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Chris Ellis in The Witness 1 October 2004

Getting the story right by Janet van Eeden

I heard of a misunderstanding in English the other day when the patient complained of snoring and the doctor thought he complained of a sore ring and gave him ointment for his piles," says general practitioner Dr Chris Ellis. "I don't know whether the patient put the ointment up his nose or not."

This story is just one example of how communicating across different cultures can lead to serious misunderstandings. Language barriers are just one of the obstacles to overcome in treating patients with different backgrounds to the presiding doctor, but cultural barriers are sometimes even more obstructive. Hence the book that Ellis has just written. He has facilitated workshops on cross-cultural communication since 1999 and found a great need to explore the topic further to clarify issues that have been problematic. And so the book, Communicating with the African Patient, was born.

I asked Ellis about the title. In our days of extreme political correctness, the title does appear to be patronising. Ellis explains that he and his publisher "did struggle over the title. The title is Eurocentric, I think, and obviously addressed to Western doctors and nurses. Although it could be interpreted from a South African view as possibly condescending, it is not meant to be so," Ellis explains. "I don't think it would be considered patronising from an overseas perspective. The message of the book is to establish clear communication between cultures, in the sense of receiving and giving messages to each other that are not misunderstood. However, I do agree it could go both ways. It could be entitled 'Trying to Understand the Western Doctor'. Perhaps that should be my next book!"

In fact, the subject matter of the book addresses very real issues of confusion, which arise specifically from the different perspectives of the Western doctor and the traditional rural African patient. Ellis treats the matter respectfully and without making value judgments about which world view is correct. As such, the book makes an interesting read, even for those not involved in the medical profession.

Ellis writes at one point about treating an elderly weaver whose rhythms of life are in tune with nature. Time is judged according to the 13 moons of Zulu culture. When the man is ill, he has to go into the Western clinic, a place as terrifying and foreign to him as a strange land. His illness also has to be explained as separate from his mind - a concept not usual to him where "his dreams, his feelings, his telepathy and his visions are part of his tangible body". Add to this that he is constantly in communication with his ancestors. Once the challenge of diagnosis has been met, the Western doctor has to explain to this man of nature how to treat his body in purely scientific Western terms.

Ellis explains that "one has to assess the patient's belief system, which - like all of us - is an eclectic mixture of the individual's, family's and also the community's health beliefs". As such, the need for time and understanding is emphasised. "Research has shown that most doctors interrupt their patients after only 18 seconds of listening to them. This same research has also shown that it takes the patient only a minute-and-a-half to tell his or her story. Carl Jung once commented that 'A diagnosis helps the doctor but for the patient, the crucial thing is the story.' Jung was right. Every patient has a story. Every community has its story. And in the telling of the story, the patient communicates anxieties and perceptions. The story becomes a metaphor for their lives. If the doctor isn't able to take the time to listen to a patient, he will miss being receptive to the cue and clues given out by the patient in distress."

Ellis stresses the importance of understanding the particular patient's story at any one time. If the doctor isn't trained in the language or the idiom of the language of the patient, then much will be missed. If you add an interpreter to the mix, the patient can be cut out of the communication process both literally and figuratively, Ellis explains.

"When you think that only seven percent of meaning is conveyed by words alone, and 55% by non-verbal body language and facial movements, we realise how important it is to understand where your patient is coming from," says Ellis. "The remaining 38% is conveyed by the tone of the voice and its fluctuations. All these aspects have to be taken into account in communication, especially when the balance of power in the doctor/patient encounter is more than usually uneven. For example, I, as a white older male doctor in a white coat, encounter a young rural Zulu girl in consultation. She feels that the doctor holds all the power, as an older male who is traditionally accorded much respect. Add to this my white coat, which is symbol of my education, and the fact that I may drive an expensive car. The power differential in that is enormous. One would have to be careful not to misinterpret her reticence for anything other than respect at first."

Ellis also speaks more about the different world views of patients. In traditional African beliefs, the mind and body are indivisible. How does this apply to the duality of depression and illness? More and more it has become apparent to experts that there is very little division between sickness of the mind and sickness of the body. I asked Ellis which comes first - illness or depression? He answers that it is very much a chicken and egg situation as every illness carries with it symptoms of anxiety. "In certain cultures, certain things are more sociably acceptable than others," he explains. "So sometimes a Western technologically culture-bound person finds it more acceptable to have a suspected brain tumour than to have depression. And just so, a person with a traditional African world view will be able to explain the disease by saying that the ancestors are angry or that a spirit has possessed him or her, for example."

I wonder if it is ever possible to get to the bottom of illnesses at all with the quagmire of miscommunication that seems to exist between people. Ellis is reassuring. "The patient usually goes to the doctor in his role as a body mechanic to get parts fixed. Usually there is a simple problem that is easily solved by application of a prescribed medicine. These are the easy cases."

But for the more complex problems Ellis states that it is difficult in the rush of modern life to listen to the patients as "the time in a hospital outpatients' clinic is so short and the patients so many. Possibly this is why patients go to the traditional healer or priest to restore the equilibrium in their lives."

Regarding the traditional healers, Ellis says there is a place for everyone in this world. As long as everyone involved adheres to a few solid Latin rules. The patients have to take into account "Caveat emptor - Let the buyer beware." And the healers have to follow the ethical code of doctors, which is "Prima non nocere - First do no harm." Sounds like a positive message for healthcare, in all its guises.

Publish Date: 1 October 2004

THE SOFT EDGES OF FAMILY PRACTICE  by Chris Ellis is unfortunately out of print as well as the poetry anthology RUMINATIONS.

