IT IS not the actual temperatures where we live and work that make us wilt – often in the 80 and 90 degree range in summer, 70s in winter in both northern Uganda and central Swaziland – but the addition of eight to ten hours a day of raw sun, variable humidity and the tropical ambience of powdered dust on roadsides, heat-cracked fissures in fields, busy insects and simmering savannah.
The hottest spot for me – and Angus Blyth, a medical colleague from Oban – came one afternoon standing on an outcrop of quartzite overlooking Murchison Falls on the Nile. A photo was taken with difficulty due to the dizziness and nausea of mild heat exhaustion and only months later did we notice it showed an elephant calmly browsing on the other side of the gorge.
A close runner-up was at a bend on the Usuthu river in Swaziland with the thermometer reading 44 degrees centigrade or about 108 Fahrenheit; we met regularly as one of the WHO malaria monitoring teams but this meeting was not a success as the little fridge gallantly battling to chill a dozen lagers had succumbed to the heat. Interestingly, our expert malariologist from South Africa always travelled with two thermos flasks in his battered Peugeot, one full of iced gin and tonic for tedious administrative meetings, the other with hot rooibos tea and fresh ginger for day-long drives.
Most of us take a siesta during the middle of the day, resuming work an hour or so before sundown. It is ironic that in many African cities, as a consequence of watching endless television, videos, or communing on cellphones, all while indoors and probably eating a poor diet, many people show a fall in their vitamin D level. This is synthesized in your skin by the sun, but a severe deficiency causes rickets in children, with ugly bone deformities; Gorbals and other slum areas in Glasgow were infamous for it until about 70 years ago.
Jalabiyas with long cotton sleeves and deep pockets are wonderfully cooling. My first one was bought in a Khartoum dukka late at night, the market ablaze with solar-powered lights after the insufferable desert heat of the day. It went with a pair of cheap Mahommed arat (‘Get up and go”) slippers and a turban, my wife remarking that, combined with a large nose, most people would now assume I was an unemployable Syrian.
Heat exhaustion is common and unpleasant, sweating ceases, light-headedness overwhelms – but a few cups of sweetish tea starts the comeback. Heat stroke is quite another matter and can be lethal – we lost a sprinkler changer in the sugarcane fields not long ago, an overweight lady who insisted on swathing herself with layers of clothing ‘to keep the sun out’ and always refused to take any of the cool water made available.
Usually when headaches, an ague or a fever occur in the tropics, most patients assume (with good reason) that they have malaria and may protest when you start to examine them.
“What are you doing, doctor? I’ve told you what’s wrong with me...”
Traditional healers usually omit any physical examination but never miss a word or nuance while listening to their clients. They are aware of malaria and heat causing headaches and lurgies but are better at sourcing the problems of modern living. Cast your eye over this recent advert in The Times of Swaziland:
TRADITIONAL HEALER – GOGO MUMU – 100% GUARANTEE.
I call back your lost lover quickly same day and he say sorry to you. Goli powder to stop him cheating on you. Headache and problems at work I can stop same day. Ome powder to attract rich men and give you money. Koki muti to win tenders and lottery. Oki powder to be loved by your in-laws. Bingo powder to boom your business and for big ladies complications.
If Gogo Mumu set herself up in Byres Road or Sauchiehall Street for a few months to test the waters, I think she’d do quite well. However she would have to explain to the General Medical Council precisely what ‘big ladies complications’ are.
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
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