Conquering Taal – A Precarious Journey To The Crater’s Edge

The 2014 Asia-Pacific Chiropractic Doctors Federation meeting in Manila had been uneventful, the papers had been put away and it was playtime. Our generous hosts had contacted the local tourist organisation, collected the requisite amount of Philippine pesos, told us to gather in the hotel lobby and be sure to have signed the necessary disclaimer.

Disclaimer? Ok, I knew that the twelfth most populous city on the planet could be dodgy in parts, but we’d been told we were heading to a nature reserve, an area of outstanding beauty outside the boundaries of this bustling squirming city. What could possibly go wrong?

As we shoehorned ourselves into the battle-scarred minibus and edged into the craziness of permanent-rush hour Manila traffic, I was abruptly reminded of my journey from the airport. Having been disgorged from Ninoy Aquino International into the stifling, sticky heat of the Manila night, ancient, beaten taxis had jostled for business, weaving between uniformed staff and overloaded luggage trolleys being painfully manoeuvred by exhausted tourists. Dazed, onesie-clad children had trailed unsteadily behind, their red eyes a testament to the 24 hour endurance exercise that had long since ceased to be exciting and was now a battle against unconsciousness.

With some trepidation, I had climbed into my two-speed taxi (stationary and maximum velocity) and had been propelled into the city centre amid a cacophony of high-revving engines, relentless horn-tooting and a stream of what I understood to be Tagalog profanity. Despite the late hour, multi-coloured lights of still-open bars, clubs and massage parlours had twinkled and flashed provocatively as I had been unceremoniously catapulted towards my destination.

I was now back in the thick of Manila’s over-clogged roadways. Our mild-mannered Mazda competed with habel-habels (improvised motorcycle taxis carrying up to 10 people and their baggage) and Jeepneys (pimped WW2 jeeps converted into chrome-plastered human sardine cans). As we idled in stationary traffic, a psychedelic message sprayed onto the rear of one of these bling-bedecked monsters proclaimed ‘God Is Good’. Catching sight of 30 or so faces pressed against the glass, with a similar number clinging to the roof, I quickly realised why faith was so important to the Filipino population.

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As high-rise apartment and office blocks gave way to the suburbs and then the countryside, we arrived about an hour later at our picturesque destination. Our driver proudly announced that we were now at Taal, one of the most active volcanic sites in the world and a designated Permanent Danger Zone. The reason for the disclaimer became clearer by the minute.

First stop was a mini-lecture where the carnage from the thirty-plus previous erup
tions was graphically described. After some fortifying local delicacies it was time for us to get up close and dangerous to the phenomenon of the Taal volcano complex.

Taal is pretty unique. Prehistoric eruptions have created a volcano within a lake, within which is another lake, within which is yet another volcano. It is the Russian doll of volcanology and our journey was to take us to the innermost one.

The prize of seeing this spectacle was, however, not to be easily won. To reach Taal there, we first had to cross the formidably large outer lake. With our group divided into two, we were led towards two rather fragile-looking craft, whose buoyancy was bolstered with lengths of bamboo lashed to their sides. The phut-phutting from the rear of the boats gave every indication they were powered by the motors of old sewing machines.

With safety clearly foremost in the minds of our crew, it was time to distribute the life vests. As I was handed my fluorescent flotation aid and the 10cc engines fired up I realised that they had probably been bought as a job lot from a Hobbit community. As I donned the vest, the polystyrene blocks designed to cover my chest stopped at the point of my shoulder blades, leaving me to fashion a bow from the two frayed lengths of string that only came remotely close to each other after ensuring that both lungs and my abdominal cavity were made completely devoid of air. As I watched my fellow tourists grapple with their own vests we wobbled our way into our respective seats and with that, we were off.

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With the shoreline quickly disappearing from view, the realisation struck that I was now in the middle of a very deep lake, heading towards a volcano with a sizable track record in eruption, and only a miniscule life jacket for protection. However, our beaming crew clearly had not a care in the world and a few short minutes later we spied the shore where our welcoming committee awaited our arrival.

Disembarking from the boats and returning our homeopathic orange safety garments, we were ready for the next leg of our trek to the crater’s edge. Eight saddled ponies of various colours stood on the sand, each accompanied by a guide. The outer Taal volcano loomed before us.

Any suggestion of equestrian expertise on my part would be a gross overstatement. Childhood memories of precariously bobbing on an ageing donkey at Weston-Super-Mare beach came flooding back, but not wishing to appear anything but an accomplished jockey I strode confidently towards my nominated pony.Having sized me up in a ‘WTF’ sort of way, his eyes bulged, betraying obvious terror at what was about to ensue.

Moderately surprised that my foot could even reach the stirrup, I set about mounting my trusty steed. Admittedly, the tack was not filling me with confidence, but I was not ready for what happened next. As I pushed down on the stirrup, my foot went straight through it and my world went black as my nosed smashed against my pony’s ribcage. My immediate embarrassment was compounded by having to spit out mouthfuls of pony hair.