Communicating with the African Patient 

Despatches from the Last Outpost.

DESPATCHES FROM THE LAST OUTPOST

 

The second printing of this book is now sold out except for some copies at Bookworld, which can be ordered

 At : cascadesbookshop@lantic.net

New Book Release

UNIVERSITY OF KWAZULU-NATAL PRESS

 

 

Communicating with the

African Patient

 

Dr. Chris Ellis

 

 

	ISBN:                         1 86914 039 7 Price:                          R75 Format:                       Paperback Size:                            213 x 135 mm, 144pp Interest:                      Healthcare Rights:                        World Publication Date:       July 2004

 

 

 

 

 

 

 

 

 

 

 

This book is filled with useful and practical language learning strategies designed to help doctors, nurses and other healthcare workers (who do not speak an indigenous language) to learn an African language through their daily contact with patients.

 

More than this, it gives advice on ways to reach some understanding of the culture, health beliefs and world views of the patient in a medical consultation.  Although English/Zulu and the Zulu medical culture are used as the examples, the underlying themes are applicable to any culture.

 

The book has retained the humour and wit of its predecessor, Learning Language and Culture in the Medical Consultation, but it has been considerable revised and expanded to include more material on the cross-cultural consultation, the Aids pandemic, as well as appendices of vocabulary and ‘survival phrases’ designed to facilitate communication and understanding in a medical context.

 

Chris Ellis is a General Practitioner in Pietermaritzburg, and an honorary Senior Lecturer in family medicine at the Nelson R. Mandela Medical School, Durban

His post-doctoral studies involve language and communication in the medical consultation.

 

 

 

 

Private Bag X01, Scottsville 3209, South Africa             Tel:  +27 (33) 260 5226          Fax:  +27 (33) 260 5801 

E-mail: books@ukzn.ac.za                                                  http://www.ukznpress.co.za

 

 

HMS Chrysanthemum

I have recently been down to watch Maritzburg College play at their rugby fields called Goldstones. It really is an amazingly enjoyable afternoon. There are the hurrahs of the supporting boys and the braying of unweaned old boys. In fact, one can eavesdrop on old boys meeting up with each other and pick up pieces of conversation such as "in my day, old Codger would never have allowed . . ." and remarks between very old boys along the lines of "was it you or your brother who died in the war?"

Apart from the enjoyment of the game, it is reminiscing time. I last played rugger as a medical student in London in the sixties. I was at the smallest school, called Charing Cross Hospital Medical School, and I played for their bottom team, the thirds. Our scrum was a group of misfits, most of whom were blind because we couldn't afford contact lenses and had to take our glasses off. Those who weren't blind suffered from Adult Co-ordination Deficit Disorder. As the bottom team, we rarely fielded 15 players and often had to ask to borrow a player or two from the opposition and play 13 or 14 aside. Our captain was a wing forward called Blod Weekes, who weighed about 45 kg, and our wing, Spider Coleman, had amazingly thin arms and legs, and was selected for his ability to recite all 42 verses of Eskimo Nell in the bar afterwards. I remember us once losing 75 points to nil and that was in the days when a try was only three points. Playing in the rain and mud in the cold English winter we slithered around and, after 10 minutes, everyone was covered in mud and it was difficult to tell who was on whose side. It must have been a nightmare to referee. Actually, thinking about it, I don't think we often had a referee.

They were very interesting games because, as everyone was covered in brown, wet mud, you couldn't tell who was an enemy and who was a friend. Consequently, no one really wanted the ball because as soon as someone threw you the sodden, slippery thing the other 29 players on the field descended on you, so you immediately threw it up in the air and made a dive for cover.

One of our favourite matches was against a team called HMS Chrysanthemum, who were a team of Royal Naval Volunteers, who we could nearly beat. HMS Chrysanthemum was a retired training frigate that was moored on the Thames at the Embankment. Consequently, they did not have a home field and had to play all their matches as away fixtures. To make up for this, they had a Wednesday evening once a month when they invited, to their mess, the teams that they had played the previous month. Once you crossed the gangplank and were on board, you were officially on a Royal Naval boat at sea and there was no duty on the drinks. Gin was four pence a tot, which to a medical student was as near heaven as you could get. I only went once. I was about 19 years of age at the time and was not used to drinking gin in such quantities. There was a lot of singing and then someone asked us to go into the boardroom for a movie. I sat down and they turned the lights out and I immediately went to sleep. I missed out on a blue movie and that is the nearest I have got to one ever since.

In our school or student days we all had a moment of glory in rugby or sport, however small. It was when we actually caught the ball and fell over the line or accidentally stopped them getting a goal. My moment of glory started on a Friday night in the Lemon Tree in Covent Garden, which was the hospital pub. It was the sixties and we were all trying to live up to John Lennon's famous dictum that if you remembered the sixties then you weren't really there. The sixties, in retrospect, seemed to be a decade of great optimism and innocence, although that may be a ubiquitous feeling of the youth of every decade. We all seemed to be on a high. This Friday night we were trying to get high on Watney's Red Barrel draught bitter.

So, in walks Charlie Burton, who was the rugby correspondent for the Irish Times, which doesn't really sound like a full-time job, does it? And it wasn't. His main occupation was running a rugby team called the Public School Wanderers. Now, myself and a friend called Dave John, who was also a member of the third team unco-ordinateds, were having a quiet pint when Charlie joined us and asked if we would like to play in his team as he was two players short for tomorrow's game. We explained that it was September and the beginning of the season and we were both hopelessly unfit. He then cunningly offered to buy us a round of Watneys as he knew that we also suffered from the Alcohol-Medical Student Mutual Attraction Syndrome. It must have been many free rounds of beer later that we had agreed to play because Dave and I found ourselves, with crashing hangovers, at St Pancras Street Station at midday as arranged the previous night. Dave was asking the train driver to go easy on the whistle.

