearest major road into the country. It took us 5 hours to get from Ingwavuma to the Hlane.

We were immediately charmed by the Swazis and their beautiful country. And we were also wowed by their superb roads system. Barely a pot hole to be seen. I got terribly excited about the smoothness. I found myself uttering phrases like ‘a positive pleasure to drive’. Self-revulsion soon kicked in, as I realised I was becoming hideously ‘Top Gearish’.

Given that we are likely to be visiting a number of game parks over the coming months, Mary and I have begun a ratings system. As it is in its infancy, we haven’t yet agreed on all the criteria or even a name. But we think it needs to be harsh for it to gain credibility.

Hlane: the positves

There were some excellent things about Hlane e.g. a restaurant right by a big lake that attracted hippos, rhinos and more. Our ensuite hut was also very tasteful. But...

Hlane: the negatives

On the downside, some idiots decided not long ago, that a major road should be built straight through the middle of the park. The result is that you can hear a faint motorway noise from most sections (think Wisley and the A3). This somewhat kills the sense of being in the bush. Secondly, the animals in the park have had to be divided into sections. The rhinos have been separated from the big cats. This is because of poachers (the park can now send round foot patrols). As a result it creates a bit of a zoo feel. Thirdly, the food did not hit the heights of Tembe. With great seriousness, I was able to lean over to Mary during dinner and pronounce that my impala steak was disappointing.

All told, we still had a great time. But still no leopard. Does anyone really sympathise with somebody that complains about his impala steak? I hope not.

Our return journey was memorable if only for the fact that I think I have worked out how to get our air conditioning system working. My breakthrough came at the end of our sweaty drive. I felt like the men at Bletchley Park after cracking the enigma code. (Their task was of course easy by comparison.) The irritation caused by the heat was only trumped by our lack of in car entertainment. We agreed that we need to buy some more CDs for the car. We have one album by a famous Zulu artist. Good as it is, we need a break from her. And we cannot tolerate any more of Durban’s East Coast Fm (station policy – ‘if it ain’t by Christina Aguillera, Atomic Kitten or Lady Gaga we don’t play it’).

PS – sadly rhino poaching in South Africa is still very prevalent and provides a real threat to the extinction of the species. SA has 80% of the world’s rhino population. They have approximately 40,000 rhino. The animals are being poached at a rate of more than 20 a month and the poachers are running ever more sophisticated operations. The rewards are massive. One large rhino horn is estimated to be worth 3 million rand (300,000 pounds). 3 million rand buys a nice house with pool and swimming court in Jo’burg.

Sometimes they don’t want our help …

Today is a public holiday in South Africa. I do not get the public holidays off as a holiday but the workload is much less because patients tend not to come in. In addition, most of the buildings are closed and there are no x-rays and even fewer blood tests available.

While working in OPD this afternoon, a very thin forty year old man was wheeled in by his wife. Immediately, I knew he had HIV, TB or both. Such is the prevalence of these disease that I can now be confident before testing simply by the way they look. Sadly, he had both illnesses.

I began to take a history. My interpreter who is a nurse informed me that the reason he came in was because he felt dizzy and his legs had lost strength. Patients here bring a card with them. His was empty except to tell me that he had started TB treatment yesterday. On questioning, he told me he started anti-retrovirals a week and a half ago. No wonder he was weak!

I examined the patient and found some of the biggest lymph nodes I have ever seen in his neck (which will be filled with TB) and a tongue covered in candida (there was no red tongue to be seen). His blood pressure was low and pulse rate was high. I explained that it would be best for him if he was to be admitted onto our TB ward in order to ensure the pills go down and also for the dietician to help him. He weighed 35 kgs.

Medicine is very paternalistic here and patients tend to agree with what you suggest. However this patient was not happy. He explained to me (which the interpreter kindly translated for me) that he was not going to stay in hospital. I was surprised and tried to establish the reason for his resistance.

Our discussion went back and forth with long pauses when suddenly the interpreter asked if it would be OK for the wife to enter the consultation room. In she came and the discussion went on.

Then the brother of the patient arrived and there was further discussion. All in Zulu. Again, long pauses. Suddenly, the brother stated in English that the patient would consent to being admitted. I looked at the patient whose face showed defeat.

I am not confident that he will stay. His prospects are very bleak. We will do what we can.

Tubal Ligation Please.