To a backdrop of schoolboy giggling from the assembled villagers, I dusted myself down and was led to a nearby rock from which I launched myself onto the back of the now quivering pony. Recovering from this rather inelegant incident, I soon caught up with the rest of the team and as we plodded through the village, waving at excited children and weaving between ramshackle huts, I soon regained my composure.

That is, until we began to ascend. With only one stirrup and my other leg dangling uselessly, it was left to my inner thigh muscles to keep me astride. On the level this was bearable, but as we headed up the grossly uneven terrain and increasingly steep gradient towards the summit, I could feel my grip loosening. Before I knew it, my saddle was sliding backwards and with horror I found my crotch directly over the poor animal’s backside. By this time, my thighs were on fire and I was having to launch myself forward every few metres just to stay on.  As sweat trickled down my face, my pony stumbled on, but even his breathing was starting to become laboured and I wondered how much longer he could go on.

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Finally, we made it to the crater’s edge. My pony was whisked away, presumably for rehydration and CPR, while I attempted to re-establish circulation in my lower limbs. As we admired the spectacular view of Vulcan Point, the innermost volcano, I remained distracted by the inglorious circumstances of my unconventional ascent.

Stopping briefly to pose for photographs, all too soon it was time to descend from our vantage point. Partially revived, my pony sensed an imminent repeat of the nightmare experience of carrying my ample frame. The poor thing looked terrified. This time it was the downhill gradient that I had to contend with. Setting off, we were soon picking our way down the rocky road to the comfort of the village below.

I still had only one stirrup. The saddle was still wobbly, as was I. As my body slid helplessly forward, rather than being over its behind I found myself straddling its mane. Trying desperately to remember how Ricky remained connected to a saddleless Champion the Wonder Horse, my exhausted thigh muscles were again called into action. The descent was equally as distressing as the ascent.

As we reached the shore once more, new boats were moored ready for our departure. Children scampered about excitedly and two young boys hopped aboard my boat, settling themselves into the rearmost seat. The boys flashed me a huge white grin and gave me the thumbs-up as I once again inhaled as deeply as I could, donned my micro-jacket and offered myself a small prayer.

By this time, the wind had got up and the waters were choppy. Waves buffeted our little boats and we soon became drenched. Time after time, our fragile boat rose up on the waves before crashing down to continue ploughing through the water. Neck and neck with the second boat, I cast a glance across to see that its occupants too had become soaked.

But there was something else. As I looked across, I caught something out of the corner of my eye. The two boys behind me were no longer perched on the seats but had been galvanised into action, furiously emptying the now leaking boat with small cups. The shore was still not within sight, the previously cloudless sky had turned a dark shade of grey, and we were perilously bobbing about at the mercy of the waves. And here was I, protected only by a bright orange fashion accessory, whose only utility was to cushion my scapulae. The only vague reassurance was that the boys were still grinning.

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As the sewing machine motor propelled us through the water at what now seemed to be an agonisingly slow pace, the small harbour eventually came into view. Conversation by this stage had quietened somewhat as we all willed ourselves to reach the comfort of dry land.

Our fears, of course, were wholly unwarranted. As we reached the harbour and stepped from the boat, our two most junior crew were still decanting lake water, but no one seemed remotely bothered. Before long, we were back on the road heading back into the traffic chaos of Manila. Our adventure was over. We’d made it to the summit of the Taal volcano and had lived to tell the tale.

All too soon, my time in the Philippines was over and the following morning I was heading back to Heathrow. For days, the residual burning ache in my legs served as a telling reminder of my brief career as a Filipino cavalryman. Did my poor pony every carry a passenger again? I prayed that someone had taken pity and allowed him to live out his days in tranquil retirement. Hopefully, an equine chiropractor had come to the rescue and put his traumatised spine back together, coupled with visits to a horse-whispering psychologist with a special interest in PTSD.

And, somewhere in that remote settlement at the foot of this iconic volcano, I’m sure that laughter still echoes long into the night as Filipino storytellers entertain villagers with tales of the day an oversized Englishman came to Taal and fell hook, line and sinker for the old broken stirrup and dodgy saddle trick.

 

 

 

 

The Long Road to Kasane

Even for the most carMap-Botswanatographically impaired, acquiring a sound knowledge of Botswana’s road network presents few challenges. Huge swathes of the country are devoid of mapped roads and, courtesy of the semi-arid Kalahari Desert, sitting astride Botswana and Namibia, most of its population is located in towns and cities out to the east.

Mahalapye sits on the A1 highway, its forty thousand or so inhabitants residing almost equidistant from Gaborone to the south and Francistown, some 240km to the north. Historically, it was home to the Rhodesian Railway Station, where the only electric lights in the town were to be found. The age of passenger rail travel has long passed but Mahalapye remains home to the headquarters of Botswana Railways at the front of which sits a gleaming, racing green and black locomotive, a lasting tribute to the bygone golden age of steam.