Charlie was in his tatty old brown macintosh, unshaven and also avoiding the light of day and had obviously tried to trim his moustache with his right hand because the left part was short and the right side was still droopy.

As we boarded the train Dave casually asked Charlie what team we were playing and Charlie, equally casually, replied we were playing the Cambridge University First team. It was their first match of the season and they would all be out to prove themselves. I was appalled and then decided to go off and be sick. There was no ways Dave and I could last even one half against their eighth team. So it was with a reasonable amount of nausea, dizziness and fear that we got off the train in Cambridge.

Dave managed to stop me getting straight back on the next train to London and we were driven to the grounds, where, to my horror, people were sitting down in the stands. We were actually going to be watched as well as humiliated.

In our changing room we were given a shirt and I sat down, feeling miserable, to dress when I began to realise that the other members of our team were enormous and seem very confident and fit. This was not like Blod Weekes's team of no-hopers at all. I asked Charlie who they all were and it turned out that Dave and I were the only ones who were not either an International or a British Lion. There was a South African on the team called Tommy Bedford as well as the English and Welsh captains.

It turned out to be the most wonderful game. I had not realised before that you could catch the ball and run forwards. I had spent my dubious rugby career trying to catch a ball thrown at my feet and then running backwards being pursued by giants. In this game, the giants were all on my side. They hadn't just come for the shower and the drinks afterwards. Our scrum actually moved forwards. It was the most exhilarating feeling. My moment of glory had come.

·  Chris Ellis is a city doctor and author.

Publish Date: 22 July 2004

Chris Ellis 

Chris and assistant 

Writer's block

Just before Easter I spent three weeks in a cottage on the west coast of England. I stayed there to recover from burn-out and writer's block. Actually, I don't think there is such a thing as writer's block.

Can you imagine a plumber waking up and saying, "I've got plumber's block. I don't want to go to work today. I don't ever want to unblock anything ever again." It would only take a matter of seconds before his wife kicked him out of bed. "Get up, you lazy plumber, you," she would say, or words to that effect.

Yet writers are allowed to have this convenient condition, so I wandered off into the country, with my block, to seek the muses.

The therapy for this condition is pretty gruelling. You take about four to six books that you have been meaning to read for the last two years. The day starts by waking up at about 9 am and reading in bed till noon. You then get up and have a scratch, wander around and put some toast in the toaster and make a cup of coffee. You actually have time to smell the coffee - delicious.

The afternoon offers a choice between watching British television, which is a series of inane shows with falsely cheerful presenters shouting at you, or going out for a walk in the countryside. Actually it is more of a shuffle as the British seem to have given up walking in their country lanes - I hardly came across anyone.

The real therapy starts in the evening and involves a trip down to the pubs to check on the natives. My survey included (but was not limited by) the Quay Inn and the Boathouse at Instow, the Swan and the White Hart at Bideford, the Hunter's Arms at Frithestock, and the gloriously named Ye Salutation Arms.

My last therapy session was at the Coach and Horses at Buckland Brewer, which is a thatched, 13th century inn. A word of warning here. Try to avoid 13th century inns in small hamlets. The rooms are usually small and the ceilings are low with beams, so that if you are over five foot eight inches tall (which must have been the height of Englishmen in the 13th century), then you are continually knocking yourself out on the beams.

I don't think the scene can have changed much over the subsequent 10 centuries either. The fellow opposite me was propping up a vertical oak pillar and was the statutory five foot eight inches tall, which is a height limited, I assume, by some form of genetic engineering that has taken place over the centuries to allow the village inhabitants to get into the pub. He also appeared to be about five foot eight inches wide.

He had a fascinating capacity of drinking a pint of bitter ale in two gulps. I was captivated. He would then spend some time sadly looking into the bottom of the empty glass, almost in amazement, obviously wondering where it had all gone.

My time was taken up watching the progress of my fellow leaning on the pillar and eavesdropping on the pub conversation. It had taken me up until then to realise that there are two main pastimes in the British pub. Firstly, it is to see who can talk the greatest amount of crap, and secondly, and this is a team effort, is to see how quickly they can all generate a fug of asphyxiating proportions, which cuts off further oxygen to the brain. To achieve this, they pack themselves in, shoulder to shoulder and start talking a lot of hot air, light up the large fireplace and pull out their pipes and start a simulation of a teargas crowd dispersal effect.

With the watering eyes and sporadic coughing and the slow cut-off of oxygen to the brains of the inhabitants, the quality of the crap being talked deteriorates even more. The number one subject of conversation is, of course, the weather. The sequence seems to be that the first customer leaning up against the bar would make an acute and authoritative observation of meteorological profundity. This would be repeated by the barman and then it would be repeated again by the customer leaning alongside the first one. They would then all fall into a period of silent consideration of the impact of their deliberations. One expects this conversation to take a dive as the evening goes on but I was rather taken aback with a new arrival.

The day had started with heavy rain and bitterly cold driving squalls of wind, and had remained miserable until the late afternoon, when the rain stopped and the wind had died down. There was heavy cloud and not a ray of sunshine all day and it was still bitterly cold.

The newcomer hailed us with the greeting, "turned out lovely then, didn't it?"

There's really no answer to that, is there?

·  Chris Ellis is a city GP and author.

