Notes from Africa

A prize sow and a piglet with a very unusual complaint

EVERY few months the Medical Protection Society sends me a reminder of the way things are in colder, more regulated countries. In return for a substantial premium, it offers sage advice and legal assistance should we be sued for negligence.

The bulletins illustrate the pitfalls of medical practice, the amounts awarded in damages, and tactful warnings not to attempt brain surgery, ritual exorcism or liver transplants unless you’ve done a recognised course and have paid the annual subscription. Therefore I keep quiet about my practice in pigs – the society might not sympathise.

It began near the Mozambican border where Nick Langton ran a piggery, 12 dusty miles from our clinic. He was inordinately proud of his boars and sows, and with good reason – their fertility was staggering and the piglets’ mortality rate was lower than in many hospital maternity units.

The pride of them all – and this was no reflection on his dear wife – was a sow called Rachel whose deliveries registered on the Richter scale. Nick accoucheured them personally, day or night.

One blistering hot afternoon, the phone rang. It was Nick, shouting that Rachel had performed well again but something had “come out” that he’d never seen before. Would I mind having a look, the only vet being on leave?

He met me at the piggery gate, unusually solemn and obviously worried.

“Old dear’s in a bad way, David. I’ve given her shots of cortisone and streptomycin, rubbed her down with sea salt and oil, but it’s not helping her.”

My orthodox jaw always drops on hearing the highways and byways of veterinary pharmacology but then again I treat unrecognised skin rashes with sulphur ointment – there are many roads to Rome, be it psoriasis or sows.

Rachel filled most of the pen. Eleven newborn piglets were latched onto her. I crawled in, wishing I were elsewhere.

I don’t know how many of you have been faced with the inverted uterus of a 350-pound sow but if you have, you’ll know how inadequate traditional obstetric skills suddenly seem.

Her womb had turned inside out after the final piglet and unless we could replace it, Rachel would die of shock. Obstetric textbooks advise doctors to occlude the mother’s vagina with a forearm, then run in a litre or two of warm saline. “The resulting hydrostatic pressure will reduce all but the most neglected cases,” it trumpeted.

Unfortunately, it would have needed the hydrostatic pressure of the Aswan High Dam to have made any impression on Rachel’s uterus. We tried, using three pairs of hands and a soft floor mop, but 12 hours later Rachel, grande multipara and splendid matriarch, succumbed, not without a tear or two from those in attendance.

Next, and to my eternal shame, came the case of the everexpanding runt. The smallest and ugliest of a litter of 12, her elusive charm ensnared Nick. He ensured she was fed and Astrid thrived. After a week he phoned to say she seemed to have a growth in her stomach.

I couldn’t feel a mass on palpation but ordered an X-ray, forgetting that our radiographer was a staunch trades unionist and shop steward. Was Astrid a private patient, he wanted to know and, if so, had the appropriate fee been charged? I pointed out that the runt’s parents were employed fulltime at the sugar company’s piggery. This satisfied him. The X-ray was normal.

On the tenth night of Astrid’s life, Nick phoned in triumph, booming down the line from far out in the bush.

“David, I’ve found what ails Astrid, man!”

“God, Nick, it’s two in the morning!”

Pause to collect my wits.

“Is Astrid a relative? Is she staying with you?”

“No, no, she’s the runt, the one with the swollen belly.”

“Oh.” Comprehension, then a flicker of clinical interest. “What’s wrong, Nick?”

“It’s her a***hole, that’s what’s wrong.”

“What’s the matter with it?” “She hasn’t got one!” came the triumphant bellow.

And he was right. Astrid, the Cherished One, was congenitally imperforate.

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