As another hot southern hemisphere summer weekend in February beckoned, World Spine Care clinical director, Geoff Outerbridge, and I decided to head north from Mahalapye to Kasane for a brief taste of Africa’s magnificent wildlife and spectacular scenery. With a prize at stake of seeing at close quarters some of the world’s finest creatures both in and on the banks of the legendary Chobe River, the fact that Geoff’s smooth-talking iPhone GPS was cautioning us that our destination was some 730 kilometres (450 miles) distant did not faze us intrepid travellers.

Once again, the WSC Toyota Prado was called into action. VeteraDSC_9316n of numerous shuttle trips to Gaborone and showing enough kilometres on the clock to circumnavigate the globe ten times, the Prado fired up on the first turn of the key, a small puff of black smoke signalling its readiness for the journey ahead. Bouncing along the dusty track in the relative coolness of the early morning, sun streaming through the windows, we headed towards the A1, passing on our way the disastrously mis-spelt Look n’Lean Nursery School.

Minutes later, the Prado was heading north. As we negotiated the suburbs of Mahalapye in what can very loosely be called rush hour, donkey carts were hastened along by their impatient drivers, while a succession of white pick-up trucks vied for the fastest getaway at the lights as they conveyed goats, cattle or human cargoes to neighbouring villages. Locals played chicken with the traffic as they scampered across the carriageway, their brightly coloured clothing becoming blurred by the fog of exhaust fumes.

Eventually, we were on the open highway and the disorganised jumble of houses, shops, workshops and industrial units gave way to open countryside. The traffic quickly thinned out and soon the Prado was nipping along at a steady 110 kph. Beyond the dusty roadside verges, vast expanses of tree-covered flatness spread out either side of us as we motored through the Botswana countryside.

For the bulk of the Batswana, travelling any distance means catching public transport. Car ownership is low and taxis are out of reach for most of the population. It is therefore left to an eclectic mix of buses, coaches and combi vans to grace the roads of Botswana, shuttling their overpacked and overheated passengers from one town to the next. Stepping aboard any one of these motorised projectiles is to risk life and limb. Adherence to any form of speed limit is ignored. Regular maintenance is often overlooked. Drivers stay at the wheel for hours on end. Unsurprisingly, accidents are frequent and catastrophic.

It wasn’t long before the first of a series of jet-propelled shuttles hurtled past us. Appearing from nowhere, the Prado was suddenly thrust into the shadow of the early morning service from Gaborone. Patches of rust interrupted the pattern of the grubby white paintwork. A sea of faces peered out, their expressions a mix of fear and passive acceptance. Emblazoned along the side of the bus in bold blue capitals were the words ICONIC EXPRESS. As it rapidly disappeared into the distance, it immediately became obvious why religion is so important to the people of Botswana.

Passing through the outskirts of Palapye, vendors appeared at the roadside. Makeshift stalls, their wooden skeletons of twisted branches crudely bound together and topped with whatever would provide a modicum of protection from the elements, displayed a range of goods. Purveyors of oranges, brooms, airtime cards and bottles of Coca-Cola were dotted along the road, mingling with goats, cattle and small children enthusiastically waving at every passing vehicle. To their delight, we enthusiastically waved back.

After three hours, a sign proclaimed that we were entering Francistown, Botswana’s second largest city. At the bus stop, the ICONIC EXPRESS was disgorging its passengers, no doubt armed with yet another tale of near-death to relate to their grandchildren.

Founded in 1897, Francistown was the centre of southern Africa’s first gold rush. Named after Liverpudlian Daniel Francis, one of its early prospectors, it sprung up as a busy town alongside the railway, transporting optimistic miners and other get-rich-quickers and rapidly becoming a wealthy centre of trade with nearby Zimbabwe, just 90km to the east. It proudly boasts the honour of having the first tarmacked road in Botswana.

P1010564As the traffic funnelled into Francistown, we were forced to slow as roadworks diverted us off the A1 and into the residential suburbs. As we bounced over pothole-filled roads and weaved through the rabbit warren of back roads, long strings of brightly coloured, freshly laundered clothes marked the perimeters of yards, proudly swept and containing small but neat single storey houses. Lowering the window of the Prado, the air was filled with a cacophony of sound: car horns hooting, roosters crowing, dogs barking, goats bleating and the magical sound of Setswana, as the locals made themselves heard above the din.

Leaving Francistown behind, we continued northwards, just inside the border with Zimbabwe. It was time to fuel up and as we pulled in to a roadside gas station and stepped out of the Prado, the excruciating stretch of tight limbs was accompanied by an intense blast of burning hot air.

There’s no such thing as self service refuelling in Botswana. Approaching the pumps, the team of uniformed attendants get ready for action. Within nanoseconds of engaging Park, the filler cap is open, the nozzle is inserted, the bonnet is up, levels are checked and the windscreen is getting a makeover. It’s the best of African service with a smile and this was one slick operation.