Publish Date: 17 June 2004

Name-dropping

During walks in the Berg and the KwaZuluNatal midlands I have acquired an elementary knowledge of the commoner trees and plants. I have this habit of pointing out the White Stinkwood and then in an understated English way, almost sotto voce, that its botanical name is Celtis africana. I then proceed to the Paperback Thorn tree and, with a casualness that implies even deeper and more extensive knowledge of a whole panoply of the earth's vegetation, that its scientific name is Acacia sieberiana.

The family feel it is rather a pathetic way of gaining some recognition. They can all repeat the litany of my limited ecoknowledge as we walk around the garden. Things don't stop here. My audience, having realised that they are in the presence of a world authority, start to ask questions and request identification of trees, whose names I haven't a clue. I then fall back on what I would call my poetic imaginative powers but what the family call, rather hurtfully, I feel, talking bull.

I make up names as I go along or apply names from my repertoire, which have a kind of impressive cadence to them, such as Ficus elastica decora. It just rolls sonorously off the tongue. To reveal that it is the name of the common rubber plant is not the same. I try to deliver this knowledge with a hint of condescension, the very obviousness of it all, to forestall further inquiries. If really stuck, I retreat to Aborescens vulgaris natalensis and Gluteus maximus.

Recently I have acquired a new name for my collection. We have a small woodland garden which slopes down to a rivulet, which I am informed goes by the rather twee name of the Teddy Bear Creek. In this garden is a large indigenous tree which I have been trying to identify for some time. I took a flowering branch to that splendid man at the Val-Lea Vista Nursery in Lincoln Meade. He identified it as Clerodendron glabrum. Can you imagine my excitement at hearing such a name?

I have had to practise how to say it a few times but now guests are steered towards it. I then in a by-the-way sort of an aside mention that it is Clerodrendron glabrum but, of course, that one sees so often in these woodland areas.

It is, in fact, one of the "Rain" trees so named because it "rains" for about a week or more in the last days of the dry winter months just before the proper breaking of the rains. The rain is caused by the nymph of a small insect called a frog-hopper, known in scientific circles as Ptyelus grossus (almost whispered as an afterthought). It pierces the bark with its stylet, sucks up the sap at great speed and then ejects it almost as pure water. This then drips from the tree.

We have a bench under the tree and, of an evening, friends are known to join us for a drink. As the Pimms Number One with the tropical fruit and the umbrella are being served, I envisage a drop falling on a guest's head. I shall look up to the sky and comment that the rains appear to be early this year. One would not want to disturb the ambience of the occasion by describing what exactly is happening.

·  Chris Ellis is author of Despatches from the Last Outpost, which has just been reprinted.
Publish Date: 27 February 2002

The 13 Zulu moons

There is an urban legend that claims that last year there was a tremor from an earthquake in the middle of Los Angeles. People ran out onto the streets and, on looking up, asked what those bright things were up in the sky, only to be told that they were called stars.

It is not surprisingly really. Modern man rushes from his office to his car, speeds home and then, looking downwards, enters his nuclear home. He stops only to switch on the telly, check on the Hang Seng index, change the fluorescent lighting in the ceiling and set the alarm for the morning. Rarely does he look up to see "the new African moon lying on her back" as Karen Blixen described her.

The pulses of the seasons, the waxing of the moon, the sudden hush of nightfall and the bird-filled African dawn are drowned out by the shrill cries of morning alarm bells and the bleeps and artificial tunes of a trillion cellphones. Time only stops, said Albert Einstein, when you take a ride on a beam of light.

There was a time, though, when we were on more intimate terms with the moon. We lived our lives by its rhythms and had a name for each one. The American Indians, the Mayans, the Egyptians and, in fact, most of the Earth's peoples had at one time names for the 13 lunar months.

The Zulus were no exception. Each name of each moon described what was going on in nature at the time that it waxed and waned in the heavens.

As we are now in summer, let us start with the Moon of Inspection (uNhlolanja), which is inspecting the land to see if the pumpkins that have been planted are starting to grow. It is also the time when wild dogs mate.

We will soon move on to the Moon of Plenty (uNdasa), when there will be an abundance of new mealies and stomachs will be full. After this, the early winter will start and the Fire Kindling Moon (uMbaso) will rise as fires are lit in the hearths of the huts.

One of my favourites then appears, the Aloe Blooming Moon (uNhlaba), and one suddenly sees those perfect slender spikes of orange and yellow, and feels the first chill wind off the distant Berg. It is then that the winter moon arrives and blankets are taken out and more wood is gathered for the fire.

When the leaves are shed and shaken off the trees, she is called the Moon of the Bare Trees (uNhlangula).

Because of the size of KwaZulu-Natal, the land of the Zulus, the same moon may go by different names in the northern tropical parts from those in the southern regions or the high grounds of the Drakensberg Mountains (Khahlamba) that rise up as pointed spears into the sky.

In the early autumn comes the Great Dust Driving Moon (known as Untulikazi by some and uMaQuba Omkhulu by others) when the hot winds stir up the dry lands and men cover their faces with their jackets. There is also the Moon of the Nesting Yellow-billed Kite (uKholo, also known as uNhloyile) as she glides on her synchronised wings in the crystal thin, blue sky.

At this time, another of my favourite moons appears, the elegant New Green Moon (uNcwaba) when the land starts to turn green after the first smattering of rain and the early crocuses peep up through the old dry yellow winter grass. It is time now for late spring and early summer with the Moon of Sprouting (uMfumfu) and the Moon when the Impala Lamb (iMpala).

