IT WAS while listening to my father’s partner one afternoon at the surgery in Stirling that I first became aware that some patients would try to engineer a few days off duty by deception.

McLeod was a miner in one of the nearby small pits and had presented with abdominal cramps, a grey face and very visible vomiting on the waiting room carpet. The receptionist had noticed him, hale and hearty, popping something into his mouth before entering the rooms and Dr Blackwood was well aware of the cause. Miners’ headlamps in those days used carbide for illumination. Swallowing a small scraping of the chemical would produce McLeod’s dramatic symptoms within a few minutes.

Artful dodgers are few in our parts of Africa. Unemployment is high and those with a job will do anything to hold on to it, employers often operating a dubiously legal ‘no work, no pay’ rule. In the UK, however, questionable sick leave was, and perhaps still is, a massive economic drain, backache or lumbago leading the field.

Genuine causes of severe or chronic back pain are usually clear cut compared to the UK. In cases of doubt, I accidentally sweep a pen or the local newspaper off the desk while remaining seated. A significant number of ‘acute lumbago’ cases will leap to my aid.

Blood in the urine is a common sign in Africa, usually due to bilharzia-infested snails in pools and sluggish streams, but it is not unknown for the brighter schoolboys to nick or bite their finger, adding the spot of blood to the requested urine sample, then angling for a day or two off to recover. Similarly when senior students from a very well thought of private school were being regularly referred to me suspected of smoking cannabis, I had to accompany them to the toilet and observe their excretions after George Gondwe, our highly competent chief lab technician had phoned.

“Doctor, this urine sample you’ve sent to us for a drug screen?”

“Yes, George. Is it positive?”

“Not exactly. It’s actually – ah – water, probably from the clinic toilet.”

Sugar company employees at the Simunye estate in Swaziland often gave our outpatient sisters a very hard time. Being a male-dominated culture, they could put all sorts of pressure on our nurses unless they were signed off work. The extended family system made it seem as if a quarter of the entire population were relatives. When sick note issues got out of hand, the unsmiling doctors took over for the first hour, stripping all male patients and carrying out a very firm hands-on head-to-toe examination with appropriate instrumental explorations. The word spread rapidly, reasonableness was restored – but it did allow the sisters an option in managing ‘relatives’.

Dodgers are skilful at dropping concentrated solutions of various salts into their eyes or a smidgin of chilli powder, both of which can be mistaken for bacterial or allergic conjunctivitis if the doctor is in a hurry. Not every potential skiver is as careful, however.

Dumisa Shabangu was a vigorous and healthy man in his early twenties. The Casualty sister shouted for me to come quickly. I found him writhing on the floor, crying with pain, and vomiting all around. The relatives could give no history except to agree that he had been perfectly well earlier that day and he was not a boozer.

While we were attempting to relieve his severe pain and stop the vomiting, I noticed an unusual odour in the room.

“Does Shabangu eat garlic? What was he eating last night ?"

Nobody could help. He was dead within an hour.

The sad background we learned later. His girlfriend had spurned him and he was desperate to see her before she left for South Africa. He had heard that if you took a pesticide tablet, the resulting symptoms would ensure the clinic would give him a day or two off.

Without asking advice, he took several weevil tablets at once. The smell of the resulting vomit resembles uncooked garlic.

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