Not everyone was treated quite as royally, however. As I observedP1010568 from a distance, two young men were filling the tank of a freight lorry. There were not uniformed attendants here. Having fashioned a funnel from a plastic bottle they were decanting fuel into its huge tank. I think they are probably still there filling it up.

Pit-stop completed, we were soon back on the road. By this time, the Prado’s windscreen had sustained yet more trauma, courtesy of a bullet-like stone chip flying from a passing truck. With a hairline crack alarmingly emanating from the point of impact, the windscreen was now beginning to look remarkably similar to the road map of Botswana, with vertical and horizontal fracture lines criss-crossing the glass.

Now heading north west, we made for the village of Nata, named after the river that flows through it centre serving the Makgadikgadi Salt Pans. By now the landscape was changing and signs had begun to appear by the roadside, warning anyone unwise enough the stray into the bush to relieve themselves that they may get more than they bargained for.

Triangular, red-bordered signs cautioned travellers of elephants and before long, the traditional Mahalapye sight of roadsidP1010583e grazing goats and cattle was replaced by our first sighting of the biggest of the Big Five. Standing by the side of the road, about to cross, was an impressive bull elephant. As we slowed to pass, it gave a show of strength, fanning its enormous ears and pointing its broad head and magnificent ivory tusks in our direction, before turning and heading back into the dense vegetation of the bush. Soon, there was another, and another. We were deep in elephant country. Being accustomed to foxes, badgers and the occasional deer on the roads of rural Gloucestershire, encountering these African behemoths crossing our path was an outlandish experience.

The outside temperature was now hitting the late thirties and as we stopped for a driver swap, the heat of the midday Botswana sun was stifling. Our Prado’s air conditioning was manfully trying to keep us cool, but intermittently was succumbing to the challenge. With less than 200 kilometres to go, we were on the final leg of our colossal journey. Staying within a few kilometres of the Zimbabwean border, the arid bushland had given way to lush green fields of maize. Hectare upon hectare, as far as the eye could see, this staple of the Batswana diet was being grown in vast quantities.

The garrison town of Pandamatenga is the last major centre before Kasane. Here commercial farmers mingle with the Botswana Defence Force. Ubiquitous Toyota pick up trucks and combi vans are outnumbered by matt green painted army trucks. Razor-wired fences enclose the military installations and row upon row of flat-roofed buildings hint at the hive of activity going on within.

With less than an hour to our destination, we realised that we were tantaliDSC_3543singly close to the spectacular Victoria Falls. However, we would have to leave that adventure for another day. As we made our way towards the northeasternmost tip of Botswana, where it meets with Namibia, Zambia and Zimbabwe, the town of Kasane came into view. Ambling pedestrians, all manner of goods being carried on heads and in arms, made their way about their business. Barefooted children played happily by the roadside. Tourists sporting large-lensed cameras, binoculars and wide-brimmed hats clung to off road safari trucks as they headed off for their evening game drives. International freight lorries from neighbouring nations rumbled through the town. Goats and chickens competed with warthogs and vervet monkeys for a piece of vegetation and scraps of whatever food had been discarded by passers-by.

DSC_9410As we drove through the gates of the Chobe Game Lodge to broad smiles and enthusiastic waves we found ourselves in a unique pocket of Africa. Sitting on the banks of the Chobe River, the calm waters gently rocked the range of craft moored at its banks. Looking out from the wooden decking, birds darted over the glassy surface of the river, while fish eagles sat high atop vantage points as they scanned the water in search of a pescetarian dinner. Later, as we drifted down the Chobe, we were treated to a feast of wildlife. Grazing buffalos, basking crocodiles, wallowing hippopotami and families of elephants taking refreshing afternoon dips in the cool water provided a captivating scene.

As the cotton wool clouds became tinged with fiery red and the blazing sun quickly dipped into the horizon and disappeared from view, the night was filled with the sound of crickets. An occasional monkey screeched in the distance. Wafting hickory smoke, gentle chinking of crockery and the low hum of Setswana voices signalled the preparation of an exotic African supper.

Eight hours of near-continuous driving and we had made it to Kasane. For me, the journey had been an unforgettable experience, where every sense had been stimulated. The magic of Africa – its landscape, its people and its wildlife – had been poured over me and like a sponge I had soaked it up.

The long road to Kasane had further cemented my love for Africa. Two days later, as the homeward trip back to Mahalapye beckoned, I resolved to one day repeat the journey, return to this Chobe River paradise and immerse myself again in this jewel within a jewel.

Spine Care in Botswana and the Lady in Red

The verdant leaves of the gnarled, twisted old acacia outside the World Spine Care clinic in Shoshong combine to create a natural canopy and a fine waiting area. As the African sun rises to herald another scorching February day in this old, rural settlement, the night music of chirping crickets is silenced and is replaced by the early morning chorus of central Botswana’s indigenous bird population.