The grass is now getting longer and the Moon of the Spittle Bugs (uLwezi) is waxing high in the night sky and the frogs start making reverberating noises in the river beds. The days become warm and the Moon of the Stinging Hot Sun (Umandulo) rises when the women prepare their gardens and start hoeing in the fields. As the summer continues, the grass grows over the paths in the veld and the Paths are Lost Moon (uZibandhlela) hardly cools down the heat of the mid-summer sun. After this, it is the turn of the Searching about Moon (uMasingana) who, from a distance, searches the land to see if the crops are ripening.

'The Moon of the Stinging Hot Sun rises when the women prepare their gardens.'

I have not matched up the Western calendar months with these lunar rhythms. The Western calendar remains pinned on the fridge door with all its rigid precision. You can see all the penned-in deadlines. They do not include the Perplexing Moon (uNdida), when people dispute which one she is. The poetry is not there. The clouds, like dark riders, slowly cross the full moon unseen by Western man as he presses his remote controls to change the channels of his programmed life.

There is a Zulu legend that the craters on the moon form the image of a woman carrying a child on her back, with a bundle of wood on her head. The story, usually told by the grandmother, is that there were certain days when the people of long ago were forbidden to go into the forest to collect wood for their fires. One woman had a very naughty child who cried out for food on a day when people were forbidden to go into the forest. Despite this, she decided to go into the forest to gather firewood. On her way back with the bundle of wood on her head, the moon, as punishment, came down and took the woman up into the sky where she will remain for ever.

The moon is thought by some to be on this side of the sky but you and I know that it is a hole in the heavens and that the stars are small white holes in the floor of the sky. They are the children of the sun. The light from them has taken billions of years to reach our upward-looking eyes. They give a perspective to our lives, which are lived in the microsecond that it has taken for you to read this last word.

·  Chris Ellis is a local doctor and senior lecturer in family medicine at the Nelson R. Mandela Medical School, University of Natal, Durban. His post doctoral studies are in cross-cultural hermeneutics.
Publish Date: 19 March 2002

The KwaZulu-Natal braaivleis

When my friends, Jannie and Andre, come around to my house I somehow find that I am not allowed near my own braai. This, they say, is for two reasons. Firstly, I talk too much and don't pay enough attention to the very serious matter of burning meat well and, secondly, I am an Englishman and don't understand the nuances and finesses that are required for the performance of the KwaZulu-Natal braaivleis.

To start with, there is the stance. Left foot slightly forward and the tongs held at just the right angle. For the Free State braaivleis you have to wear an old pair of blue rugby shorts and long socks with optional moustache, but for the KwaZulu-Natal braai you can wear khaki shorts or longs and wave the tongs to emphasise points in the conversation. Apparently it is easy to miss some of the artistry involved when a braaieur of provincial class is in action. There is the timing that is involved with the exquisitely turned boerewors. It all depends on the sizzle. One must almost act on a sixth sizzle sense, which requires a combination of eye, hand and nose co-ordination. One could easily miss the moment if one was talking about one's compost heap over a glass of Robertson's chateau black box.

Then comes the cooking of the steak, known as the KwaZulu-Natal steak ritual. This can only be done by a male. In fact, the whole KZN braai ritual is a deeply sexist affair. As couples enter the garden they must split up. It is permissible for the man to meet his wife or girlfriend again to obtain cigarettes or matches or on his way back to the kitchen fridge for refuelling purposes from the Chateau Spar 2002.

The ritual begins after the men have cordoned off the braai with a discussion of where to get the best steak in town and involves telling a lot of lies about what price one has paid for the steak.

The women then sit down together at a distance on garden chairs or on the stoep. Conversational topics for the men's group can be chosen from, "I see you have bought a new 4x4, Nigel", "Old Mike was sinking them well at the club last night" and "Are the Springboks ever going to pull themselves together?". The women's group can choose from "What is that new diet you said you were on?", "I've had to give the maid the day off tomorrow and we've got people coming for the weekend" and "My gynae says it was the biggest one he has ever seen".

As the evening progresses, the most experienced braaieur will hold a hand over the heat and may ask his vice-captain to check that the temperature is just right. Judgment is then made and variations on steak preparations and sauces are proposed.

I have - and I would rather you did not tell anyone else about this - on occasions invited Mrs H. S. Ball to add her peach chutney to a piece of rump before sizzling it on the flames. I imagine Mrs Ball (which is a very singular name) to be a rosy-cheeked, jovial, rotund farmer's wife but I lie awake at night wondering what her initials H. S. stand for.

My friend Pottie tells me that the preparation of the KZN steak is everything. His eyes light up as he describes it in anticipatory delight. Half an hour before the steak is put onto the flames, he states emphatically, one must rub a mixture of curry powder, ginger and garlic into the steak. After offering this recipe, others will immediately chip in with their own versions.

Now I have heard that at some braais in the Upper Montrose and Very Upper Wembley areas they drink wine from bottles and not boxes. This has lead to an ongoing dispute among KwaZulu-Natalians of the upper crust as to when is the right time to take the cork out of the bottle of red wine. Some like the wine to breath deeply for an hour or two by removing the cork after breakfast and just occasionally picking up the bottle and wistfully looking at the label as the day goes on. Others like to just test the wine from time to time and see that the respirations are regular. One does not want it to get too long in the leg, as they say in the classics. It should haunt rather than linger on the palate in order to release its honeyed eloquence.

There is, though, one thing that KwaZulu-Natalians have consensus about, and this is the wisdom with which I leave you, and that is that once the cork has been removed it should be thrown away as far as possible.

One would not want someone passing by to see it and put it back in the bottle.

