MOST of us in the bush wear flip-flops or sandals without socks, our eyes on the ground in front of us, forever on the qui vive for Nature’s little surprises like red centipedes or small scorpions with bulbous tails or a dense column of ants, all of whose bites are painful and disabling. In houses or huts at night, given the restricted light of sputtering candles or paraffin lamps, footwear is always worn by the sober – rather the crunch underfoot of a large insect than the intimate caress of six unidentified legs against naked skin.

The 4x4 sandals I wear everywhere now were spotted by my son, Matthew, on a crowded pavement outside the Bonita Up-and-Down Guesthouse in Kampala. The soles are fashioned from recycled car tyres with a stout heel guard and broad foot strapping, not dissimilar to those of a Roman legionary patrolling Hadrian’s Wall.

For many years of hospital practice, I wore suede shoes. They were cheap and without laces. Unfortunately they were absorbent, changing colour from light fawn to a deep tawny rouge as a result of delivering numerous babies or dealing with the bloodied victims of assaults and road accidents. If invited to respectable houses, I left them outside the front door.

When in hospital now, I wear lightweight blue jobs from China. These are squeakless, a great boon when checking that night staff in the ward duty station are awake. The least silent were a pair of Iberian shoes with raised heels, bought when I started my first – and definitely last – private practice in Swaziland. I was under the mistaken assumption that if such shoes, together with a black pinstriped suit, were de rigeur in London’s Harley Street, they couldn’t fail in the mountain village of Piggs Peak. I resumed normal apparel within weeks – the area was at the height of the AIDS disaster and I was frequently mistaken for an undertaker...

Shoes, like most consumables in Africa, are not thrown away as in societies with a disposable culture. Mr Mkalipi does all our repairs, transforming the terminal and disintegrating wrecks we present him with into reborn assets with new soles, stitched uppers, holes patched, and deformed heel pieces or toe covers soothed and smoothed. He sits peacefully under a yellow sun umbrella, the table in front of him piled with pedal detritus, its small drawers and ledges full of instruments and materials of his trade. Being completely deaf, he appreciates if customers bring blank paper to write their needs with space for him to draw diagrams and suggestions.

My first attempt at correcting a dislocated shoulder involved both a foot and a diagram. I had not long arrived at Nsambya Hospital in Kampala. The drawing in their rather dated orthopaedic textbook showed a surgeon with his foot in the unconscious patient’s armpit; the traction he then exerted reduced the dislocation. Pius, our capable, wide-awake anaesthetic technician, looked politely surprised when I took off one shoe and assumed the position illustrated in the book. At this point, Sister Veronica Cotter, specialist physician and medical superintendent, appeared and was about to wish us all good evening when she saw my preparatory stance. Her cheeks pinked slightly.

“David – ah – are you feeling all right?”

“I’m fine, Veronica. Just going to reduce this man’s shoulder.”

“Oh? So that’s what you’re doing.”

A tactful moment’s silence.

“Is that how they do it in – um – Glasgow?” Pause. “That’s pretty hard, what you’re doing with your – eh – foot.”

Was that a suppressed snort I heard? Surely not.

“Here, let me show you another way. We do things very simply here. Very simply.”

She took the patient’s elbow, flexed and rotated it, then clucked with satisfaction as the head of the dislocated humerus audibly clunked back into position.

When she was about to leave, my saviour found me putting my shoe back on.

“ Oh, David, I should have mentioned it before. Buy cotton socks. They’re cheap, dry quickly, and your feet don’t – ah – perspire. Good night.”

Dr David Vost studied medicine at Glasgow University and is currently working at a hospital in Swaziland. He and his family live on a small farm in Northern Uganda near the Albert Nile. davidvostsz@gmail.com