I was working last weekend on-call. I had been told by the medical manager that the priority for weekend on-call should be to the ward patients. Conversely, the patients waiting in outpatients were (and always are) lowest priority. Last Saturday was very busy on the wards – sick child fitting on paeds ward, acute psychotic patient hitting staff members on male ward and maternity ward heaving with complicated labours – this resulted in me ending up in OPD at 15:00. By 15:30 I was ravenously hungry so decided to take a 30 minute break for lunch. I went back to OPD and continued seeing patients.

At 17:45, a woman stepped in holding a blanket and asked for a tubal ligation. Although this is a procedure we perform often in theatre, it is not an emergency. Whilst explaining this, a cry came from the blanket. Mum had brought her small baby to her breast. I asked Mum the age of her child. Her response, ‘One day’. She had travelled 3.5 hours to get to the hospital. She had left her house at 5 am to travel to Mosvold to wait over 8 hrs. I had to tell her that we would not do the procedure on a weekend. Mum showed no sign of frustration. In consolation, I ‘offered her’ the floor on paeds ward to sleep. She had her tubal ligation yesterday. I think she will be happier knowing she cannot have a seventh child. To quote one of my favourite people - the mind boggles.

NB. Zulu men would never agree to a vasectomy so it is the women who ask for a tubal ligation (or we offer after child number 5 or so). It is done in a secret way from the father of the children – usually prior to a c-section or the day after normal vaginal delivery. I always feel a bit sorry for the woman.

Close to greatness

This weekend we are heading to Swaziland to Hlane National Park. Mary is being very tolerant of my ever increasing leopard obsession (Toulson family – think Michael Jordan Chicago Bulls shirt). The tree bound big cat has thus far hidden from me and I am growing tired of its games. Keep your fingers crossed for us.

I should also mention an incredible discovery. Last night was the first meeting of the Ingwavuma Half Marathon Committee. After the meeting one of the group casually mentioned that Nelson Mandela had used the toilet in our house. ‘Pardon? The world’s greatest living human used the toilet of number 110.’ I had not misheard. Not only did he sit on our toilet but he also sat on our couch! It turns out he came to Ingwavuma for an ANC rally in 1993. He came to our house to meet the Chief Doctor.

In my excitement I immediately sought our copy of his autobiography. Surely he will include mention of his visit to 110. Alas not. No mention of any rally either. Nevermind. There are plenty of people still here who were present that day who have confirmed the veracity of the story. Surely that puts our property on a par with Robben Island. Best not tell the tourists.

A Well Deserved Holiday?

I have just completed three days at Ntabayengwe Primary School.

About the school, its name means mountain of the leopard. It is called this either because: a) there used to be a leopard that hunted in the area killing lots of sheep b) the mountains behind the school make the outline of a leopard. (Mme Ntembo - Deputy Principal - took time out to show me the leopard-like shape of the surrounding hills. I wasn’t entirely convinced. I tried to argue that it looked like any sedentary animal. She was adamant that it resembled a leopard. I didn’t push my point.) The school is about 15km from home. Being at the base of the mountains it is 5-6 degrees hotter that the temperature at the hospital.

Though Mpontshini (school I was at last weekend) was hardly Charterhouse, Ntabayengwe is much more desperate. Most of the buildings have temporary roofs. There are very few staff. One of the two male members of staff is very sick and so is rarely able to attend. There are almost no classroom resources. Despite all this, I had a much more enjoyable time with the children. The main reason for this was that the school has much fewer pupils. As a result I was able to teach classes of 25 instead of 70.

I taught most of my lessons to a group of grade 6s. What they lack in English they make up for in huge enthusiasm. Being only 25 in number, I have learnt most of their names (or shortened versions) which they are very pleased about. This has helped us to bond. They clearly like me, even if they are puzzled by my lessons. My biggest appeal is that I do not hit them if they are not paying attention. This is the practice of the fearsome lady who usually teaches them. (She now sits in the corner of my lessons and acts as translator when they look entirely lost.)

The quality of my lessons is very suspect. The trouble is that what I am meant to teach them is far above their ability levels and often extremely dry. My challenge is trying to inject some interest but without any resources. I have had some successes but more failures.

Failures:

In social science lessons we have been looking at causes of ‘change’. We looked firstly at technology and the impact of the computer on the world. We went through examples of technology. The children were familiar with cars and phones. None have electricity. Most had seen computers. None knew about the internet. My lesson on the profound impact of technology and computers on the world ‘we’ live in began to unravel.