·  Chris Ellis is a city GP and author.
Publish Date: 20 July 2002

Twitching in darkest Scottsville

We have - and I don't want you to think that I am boasting - five birdbaths. They are strategically placed around my cottage garden. There are also three bird feeders, one of which is stationed near the kitchen. I get the seed for them in 10 kg bags from the farmers' market at Camps Drift and thought that it probably came from somewhere like the Free State but I am told it comes from mainland China. So my wild birds are getting Chinese take away.

The best viewing spot is from the kitchen window but we have a paranoid schizophrenic Pin-tailed Whydah, which dives at us and head butts the window. If you are not used to it, and you are just visiting, the noise can be a gin-and-tonic-spilling occasion. Unfortunately neither of us can speak Whydah, although I have been known to speak Bulbul on occasions. Whydah appears to be one of those difficult languages with lots of suffixes and prefixes. It sounds like a lot of expletives too as our Whydah seems to be very cross with us. We have come to the conclusion that he has a general attitude problem because he treats all the other birds in the same manner and jumps on them like a cat. We have also been wondering what the collective noun for Whydahs might be as apparently they can congregate in flocks. Perhaps it should be a riot of Whydahs. One could add it to those other delightful collective nouns of birds that twitchers like to casually mention, such as an ostentation of peacocks or a murmuration of starlings.

Our main bird population is a flock of Laughing Doves, who give out a most relaxing background cooing in the early mornings, although recently they have begun to sound rather mournful. This may be due to the rand exchange rate and uncertainties about the coming election. As you know there is nothing worse than a flock of depressed Laughing Doves so we are looking for a dove psychologist, but they are difficult to find these days as most of them have emigrated to New Zealand. Our next plan is to mix some Prozac in with the Chinese take away and wait for the happy coo to come back.

While on the subject of coos, we have been discussing the delights of waking to the squadron of hadedahs that take off from our roof at 5 am. The suggestion is that we cross-breed the doves with the hadedahs and get a hadedah that coos like a dove. This needs more planning because if the experiment goes wrong and we end up with doves that coo like hadedahs we will have to leave home. This is obviously "work in progress" and needs more discussion over the Twee Jonge Gezellen, Muscat de Frontignan.

What has really cheered up the garden is that suddenly about two weeks ago, there appeared, to our amazement, two budgerigars. They must have made a break from someone's house nearby. They are a brilliant lime green and yellow and were rather shy for the first few days. We thought our wild bunch of raptors would have finished them off but they are now the dominant pair. They fly in low like a couple of Impala jet fighters and ferociously attack and defend their portals at the bird feeders. The most offended by this intrusion are the Red Bishops. We have three pairs and we weren't sure whether they were Anglican or Methodist when they first arrived but two of them have beards and high crests so we think they are probably Greek Orthodox.

Added to all this is the fig tree that is now bearing fruit and literally shakes with the different varieties of birds all helping themselves. There are Red-Winged Starlings and a lot of assorted weavers with disgusting table manners who seem to be able to eat and excrete simultaneously. These bigger birds tend to intimidate a whole collection of little brown jobbies who hang around in a holding pattern to await their turn. The majority of these seem to be sparrows of the non-farting variety and they adopt a storming strategy of flying into the fig tree in formation only to be driven off in furious hand-to-hand combat. So it is not all country bliss and quiet birdsong here in Scottsville, which as you know is the ornithological centre of the universe. And after the budgerigars, what next? We have decided that if either of us see a flock of flamingoes in the swimming pool we are both going to stop drinking. Oh, by the way it is not a flock, it is actually a flamboyance of flamingoes.

·  Chris Ellis is a city GP and author.

Publish Date: 25 February 2004

The art of menu reading

One of my great delights is going out to restaurants. It is not only the night out but the whole occasion, with the ritual of the waving of menus and the eloquent recitation of the specials.

I have always been fascinated by food- and wine-speak, and avidly read the menu to see if the food has been extravagantly described with wanton poetic abandon. You know the sort of thing that goes "lightly dusted with a hint of . . ." or "garnished with fresh mountain herbs" or "nestling in a bed of aromatic tarragon". My favourite is something along the lines of "dew-soaked wild mushrooms picked before dawn by virgins from the northern slopes".

At the meal I find that, suddenly, I am being asked what I want to order and have no idea as I have being carried away by the thoughts of the chefs gaily skipping around the kitchen dusting meringues and drizzling things over the salad.

What is also fascinating, on menus, is the translations of foreign language terms into English. I have recently been to Spain and we collected some interesting examples. In the Don Julian Restaurante in Seville the breakfast menu was inclusive of coffee, tea, milk or beer. I had an idle subversive thought of asking for a selection of the breakfast wines but managed to suppress it. I might have been surprised because it was only

9.30 am and some of the customers were already drinking beer. We put this down to the fact that it was Wednesday morning, which is the beginning of the Spanish weekend.

Some translations are rather encouraging, for instance, starters, which is entradas in Spanish, was nicely translated on one menu as "incoming", which always gives one hope. Another translation of a main course was "deep fried chicken in the moment". I imagined the chef waiting for what the French call "la moment juste", or just the right moment, to plunge the chicken in. Perhaps it should have been called "Inspirational Chicken".

Another menu had "rolls but not available in rush hours". As the restaurant was not busy and we were not exactly sure if there ever was a rush hour in Spain, we ordered them and were successful. Eating in Spain, as in most Mediterranean countries, is a leisurely business and the Spanish have still the wonderful concept of manana, which is a slow pace of life and postponing things until tomorrow. It is very similar to Ireland and you will remember the Irish professor of linguistics who was asked if there was an equivalent of the word, manana, in Irish and he replied that, yes, there was but that it did not convey the same degree of urgency.

