IN Scotland, the nearest thing to do-it-yourself surgery was squeezing a spot. The afflicted in many parts of Africa are more ambitious, clinics often being bereft of basic resources, doctors far away and costly.

Jabulane Twala was a good example. He was a hefty truck driver from Matsamo border-gate in Swaziland who had crushed three fingers while changing a tyre. For first aid, he wrapped strips of cloth round them as he couldn’t afford to be off work. Humid heat and the encrusted grime on the steering wheel resulted in infection with increasing pain and swelling. One evening he pleaded with a cousin to let out the “badness” inside the now-smelling digits.

Happy to help, the relative opened up the festering finger tips with a razor blade and applied a dollop of herbal medicine. By the time he came to us, Jabu’s fingers resembled a bunch of rotting bananas and he was weeping with pain. Still he refused surgery until his mother had cleared it with elder relatives, and sought guidance from the ancestors as well as the local inyanga or traditional healer.

DIY instruments are varied. Enemas are given via a cow-horn although non-rigid garden hosepipes are more common; the contents include soap powder.

The women of several tribes display colourful wooden discs in their ears, the initial entry hole in the earlobe being gradually enlarged into a loop. When these are torn, the local repair may involve opposing the ends with a safety pin until healed. One innovative girl used a large office stapler to bridge the gap.

Various manoeuvres involving a length of rope, two strong men and a distended bladder or, worse, a pregnant uterus, are not for the faint-hearted – or for newspaper readers seeking tranquillity.

Broken arms and wrists can be immobilised in barkcloth from various trees and secured with wild sisal bands, the results being highly variable. The widespread cure for chronic pain is to make a series of superficial cuts with a razor blade over and around the site, the resulting small scars being helpful to many of us doctors as a clue to the diagnosis.

For example, I couldn’t understand why one limping young man was also having symptoms of an enlarged prostate until the nurse pointed out the tiny line of scars down one of his thighs which showed the course of the sciatic nerve; his hitherto unsuspected “slipped disc” was pressing on spinal nerves that affected bladder function and walking.

Almost any deep damage to black skin results in keloid formation with the appearance over time of raised lumps or lines of hard tissue.

In some areas they are deliberately caused on the face and trunk, being regarded as signs of beauty – and if you shake your head at such strange beliefs, just check out where British young (and not so young) women and men allow themselves – nay, demand! – to be infiltrated with Botox and other injectable quick fixes.

Coming across a few youngsters in Northern Uganda with tender lumps on their scalps, I was at a loss until a Madi shop owner told me of a belief that if certain herbal concoctions are introduced into the scalp – similar to inserting garlic under a chicken’s skin before cooking – they can alter behaviour.

My wife and I did not shake our heads in disbelief when our son came back after a weekend visit to relatives and seemed rather odd. Two cousins had pushed something sharp into his head just above one ear, he said, and it was true. The lump was palpable, small and tender.

One sunny afternoon in the casualty department at Good Shepherd Hospital in Swaziland I examined a distressed young man who had two self-inflicted penknife cuts over a lump on his scrotum. The father had applied herbs and leaves after the incisions.

The very painful and impressively swollen contents of Ground Zero were now encased in a plastic bag suspended from the poor patient’s waist – the bag was vivid yellow and emblazoned “Another happy customer from Fraser’s Family Supermarket” ...

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.