Yesterday, in a follow up lesson, I brought in my computer. I hoped to be able to show them the internet. Unfortunately, I could get no connection. To try to make up for their disappointment, we played a game of computer chess. They were thrilled. After this we looked at how individuals have changed the world. We discussed Nelson Mandela. Then muggins here, decided to teach them about another great individual – Albert Einstein. Why did I pick him? Because he was the example in the text book. Crap reasoning. My monologue on Einstein quickly descended into farcical levels of detail. So atoms…and splitting….and huge release of energy…and nuclear reactions…and atomic bomb…and Hiroshima…and the Cold War…and prospect of nuclear holocaust. Lindon’s increasingly animated nose picking in the back row was the only productive part of the lesson.

Then, I give you the example of my social science lessons. Prior to my arrival, the children had been learning about human rights. I was given the task of explaining gender stereotyping and sexism. Before tackling this, I thought a recap on rights would be worthwhile. What were their rights? I focused in particularly on their right not to be subjected to physical abuse. I’m not sure what my friend in the corner thought about my emphasis.

Looking at gender stereotyping, the boys and girls congregated in different corners of the room. Right, says I, ‘What do most boys like doing?’ Answer from bright girl called Slo, ‘Playing football’. ‘Guhle’ I say (meaning good in Zulu; must be pronounced as if thoroughly inebriated). ‘But, obviously, not all boys like playing football’. Except, all the grade 6 boys at Ntabayengwe do. Nevermind. Then we reversed it (with equal success) to look at how not all girls like netball.

‘Now, what if I said that all the boys in this corner are very clever. They all have big brains. All the girls in this corner are not clever. They are all stupid. Would anybody disagree? What is wrong with what I just said? Please somebody put up their hand. Girls, please defend yourselves.’ Silence. Rest of the lesson was spent trying to show that boys are not more clever than girls. I’m not sure I changed many opinions on either side.

Last but not least, my English lessons were truly horrid. Yesterday was spent teaching about prefixes and suffixes. Never have I been so boring. Regardless, at the end of each lesson the children my departure would be accompanied with a chorus of ‘Thank you, Sir.’

Football

The end of the day I was able to organise games of football and netball. The football match took place on a pitch outside the school. When we arrived, one end was occupied by cows. They willingly vacated the area when we made clear our intentions. The pitch has no grass and has many rocks. I split the sides into two. And they kicked off. The game was utterly brutal. There was little passing as nobody was clear on their team mates. (I need to try and make them some bibs). The boy in possession of the ball was routinely hacked down. The referee made an early decision to let the game flow. As a result not a single foul was called. Though most of the players were bloodied and bruised by the end nobody complained once.

Sadly, today marks the start of a school holiday. The holiday runs until the end of next week. To fill my time I have taken on responsibility for organising the Ingwavuma half-marathon. I will let you know more about this.

After half-term I will probably return to Ingwavuma High School to get a better idea of what it would be like to teach there. Unless I really enjoy it, I am likely to return for good to Ntabayengwe.

Reed Dance Festival

Daily Mirror says ‘Get your breasts out for the King’
Sun says ‘Best of the Fest of the breast’
Daily Sport ‘Breastacular’

This weekend Mary has been on call. Being a doting husband I decided to stay and keep her company.

That at least was the official line. More accurately, staying put allowed me to go to the ‘Reed dance festival’ that takes place each year in Ingwavuma. This long running event provides the Zulu King with an annual opportunity to add to his collection of wives. Here is how it works:

1) Thousands of women from across Zululand converge on Ingwavuma hoping to catch the eye of the King.
2) Each must carry a reed to the festival. The reed is a symbol of virginity. The reed acts as a ‘lie detector test’. If any girl’s reed wilts or breaks, then this means the girl is not a virgin. (I was unable to establish the consequences for a girl if this happened.)
3) The girls parade before the king wearing a traditional skirt and with their breasts on display.
4) Then they dance and sing and have a good time.

Hearing this description of the event, I felt a strong moral obligation to demonstrate my respect for local culture and traditions.

After a 10 minute drive, we (I accompanied some other medics) arrived at the site for the ceremony. As the Lonely Planet guide promised us, so we were immediately surrounded by half-naked ladies with reeds aloft. They were walking together in regional groupings rather like at a girl guides’ parade.

We made our way to the centre of events – a marquee to house the royal entourage. We were accompanied by a couple of Ingwavuma locals. They headed for seats not far from the King. We followed. I was stopped and asked, ‘Are you part of the Zulu Royal family?’ I was very impressed by the politeness of the question. I pointed and said I was just following my group of friends. This seemed a satisfactory answer.

We took up seats and awaited the entry of the King. We were not disappointed. After not many minutes, a number of chiefs began arriving. They were dressed in leopard outfits. All looked very traditional except for the football shirts many were wearing underneath and wrap around shades.