Our best menu was at the Taberna Almendro in a small seaside village in the province of Murcia in the south of Spain. An item under pescados (fish) had been translated as "battered John Dory". I had this vision of poor old John Dory staggering in after being beaten up on the quay side, so out of compassion we thought we would give him a miss. There was also a dish called Revuelto de Setas. This is chopped or scrambled mushrooms that had been magnificently translated as "a mess of untidy mushrooms", which sounded, well, rather revoltas so we left that one too and found another item called tigres.

This is actually stuffed mussels but had been translated as "tigers". Now I don't know about you but I can't remember ever having had tiger on the menu before and I certainly didn't want more than one anyway. After an in-depth discussion, we thought we could manage one small one between the two of us served, of course, with the tail and, as one always does with tiger, a bottle of chilled white wine from the north end of the vineyard.

·  Chris Ellis is a city doctor and menu aficionado.

Publish Date: 21 October 2003

The art of making compost

As autumn lays its cover of surface dew on the early morning veld here in the KwaZulu-Natal midlands, talk at the Boshoff Street Country Club has naturally turned to making compost. The world, as you know, is divided into two groups of people. Those who make compost and those who don't.

A friend of mine, who is also a compost aficionado, says she recently moved house and one of the things she misses is her compost heap. It is sad to leave a good heap behind. I wonder what the movers would say if you asked for your compost heap to go with the baby grand and the Persians. How would you value it for insurance?

At home I have been known to take visitors out especially to view ours.

Admiration is encouraged. Not over-the-top praise but oohs and aahs are not taken as out of place. Perhaps only compost connoisseurs will understand the inner warmth that a compost heap can generate, not only in itself but in the owner's soul.

Eugene Marais wrote in his book, The Soul of the White Ant, about the life that goes on in the private parts of an anthill. My opus magnus on The Soul of the Compost Heap has yet to see the light of day but will describe the inner hierarchy of compost dwellers. All the characters of life are there and a cosmopolitan lot they are too. Colonies of bacteria lord it over the lower orders of moulds and mushrooms. The aristocracy of the heap appears to be the worms. They are an aloof and elusive lot and also the largest, except for the odd lonely maggot chewing its way in melancholy solitude through the cabbage leaf.

Once decomposition is really under way - and decomposition is the name of the game in these parts - the heat emanating from the centre tends to make life rather uncomfortable for the higher orders, whereas the micro-organisms revel in it. The warmer it gets the more action in the bacteria. Like a whirling discotheque, it's almost reproduction at every second.

So you can see that it's all action here in the Last Outpost.

Over the years I have found that the care of one's compost heap is a difficult subject to raise as an object of discussion. It is not really suitable conversation for over a meal. There are few enthusiastic takers at a polite Wembley dinner table. Perhaps it is a very personal subject that should not be aired in public. One might offend the sensitivity of the cook's creamed spinach. But compost heaps themselves have, I'm sure, a cheerful disposition.

This brings up the subject of whether one should talk to one's compost heap like beekeepers talk to their bees. Apparently bees in the hive at the bottom of the garden like to hear about news such as births, deaths and marriages in the family. Perhaps one could talk politics to a compost heap - that should take care of its cheerful disposition. It might decompose even faster. After all it is a living organism and a depressed compost heap can't be a pretty site. Perhaps one is being presumptuous in assuming that they speak English. What language would one use? I know my wife says that I have been talking compost for years.

Then there is the vast subject of what one should add into the heap.

Almost every type of vegetable, the autumnal leaves and summer grass give a seasonal variety and character to each occasion. The ultimate touches are personal ones. I am referring, of course, to that evening excursion to pee onto the heap under the light of the moon after a well-matured bottle of Shiraz. For was it not the Prophet who said that man was but a minutely set, ingenious machine for turning, with infinite artfulness, the red wine of Shiraz into urine. And what better recipient than our friendly mound.

I should think it would appreciate the added warmth.

One could form life-long friendships with people one met in this way. Fellow compost connoisseurs bonding together over a ripening heap and swopping recipes. It beats talking politics any day.

·  Chris Ellis is a Grand Chef de Compost and a city GP and author.
Publish Date: 22 May 2002

Captain Morgan's March

As this is the season of concerts and shows I have taken to reminiscing about memorable concerts that I have listened to. One such concert took place in the late seventies when we lived in Estcourt and my sons attended the Drakensview Primary School. One of my sons, I forget which, was chosen to represent the school in the recorder octet or first team, which consisted of four young girls and four young boys from Standards 4 and 5.

The concert was an inter primary schools Eisteddfod to take place in the Durban City Hall. As I owned a HiAce bus in those days, the headmaster asked me if I would take the team down from Estcourt to Durban.

The day arrived and I collected the Drakensview first recorder team from school, kitted out in their uniforms, the girls with floppy summer hats and the boys in white shirts and khaki shorts. We were rocking gently towards Hidcote when a sweet little thing in one of the floppy hats said "Please, Dr Ellis, may we practise our piece?"

I solicitously inquired what their piece was called. "Captain Morgan's March," chorused the team and swiftly started to unsheath their recorders.

It was just before Mooi River that the leader, a tall blonde girl, gave the one, two three and they attempted their first rehearsal. At first I could not believe my ears. It was appalling. No one was in time and the din was punctuated by high-pitched squeaks as notes escaped almost an octave higher than they should have been. They sounded like a bagpipe band trying to fight their way out of a metal biscuit tin.