As Shoshong slowly wakes up, other sounds fill the air. Goats of various colours nibble at the roadside grass, occasionally raising their bearded heads to bleat a call to their companions. Brown, black and white cattle, their thick, wrinkled necks bearing collars to which are appended clanking bells, lazily jangle their way to their grazing spots under the watchful eye of the farmers who tend their prized beasts from dawn to dusk. Buses fire up, spewing out thick diesel fumes as they prepare to transport Shoshong’s commuters to the nearby towns of Serowe and Mahalapye. Meanwhile, the dull clip-clop of multiple hooves on the unmade road signal the approach of teams of donkeys, leaving clouds of dust in their wake as they haul carts laden with goods through the village en route to neighbouring communities.

Approaching the World Spine Care clinic, we pass the medical centre. OShoshong clinicpen 24 hours a day, this cramped, single storey building serves Shoshong’s population of over 7500. Here, they care for the diseased and the sick with a team of committed nurses and Dr Moshimbi, a smiling, genial man in his early sixties, to whom the poorly come in hope of relief from their suffering.

The clinic is led by Rebecca Kowa, its tall and imposing matron, whose commitment to her role is immediately evident. A strong supporter of World Spine Care, she stands and waves enthusiastically as we pass, the glistening white of her nurse’s tunic contrasting sharply with the scorched earth and worn brickwork of the medical centre just behind her.

People value healthcare in Botswana. Both at the District Hospital in Mahalapye and in Shoshong, a visit to the doctor is regarded with respect and reverence. As the reputation of World Spine Care spreads, so the radius from which patients are drawn steadily expands. Referred by doctors, friends and family, patients travel from Francistown, some three hours to the north, and Gaborone, two hours to the south clambering aboard buses, coaches and combi-vans as early as 5am to ensure they arrive for their appointments on time. Others stand by the side of the road to hitch a ride to Mahalapye or Shoshong, their outstretched waving arms appealing for a lift, just so that they can receive the spine care on offer.

Arriving at Shoshong last weDSC_9652ek, we encountered a sight that will remain one of the lasting images of World Spine Care. Outside the clinic, in the shade of the old acacia tree, sat my first patient. Hands clasped in front of her, and displaying an enviable sitting posture, she rested on a grey, upturned concrete building block,

Wearing an immaculate short-sleeved red dress, her attire was perfectly complimented by a smart, wide-brimmed sun hat. Dressed as though she were meeting the President of Botswana, this lovely lady had travelled far and arrived early. She brought with her a new set of x-rays, taken at Mahalapye, which had themselves necessitated a round trip of over 80km.

But perhaps the most beautiful thing that this dear lady was wearing was her smile. Beaming, she greeted our arrival with an expression that typifies the people of this wonderful country. Highlighted by the darkness of her skin, the perfect whiteness of her teeth radiated a contagious sense of happiness.

As the morning wore on, the procession of Shoshong fashionista gracing our ‘waiting room’ continued. Floral fabrics with matching head scarves, smart summer frocks and an assortment of head wear that would not have looked out of place in an Edwardian milliner’s shop window all conspired to created a brilliant display of colour.

Perhaps the most dramatic attire was an elegant lady who attended her appointment wearing a magnificent pink and white three-cornered hat with a matching dress reminiscent of the Victorian era. As she slowly and majestically swept into my treatment room, it felt as though I was in the presence of African royalty.

This, it transpired, is the traditiDSC_9319onal dress of the Herero tribe of Namibia, formerly known as South West Africa. Victims of terrible oppression and slaughter under German occupation, men and women began dressing in the style of their oppressors once occupation ended in 1915. Women in particular adopted the styles, airs and graces of the Christian missionary women that accompanied the European colonisers.Today, the dress is worn by the Herero tribes people as a permanent tribute to those who perished during the 1880s and 1890s.

The distances patients travel to the World Spine Care clinics, the way they dress for their appointments and the time they are willing to wait in the heat for an appointment all tell a story of the current level of primary spine care provision in Africa. With no full time chiropractors and a single spine surgeon serving the entire nation, access to effective evidence-based spine care is absent in many communities..

World Spine Care exists to bring relief to those suffering from a condition that remains the leading global cause of disability. As a non-profit charitable organisation, it relies on donations to continue its work. If all those associated with the treatment and management of back and neck pain were to pledge the value of a single treatment, the ability of World Spine Care to expand its operations to further underserved countries could be assured.

Working here in Botswana has been a revelation and a privilege. I have learned so much since my arrival nearly four weeks ago and soon I must return to my home in Gloucestershire. It will be with a heavy heart that I shall soon depart, with priceless memories but a firm desire to one day return to this captivating and beautiful land.

Shoshong: World Spine Care under the African sun

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Most of the roads leading out of Mahalapye are straight. Sitting directly on the Tropic of Capricorn between Botswana’s capital, Gaborone, and its second city, Francistown, the sparsely distributed population outside of this bustling mining town meant that road builders were able to construct straight, undeviating arteries through the African countryside to connect it with other settlements of importance. Drivers in Botswana can expect mile upon mile of baking tarmac, stretching far towards the horizon and culminating in the mirage of a shimmering liquid haze.

