International fugitive

A ‘minor’ oversight on my part back in June on leaving South Africa has complicated my travel plans for the next year. I confidently strode up to the immigration official at Johannesburg airport to leave the country for the final time only to be told that my visa expired the day before. Cue an awkward, intense interview in a prison-style windowless room, a slap on the wrists and banishment from South Africa for a year. I tried sending an email afterwards to contest the punishment. I stated how important a tuberculosis doctor I am in Southern Africa, and the need for me to attend conferences  in South Africa (I’m not and I probably won’t) – the silence in response has been deafening.

The ban normally wouldn’t be a huge problem as I don’t often visit South Africa, but while I’m in Namibia it is by far the easiest country for me to travel to on my time off. Every long haul flight from Namibia stops in South Africa and I’m now banned from leaving the airport. Every long stop-over I have, I have to remain in the airport like a British Tom Hanks from the film The Terminal.

The matriarch of one of the villages we visit

One of our outreach sessions recently was to a village we hadn’t been to before called Vergenoeg. The journey there was longer than most of our outreach locations but the welcome more than made up for it. The school principle arranged his 150 schoolchildren to sing a welcome song to us, then I had to perform an impromptu speech (via translator) from the principle’s lectern.

The amount of untreated medical problems was huge: we saw horrible infections due to lack of access to antibiotics, obvious cases of TB, wildly uncontrolled high blood pressure, severe lung problems and fungal infections in children. There were so many patients to be seen that we had to return the following week.

The second visit was notable for the fact that the ambulance broke down. Vergenoeg is in the middle of nowhere, 3 hours from our village. I had to walk 2km up a hill to reach mobile phone reception and then waited 5 hours for the rescue team to arrive. We were waiting in the complete darkness in a small village in the middle of the Kalahari for hours, finally arriving home tired and hungry around midnight. An advantage of this interlude, was that during the afternoon we had extra time for all the San patients that queued up to be seen. Anna, our nurse and I saw 78 patients during the day.

A scene when I visit one of my TB patients on a remote desert farm

A few weeks ago was the measles vaccination campaign for our area. Sarah, the other doctor and I had to have our unnecessary measles jabs again, then our little finger nail marked with indelible ink. This was to prove to the community the benefit of the injection. Trying to explain to the villagers with limited or no education the benefit of herd immunity, or the serious complications of cerebral measles is difficult. Showing everyone that the doctors had been vaccinated was much easier. Next week there is a circumcision campaign (to reduce HIV transmission) that I am keeping as far away as possible from.

The San football team I set up for my village had their first match yesterday. We played against the Pos 13 San team who were an altogether more serious outfit. They had a manager, a team kit, substitutes and were drawing lines and positions in the sand in a pre-match team talk. We arrived with mismatching shirts (I’ve ordered our new blue kit but it hasn’t arrived from Windhoek yet), only 11 players and decided which positions we would play in the minute before the match started.

Pos 3 team + our current medical students

I had arranged for kick-off to be around 10am as the temperature goes up drastically soon after. After rounding up all my players from various houses in the village, driving 40 minutes to Pos 13 and then rounding up all their players – kick off started perfectly at midday. We played for 90 minutes in 35 degree heat without any drinks breaks except half time. I nearly died. Considering how unprepared we were compared to the organisation of the other team, we played well. It was 3-3 until the final 5 minutes when I was taking my turn as goalkeeper. I spilled a routine cross straight to their striker who was delighted to be presented an open goal from 1 yard out. We ended up losing 5-3. I spent the evening watching goalkeeping errors from the Premier League, trying to console myself. The guys seemed to enjoy it though and will be super excited when the new team kit arrives and we start training for our next match.

There are many social problems the San have here that support and money could change. One of the difficulties is who deserves support most with our limited resources? The San football team that might give the young guys some purpose and pride, the young adult with psychiatric problems that has to scavenge food from dustbins, the 16 year old girl – top of her class – that doesn’t have the money to finish her last two years of school in the local town, the hard working man who wants to be an entrepreneur but has no investment, my intelligent translator that needs to go back to repeat her last year of school in order to fulfil her dream of being a teacher, the 7 year old girl with cerebral palsy that is occasionally tied to a tree with a rope by her neck while her mother is drunk. I don’t really know, but the only real long term solution is concerted efforts at government level. What we are doing as a charity clinic is valuable, but ultimately only an sticking plaster on the open wound of the San’s social situation.

The house of one of my favourite patients

Lastly, the other day I visited a patient that we heard was unwell. They happened to be fine but described their neighbour as having coughed up blood. The teenage boy offered to show us and promptly set off into the Kalahari bush. He rode through the sand and thorn bushes on a bright white horse (no saddle) while we tried to keep up in our truck. To complete the slightly surreal situation, my translator Anaki was singing along with Backstreet Boys on full volume in the truck with me. That was one of my occasional moments that I stopped and thought ‘how on earth did I get here – following a man on a white horse through the desert while listening to 90s boybands?’


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