At this stage I think one of the girls must have elbowed a boy because a fight broke out and it looked, through the rear view mirror, like a scene from the eight musketeers as I swerved between the lanes.

I had to use my regimental parade ground voice to bring things to order and, with a sense of dread, suggested that we would have to rehearse it again because there was no ways we could go on stage sounding like Stravinsky's Firebird Suite for recorders.

And so we started to rehearse Captain Morgan's March. We played it going past Balgowan, Lion's River, Howick, Hilton and by the time we got to Pietermaritzburg it was, unbelievably, worse than the first time.

Now I want you to imagine coming into Durban in rush hour past the old Alhambra theatre and weaving in and out of the traffic to the 14th and final rehearsal of Captain Morgan's March with two boys still playing one note behind the rest.

Thankfully, our music teacher had arranged to go on ahead and meet us and we herded our team of stragglers into the hall, which was filled with smart blazered city children with neat partings and polished shoes. Our shambles looked like the Country Bumpkin Players, floppy hats askew and shirts hanging out of trousers. We dusted them off and sat in our designated row with a lot of fidgeting, dropping of instruments and nervous running to and fro to the loo.

The concert started and the first few teams were terribly smart, confident and really top class. Inevitably our turn came and our team got up on stage. After a few goes at getting our team formation into line, the tall blond girl gave the one, two, three. I felt my self sinking down into my seat and covering my face with my hand.

It was only after a few moments that I realised that they were playing it absolutely magnificently, in perfect time and tune, without even a squeak or vibrato. The little beasts completed the March in perfect military style and received enthusiastic applause.

The music teacher and I and the team gave out a rustic cheer when it was announced at the end that we had come third.

And so a weary bunch set off back up Field's Hill heading home to the mountains. Before we started I addressed the occupants of the bus and informed them I never ever, under no circumstance, not even if the urge was insuppressible, never ever wanted to hear - not even one note - Captain Morgan's March ever again. No one disagreed.

·  Chris Ellis is a city GP and author of Despatches from The Last Outpost.


Publish Date: 28 December 2002

Beach-bumming on Bondi

ONE of the excitements, and sadnesses, of living in Pietermaritzburg is that many of our children have emigrated to all corners of the world. I see patients every week, who are off to the U.S., Canada, England, Australia and New Zealand to visit their children. I have just been on one of these excursions myself to visit a son who lives at the exotic Bondi Beach in Australia.

Bondi somehow has a touch of the Mediterranean about it and everyone hangs out there in a topless sort of way. It has a sixties drifters feel to it. The beach itself has fine white sand, peppered with a generous supply of breasts pointing towards the sky.

'If you were an extraterrestrial and first landed at Bondi you might wonder what sort of things they were trying to grow on earth.

To get to the sea I had to tread carefully between these antennae, while nonchalantly concentrating on some of the other fine points of life in the far distance.

All is not over once you have reached the sea. I was standing waist-deep in the waves when out of the crest of a wave came that most terrifying of creatures, the Great White Australian Mammary Glands. Being of British stock, I assumed that you had, like meeting a tiger in the jungle, to stand your ground and look them straight in the eyes. Showing fear or making a run for it might lead, especially if they were coming down from on top of a dumper, to instant mummification. I somehow felt I needed a matador's cape to flourish as they swept magnificently by on their way to impalement on the sand.

To recover from the terrors of the deep I was taken, for resuscitation, to the first floor of Ravesi's restaurant, overlooking the beachfront. Now I don't know if you know this but Australians have a thing they do called drinking. You might have heard of it.

The password in New South Wales is "no worries, mate, I'll have a VB" which stands for Victoria Bitter. Home in Australia is where the beer fridge is and apparently there is one in every three Australian homes.

Apart from VBs, they make a cocktail, which has amazing powers of transference, called a Blue Lagoon. It is made up of gin, curacao and lemonade, and has a translucent, aquamarine colour to it.

My psychiatrist tells me you only need three to reach another plane of consciousness. By common consent, if you wake up the next morning with a tattoo, you have had too many.

Blue Lagoons also appear to induce what in medicine is known as a disinhibition syndrome. It allows one to discuss some of the great philosophical debates of the century.

We ended up in an absorbing discussion on the difference definitions of a nerd, a geek, a wally and what the Australians call a yuppie loser.

Opinions are accompanied by extravagant gestures and participants assume that everything said is masterfully eloquent. It is better if the whole table has Blue Lagoons as there is therefore no need for further sensible conversation by anyone. Abstainers might miss out on the exquisite nuances and subtleties of the dialogue.

Ravesi's restaurant is well known, as are many Sydney eating places, for its seafood and, following the BEs, we had Blue-Eyed Cod with broccoli dressed with Pesto alla Genovese and a variety of nut oils and basil. This was eased down with another Great Australian White, Coonawarra Sauvignon Blanc.

Looking out over the sun-drenched beach I thought that nothing could possibly disturb this idyllic view yet there is an interesting new phenomenon called Wave Rage, obviously coined after the phenomenon of road rage.

The condition arises when there are too many surfers hanging out on the back line and they are all competing to get on a good wave.

Assaults have been reported between surfers, who poach on what is perceived to be the other surfer's territory.

How one indulges in a bout of fisticuffs while standing on a surfboard is somewhat hard to imagine.

I should think with the first swing of the fist, one would land overboard. Presumably they wait until they have reached the shore and then swat each other with their surfboards.

I never saw anything but sunshine and harmony. The main dangers, it appears, for tourists in Australia are the Great Australian Whites and the Blue Lagoons.

Publish Date: 22 April 2003