The World Spine Care project in Botswana takes in not just the District General Hospital of Mahalapye but also the rural community of Shoshong. Established in 2012 with the backing of the Botswana Ministry of Health, the clinic in Shoshong serves  its 7500 inhabitants and the surrounding villages and settlements.

Once of strategic importance due to its location on important trade routes through the region, Shoshong’s influence and population declined over the centuries, but its magical hills in an otherwise flat landscape attracted many visitors and settlers, including the missionary societies from England and Germany in the 1850s. Here, spectacular scenery and varied wildlife combine to make it a hiker’s paradise.

The journey west to Shoshong from Mahalapye features forty kilometres of mostly dead straight road. Broken only by gentle curves around the Shoshong hills it has few features to afford it any protection from the elements. Cattle and goats graze contentedly by the roadside; wild donkeys occasionally amble across and impressive birds of prey sweep overhead in search of road kill.

As we trundled into the village, our pace rudely slowed by a series of unforgiving speed humps outside the local primary school, I had my first glimpse of Shoshong. At 7.45, I realised it had to be rush hour as a team of three, smoky-grey donkeys trotted past us in the opposite direction hauling a cart laden with freshly-collected wood. Small children wearing immaculate uniforms skipped along carrying rucksacks almost as big as themselves as theyDSC_4141 made their way to school. Accompanying them were their parents, gripping colourful umbrellas to shield their skin from the early morning sun as they coaxed their small charges into the playground. A hundred yards further on, an fascinating mix of dust-covered buses and coaches stood ready to transport their passengers to work in neighbouring towns and villages.

Driving off the road, past street vendors already set up for the day and displaying their wares under makeshift canopies, a solitary rooster announced our arrival. Before us sat a prefabricated, single storey building, mounted on steel legs fronted by a small flight of steps and a gently sloping ramp. A sign mounted on wooden posts announced that this was the Shoshong World Spine Care Clinic.

As we bounced over the uneven, rust-coloured earth I noticed a small group gathering under the shade of a tree; an elderly man in a wheelchair, two or three large women wearing wide-brimmed hats and a thin, younger man, his arm bandaged and his body twisted as he conversed happily with the others. All were clutching what looked like A4-sized exercise books. This, it transpired, was the waiting room, Shoshong style.

World Spine CareDSC_9642 (www.worldspinecare.com) is a global charity committed to tackling spinal disorders in the world’s most underserved communities. Not only are spinal disorders the leading cause of disability globally, but they constitute the disease with the greatest economic impact in the developing world.

Botswana, a country the size of France with a population of just over 2 million, was the first of the World Spine Care projects. With extremely limited access to primary spine care and just one spinal surgeon for the entire country, those with back and neck pain in rural communities are often left in chronic pain or permanently disabled. World Spine Care aims to make a difference to these people by providing sustainable, evidence-based care, education and preventative strategies.

There was no time to lose in acquainting myself with the protocols and layout of the clinic. Its tardis-like interior contained two treatment rooms, admin office, washroom and reception area. Not only that, there was WiFi! I was instantly impressed. With the 90-second tour completed, I was ready to go.

That first morning in Shosong was unforgettable. Twenty-five years as a chiropractor, cosseted in private practice with a largely affluent Gloucestershire population seemed a million miles from what I was encountering. This was Africa in the raw, and I was seeing patients for whom back pain was not simply an inconvenience, but a devastating condition which impacted on individuals, families and communities.

The first patient could not have illustrated this stark truth more graphically. The old man waiting patiently outside the clinic on our arrival had wheeled himself slowly and painstakingly up the ramp and had been led into my room. The wheels of his chair were caked with mud and dirt and his arthritic hands were calloused from years of propelling himself across unpaved and rutted paths. He greeted me with a broad, toothless smile as he extended a hand of friendship, eager to receive whatever treatment could be afforded him.

As he positioned himself beside the state-of-the-art Elite chiropractic table, he applied the brakes of his chair, removed its side arm support and, with massive effort, slid himself across onto the table.

As I scanned his clinic folder and his medical records (contained within the A4 folders carried to every appointment) the medical catastrophe that had befallen him became clear. Some 15 years earlier he had contracted TB of the spine. Extremely rare in Europe, but still a major health problem in Africa, tuberculosis of the spine can lead to vertebral collapse and spinal cord damage. It has devastating consequences.

Before me, this local Shoshong man exhibited them all. TB had ravaged his spine, leaving him hunched and deformed. Where his spine had disintegrated, the essential neurological pathways leading from his brain to his body had been irreparably compressed, leading to complete paraplegia. As he manoeuvred himself out of his chair, I was reminded of the indignity of spinal cord injury. Rising from a roughly hewn piece of thick, uncovered upholstery foam, his lifeless limbs dragging beneath him, he carefully ensured that his indwelling catheter and drainage bag did not become detached.

