When I receive texts from friends and acquaintances in the community, sometimes they’re amusing, and sometimes I have to work out what they mean. One of the football players from the neighbouring village texted me late in the evening once, saying ‘Sir, all of my stars have finished’. I wracked my brain for what he could mean and could only come up with the idea that he was unhappy with life and was considering suicide. I replied in a hurry asking him whether he was alright and what I could do. After several more confused texts it became obvious that he had been asking me to buy him new studs for his football boots as all of his studs (stars) had fallen out (finished). Phew.
There is a patient, Anton (name changed) in our area with mental health problems. Life is tough for him. The community does look out for him to a certain extent but he will often have to sleep outside and scavenge food from the dustbins when the community has literally no shelter or food to spare. We are not sure of his complete backstory but he can read and write to a reasonable level in his second and third languages, which indicates a high level of education before he became unwell. San, his mother tongue, generally isn’t a written language. He occasionally has moments of insight into his condition and came to the clinic a few weeks ago looking forlorn, asking us for help so he ‘wouldn’t be crazy anymore’. We took him to Windhoek to see the psychiatrist soon after, having to drive the 9 hour round trip in a single day (it coincided with another urgent job we had in Windhoek midweek).
We made a quick detour to buy some fabric that day and left Anton by the car. He’s at risk of wandering off but we asked him to stand next to the car, and the guard looking after the car to keep an eye on him. After a short time in the shop we arrived by the car again with him nowhere to be seen. I had a momentary panic until we found that he had climbed into the back canopy of the 4×4, relaxed flat on his back on the mattress with his feet up, and started smoking a cigarette. Also, recently we took one of the village chief’s to hospital with a nasty chest infection. A few days later we heard that he had died in hospital. I was in Gobabis on the way to visiting the hospital when I had to do a double-take as Chief was walking down the street whistling and carrying his weekly shopping. Our translator shouted him over and he explained that he was feeling great, having had antibiotics for 5 days and was discharged that morning. It is almost impossible for the San community to know what happens when someone goes into hospital when they are unwell. They assume, often rightly, that no news is bad news and that the longer the patient doesn’t come back to the village, the higher the chance is that they have died.
The psychiatry department in Windhoek were excellent with Anton and he has been started on treatment. Unfortunately he needs assessment regularly for the first few months, which requires more midweek trips to Windhoek. Perhaps us not taking him to be assessed earlier appears neglectful. Maybe taking him at all appears to be a waste of resources. At the clinic we have to think about where our resources are most useful, with the time and money we spend on one patient coming with opportunity costs for other patients. There will not be any TB work done on the days we take him to his psychiatry appointments so there is a chance that a patient with TB could have been found and diagnosed that day. It is a difficult choice and I’m less sure now than when I started about what is right. A personal example of the Dunning-Kruger effect in action.
I arranged the first ever Omaheke San Football Tournament a couple of weekends ago. I say Omaheke, our region, but there weren’t any teams from the south of the region as I don’t have such great football contacts there. Also Wikipedia says that a tournament involves ‘a relatively large number of competitors’. That is quite a stretch, as the 5th team dropped out the night before the tournament due to a funeral. Perhaps the Northern Omaheke San Football Playoff is a more down to earth title for the competition that was played. I spent some money that had been kindly donated from Canada on footballs for each of the teams, banners, lunch and dinner for all 60 players, a trophy and some prize money. Surprisingly for me, the most popular offering was the trophy. The other teams were so excited by the rumours of a trophy that during the week prior to the tournament they sent delegates to inspect it, before reporting back that they had to ‘train hard to win Doc-tah’. Considering the poverty that the San live in, I did not think the food and prize money would be side shows to this trophy. It reminded me of a trophy I still have somewhere at my parents’ house from when I was awarded ‘Most Improved Player’ at Under 9s football. (‘Most Improved’ = tries hard but zero talent).
The secondary school closed for holidays a week early, which was a slight disaster before the tournament. As my players are almost all school children and come from up to 180km from my village it was going to be a nightmare for any of my players to get back at all. Six of the most ingenious ones solved that problem by ambushing me late in the afternoon on the Sunday when I had just arrived back from Windhoek. They had ‘missed’ their transport back to their villages and now that the school hostel was shut, they had nowhere to sleep and could I let them stay. After discussing with Clare and our nurse Anna, we decided they could stay in one of the empty patient accommodation rooms for the week. In return they had to work hard in the garden all morning and then could go and train for the football tournament in the afternoon.
One night during the week our patient accommodation rooms were full with patients so they had to sleep in the small living room area just off my bedroom. Their intentions were exemplary but I inspected the damage in the morning with our gardener/handyman (and fellow member of the football team) Fricky. All of the curtain rails had accidentally come away from the wall, the towel rail was pulled off the wall and there were tea spills all over the floor. They were also super thoughtful when using my ensuite toilet during the night by not turning the light on. Unfortunately the pitch black didn’t help their aiming and there was almost certainly more pee on the floor than went into the bowl that night. Fricky clicked the same San word at me twice as we surveyed the damage. ‘Baboons, Baboons’ was the translation. I laughed a lot as he continued to be slightly annoyed at his friends for the extra work they caused him. They’re such amazing kids and I’m sure they didn’t mean to cause damage.
The tournament was a great success with the remaining 4 teams, thanks mainly to the hard work of Clare and the translators who helped with all the food, transport and community engagement. All the teams got to play each other in 65 minute matches with the matches being super competitive and close games. The food we cooked on open fires in large potjie pots was gratefully received by the players between matches. My Lifeline Clinic Youngstars team won all three of their matches 2-1, 1-0 and then 2-0 so they won the tournament. They were the most excited that I think I’ve ever seen any San people and made us take a million photos. The party back at the clinic involved large amounts of Coke, Fanta and Sprite to celebrate, dancing to loud music and more photos of them drinking ‘cool drinks’ from the trophy.
The longer I’m working in Epukiro, the more I enjoy it. Longer periods spent here is more rewarding mainly because it is working with the San. When westerners think of ‘African tribes’ they often think of the stereotypes of them being happy and outgoing, welcoming you with open arms into their houses, eagerly showing you their culture, and being ‘happy despite their circumstances’. The San are the opposite to that – intensely private, unwelcoming of strangers, without obvious outward displays of emotion and carefully protective of their culture. This leads to a gradual, grudging acceptance by the community that makes it all the more rewarding when progress is made.