what's in a name?

when i was still studying i heard a story about one of the surgical candidated from up north who totally messed up a question in his final exam. candidates from other african countries sometimes write exams in south africa. the exams are usually for registration as a surgeon in their own country and only limited registration in ours. this means they are easier than the average final here. the question that floored him was to discuss sjambok syndrome in its totality. i thought that a very reasonable and even easy question. the only problem is that candidate was not a south african and had absolutely no idea what sjambok syndrome is. he simply wrote on the paper in bold clear letters; 'i have never heard of sjambok syndrome.' i would have just left it blank if i were him.

rhabdomyolysis, also known in the literature as crush syndrome and known in south africa as sjambok syndrome, has a very specific profile here. but before i get to that, a quick word on the sjambok (http://en.wikipedia.org/wiki/Sjambok). the sjambok is a whip made from hippo hide. hippo hide can be up to 6cm thick so you can imagine the resultant whip. it is about a meter ling and fairly rigid. it can be bent, but springs back to its origional form. rhabdomyolysis is when enough muscle tissue is dammaged to release enough breakdown products to override the kidney's ability to clear them, thereby causing kidney failure.

so in south africa, we get our rhabdomyolysis not from getting crushed under walls or gravel or cars or whatever, but rather from getting the crap beaten out of us with sjamboks. and who does the beating and who gets beaten? the community does the beating as a sort of community justice when someone is caught doing something undesirable. when i saw my first sjambok syndrome as a doctor i asked the guy what he had done wrong. his answer, an answer given by every single sjambok syndrome patient i've ever treated was that they got the wrong guy and accused him of something he didn't do. that time, when i asked the accompanying police officer (by the time they get to hospital they are usually under arrest) what he had done, i was told the father of a ten year old girl had actually caught the guy in the act of raping his daughter.

as time went on i could judge the severity of the crime by the severity and spread of the injuries. the worst i saw was a guy who had no part of skin on his entire body spared, including the soles of his feet and the palms of his hands. he was apparently caught sodomising an infant. the one pictured above was caught stealling so he was only beaten on his back. it is interesting to note the prison tattoo on his right shoulder (maybe a blog for the future). sometimes if the victim was very drunk, the beating would be mainly around the head, often with intracranial pathology to boot (even often caused by a boot). then the experienced doctor looks at the number of defence injuries on his forearms. a total absence of defence wounds means severe intoxication at the time of the beating. the greater the number of defence wounds the more sober the victim. and a general spread of wounds with fair sparing of the head indicates a sober person.

the interesting question that arises is my personal feelings about this sort of barbaric behaviour. i do not agree with it. but.... in a country where crime is totally out of control and the powers that be do nothing for whatever reason and after hearing the numerous henious acts commited by these people, i can't say that my heart is filled with pity for them. i suppose that means that to some extent my environment has changed me. that is something i'll have to look at in myself.

but anyway, what's in a name? that which we call sjambok syndrome by any other name would sting as sharp.