Then the Zulu King arrived. All rose. He was identifiable by a feather in his hair.

And so the festival began.

From an outsider point of view there were two main detractions from the enjoyment of events. Firstly, each dance was interspersed with very long speeches in Zulu. This obviously made no sense to us. Furthermore, they clearly bored the locals. By the end of the ceremony, a number of the chiefs were fast asleep. The King gave a particularly long and dry (judging from the amount of laughter) speech.

The second drawback was that the King did not pick a wife. Seemingly, he never picks a wife on the day. Instead, he picks later from photos and from research done by his advisers. This created a great sense of anti-climax. Should they choose to commercialise the event I think they will need to change this.

In the end, I was very glad I brought a book with me for proceedings. The only slight peril of reading through the ceremony, was making sure I stood up, with all the other males present, each time the King rose. This happened quite a lot. Suddenly I would have to raise my right arm three times and mumble a Zulu word. Despite the danger, all passed off smoothly.

Unfortunately, after the event, I returned home to find Mary with a gastro bug. She valiantly completed her 24 hour shift at 8 this morning and is now in bed.

How's That ?

I have just finished my week at Mpontshini Primary School.

1) The highlights of my week were:

The school run – Each day I ran a taxi service to and from school. I would stop my car at the beginning of the dirt road and shout ‘lift’. Tens of children would surround the car all trying to fit in. Somehow I would manage to fit 8 or 9 in the back of my tiny 3 door car. I hope to take a picture to prove it.

Umpiring cricket matches - After school sports are on Tuesday and Thursdays. Some of the kids but none of the teachers showed great enthusiasm for the leather and willow (or our substitutes). So I decided it was where I could best help. As well as umpiring I provided a running commentary during both matches. Many of the players were younger children they could not understand me. Nonetheless they seemed to enjoy it and trying to imitate me. At the end of the games all gathered round to hear me read out the scores. Making no sense at all, everyone would then celebrate – hands aloft waving pieces of kit in the air.

2) The lowlights for my week were:

Social Science classes - Being invited to teach the slave trade seemed something of a hospital pass. Thankfully, none of the children seemed to hold me personally responsible.

The school toilets - Unfortunately, a great planning booboo was made in siting the school downwind of the ablutions. The odour that drifts across with the Ingwavuma Mistral is horribly pungent.

Next week I head for another primary school. I shall report back.

(I should perhaps explain that the grades roughly correspond with the UK comprehensive system. However, in SA, each year group contains some much older pupils. In my year 7 class I was teaching some 17 year olds.)

An unusual afternoon.

This morning I was in theatre. Our first case was a c-section. The indication was a twin pregnancy with the first twin in a breech position (feet first instead of head). Two beautiful healthy girls came out. I was excited (as have seen many not survive) but mum was less than amused. Mum’s name in Zulu was ‘happy’ but the surprise of twins made her cross. She is 22 years old and already has two children at home and cannot afford another two. After a tea break, we were supposed to do another c-section. Prior to inserting her spinal, I was examining her and realised she was not 38 weeks but in fact 26 weeks! This is a common occurrence here – I would say half the women I see do not know their last menstrual period! Our third case was (very sadly) a rape case. I will not go into the details as it is very depressing but needless to say it involves one of my lovely paediatric children who has now developed an ano-vaginal fistula.

After lunch I was in OPD. My first patient complained of hot and painful feet. This symptom – peripheral neuronitis – I have learned is common in both TB and HIV patients. Typically, the patient has both conditions. Whilst prescribing TB treatment, in steps the medical manager of the hospital. He asks me if I would be willing to remove a dead baby from a dead mother. I look up entirely perplexed. Two minutes later, I was in mortuary about to carry out the procedure. The reasoning behind the request relates to Zulu culture. This dictates that as mum and baby are brought into the world separately they should leave the world separately (even though they are going be buried in the same coffin). The case was of a 19 year old pregnant woman who complained of abdominal pain and then died suddenly in one of our community clinics. I am very aware of needle stick injuries so completely gown up with ski goggles, two gowns, two pairs of gloves and of course mask and boots. (I look quite funny in full kit but don’t care). As I conducted the post-mortem and c-section (thankfully with the help of the mortuary technician), I uncovered lots of congealed blood directly under the abdomen (she was cold) and after some searching, realised she has a ruptured right ovarian cyst. I removed all the blood and then conducted my c-section. The baby boy was approximately 5 months old and looked healthy. I then needed to remove the placenta (which was intact) as this too needs to be with the baby. We then sewed up the body.

Yet again my day had taken a very unexpected course.