As he lifted his tattered pullover and threadbare shirt to expose his broken spine, the true meaning of World Spine Care struck me. He had come to the clinic, because what was being offered, here in rural Shoshong, was making a difference. Through Malebogo, our health care assistant and interpreter, he explained that the treatment provided to him was helping him and making his life easier. It was immediately apparent that World Spine Care was supporting this close-knit community, one spine at a time.

I was still reeling from my humbling encounter when my second patient at Shoshong made his way into the treatment room. A much younger man, he limped badly with the aid of a crutch and wore an elastic bandage on his wasted forearm. With each step he was forced to hitch his hip and swing his leg clumsily forward. His speech was slow and laboured, his face contorted by the stroke that in an instant had consigned him to a life of permanent disability.

For the first time, I was seeing in the flesh the manifestations of a disease that in Botswana afflicts one quarter of the population over fifteen years of age. With a prevalence second only in the world to Swaziland, HIV is endemic in Botswana.  While the provision of free antiretroviral drugs has increased the life expectancy from 49 in 2002 to 53 in 2012, new cases reported annually have not declined.

Quickly researching on the internet, I discovered that the effects of HIV increased the risk of stroke by up to 40%. Like the patient before him, here was a man for whom the prospect of recovery was nil, yet was finding World Spine Care was making his life more tolerable.

And so the morning went on. More and more people made their way slowly along the dusty track to the clinic’s open door. Generously proportioned ladies, their knees painfully swollen by arthritis; smallholders whose backbreaking labour under the scorching African sun had reduced them to a slow hobble; mothers, for whom multiple births and decades of housework had left a legacy of spinal pain: here was a proud community that modern technology had barely touched and for whom nineteenth century working practices were still the norm.

As my first day in Shoshong drew to a close, the power went off. The intermittent electrical supply in Botswana, whether due to one of its spectacular thunderstorms or by system failure, is legendary. People shrug their shoulders, accept that power will probably be restored soon, and carry on. Not wishing to appear phased by having a suddenly inert treatment table, no air conditioning and limited light, I soldiered on as if nothing was amiss.

By the time my last patient walked out of the door, the temperature in our prefab building was over 40 degrees. As I quickly slugged back a litre of cool water and breathed a contented sigh, I reflected on my day in this remarkable environment. I had been enlightened, humbled, educated and enriched.

Nothing could quite DSC_1129have prepared me for the rush of emotions that Shoshong delivered on that first day. Each subsequent clinic session has provided yet more. The first patients of the day still gather under the tree. Animated conversations conducted in Setswana continue to fill the air. The sun still beats down.

And the rooster is still crowing.

Cobra alert!

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Zulu and Scooby are wiley old hounds. As joint heads of security here at Plot 79, they patrol the grounds with zeal, ensuring that any potential intruder thinking of breaching the perimeter fence is made perfectly aware of the type of welcome they’re likely to get if they foolishly decide to set foot on the property. Retrieved a few years ago from the Botswana SPCA, these two World Spine Care mutts are unlikely ever to win any prizes at Crufts, but they are affectionate, charming and loyal. As a duo they are the canine equivalent of smoke alarms, launching into a chorus of barking at the faintest hint of something unusual.

So it was when, two nights ago, Zulu decided to unleash an incessant stream of woofing at around 2:30 in the morning. Popping his head out of the window to see what was going on and seeing nothing, my colleague Geoff thought that poor old Zulu had lost the plot over some scampering lizard on the patio. A few choice words aimed in his direction and the African night was peaceful once more.

Last night, Zulu and Scooby were both at it, their bark alarms in full glorious stereo at 1:30. Eventually, they calmed down without Geoff’s intervention being required. Having (we foolishly assumed) cried wolf the night before, we felt sure that another hapless gecko had dared to come on to their radar and that they were somewhat over-reacting.The combination of a clear balmy night and a spectacular full moon ensured that nothing was going to get past our canine sentries.

This morning (Tuesday) was another routine day for Geoff and I at the World Spine Care clinic at Mahalapye Hospital. After an early start, we settled into our respective patient lists, aided by the World Spine Care assistants Marcia and Malebogo. Everything was calm, orderly and relaxed.

With the day almost over, we were completing paperwork when Geoff took a call from Kgomotso, the housekeeper at Plot 79. Clearly distressed, she asked us to return immediately. She had seen a snake on the property and was terrified.

On the 15-minute journey back to the house, we discussed what it could be. Only two nights earlier we had been invited to a farm where the owner, who had lived in Botswana for 20 years, had told us in rather too much detail of the number of black and green mambas that had been found hanging from the leafy branches directly above our heads. Over the years, he  had become somewhat of an expert in dispatching them and along with scorpions and spiders, the African wildlife held no fear for him.

As someone who gets a little twitchy in the reptile house at Bristol Zoo with inches of shatterproof glass acting as an impenetrable barrier between me and the serpents on show, I could not say that I shared this indomitable African spirit.

As we swept through the steel gated entrance of Plot 79, Kgomotso stood nervously clutching a teacloth, while her husband Aaron, who had received the same emergency call as us and had raced over from the other side of Mahalapye, pointed us in the direction of a magnificent old tree standing close to the house next to the boundary wall.

There, in the opening of a hollow about eight feet from the ground, sat an enormous snake. Only a small portion of its mid section was visible, but its girth clearly marked it out as a very sizeable reptile indeed. With the aid of quickly retrieved binoculars we could see its black beady eyes calmly surveying the scene.

It was time to get the Book of African Snakes. Flicking through the pages, we quickly matched the distinctive markings of the scales and concluded that what was facing us was a snouted cobra.

i was on to Google in a flash. As I scanned the various websites, words like deadly, venomous and neurotoxin started jumping off the page. We were dealing with one of the most dangerous snakes in Africa. Further reading showed that they could grow up to eight feet in length and could deliver 250ml of venom in a single bite. It was time to stop reading.

This was clearly not a snake to mess with and with no cobra catchers listed in the Yellow Pages, it was time to take drastic action. Quickly, a local marksman was sourced and the equivalent of Mahalapye’s Snake SWAT Team was on the scene. Sadly, a single shot missed its target but was close enough to disturb the dozing cobra, which slowly withdrew into the depths of the tree and out of sight.

What the hell were we to do now? A deadly venomous snake was in a tree just feet from the house and was now aware that someone was taking pot shots at it. Cue one highly hissed off (sorry!) snake.

Meanwhile, word had got around the neighbourhood that Plot 79 had a cobra in its back yard. Even by African standards this is a rare event and it wasn’t long before curious visitors had come to see the slithery monster.

Advice was coming thick and fast but the general message was that we had to kill the snake. A nervous tension hung in the air. Africans do not like snakes one little bit, and to them the best snake is a dead one. To be honest, the prospect of just leaving it to set up home, have babies and live happily ever after did not exactly fill us with joyful excitement either.

With the Snake Swat Team covering all of the exits, the main hollow was plugged with an empty tin. By now, the crowd had swelled to about 20, some of whom seemed to be virtually advocating the use of weapons of mass destruction to eliminate the threat of a snake bite.

Eventually, it was decided that concrete was the answer to seal up the remaining holes. Seemingly taking inspiration from the designers of Alcatraz, no escape route was left unplugged. Our unwelcome visitor was destined to be permanently incarcerated within a wood and concrete prison.

Throughout all of this Zulu and Scooby sat impassively, watching the proceedings from a safe vantage point. Did they know what all of the fuss was about? As I looked into their eyes I wondered whether I detected a knowing look. Had they encountered our new resident on the move the two nights before? Who knows. The one thing I’m sure of is that when a smoke alarm goes off again, I’m going to take it  more seriously.

Mahalapye – a rapid immersion into World Spine Care

Mahalapye is Botswana’s tenth largest town. Sitting directly on the Tropic of Capricorn  on the edge of the Kalahari desert, its 41 000 inhabitants enjoy a subtropical climate with long periods of sunshine interrupted only by a brief rainy season.

Arriving in this southern African paradise, it was difficult to imagine how cloudless skies and the benevolence of what appeared to be an ever-present sun could be broken by inclement weather. Here I was, well over five thousand miles from the icy blasts and disruptive flurries of snow sweeping across the United Kingdom. I was destined for a month of unbroken heat and was confident of a climate that would quickly transform me into a bronzed Adonis.

There was no time to waste in getting started with World Spine Care. Waking to the early morning sun beaming through the windows, we enjoyed a hasty al fresco breakfast before donning our natty WSC shirts before firing up the Prado and joining the Mahalapye rush hour to head to the outskirts of the town.

To say rush hour is something of an overstatement. Firstly, no one seems to be rushing and secondly I doubt whether it lasts an hour.  It pays to get up early in Botswana. Once the temperature rises to its scorching maximum in the afternoon, even for the locals it becomes a trifle too warm. The smartest people therefore get up with the larks and make the most of the cooler start to the day.

Our early morning drive to the hospital took us past children happily skipping their way to school, mothers strolling to town with their babies strapped to their backs and ageing flat bed trucks carrying gangs of smiling labourers trundling slowly along the dusty highway. Whether powered or not, the pace was, most definitely, pedestrian.

Officially opened in 2008, Mahalapye District Hospital proudly stands as a monument to the Botswanan Government’s programme of bringing specialist medical services to the community. With its contemporary red brick construction, topped with roofs of green tiles, it looked every inch the modern healthcare facility as we passed under the Stop barrier that had been raised for our arrival.

World Spine Care has its own dedicated rooms within the  physical therapies department. With two sizeable treatment rooms, an admin office and a waiting area, it is well-equipped and sports two state-of-the-art Elite chiropractic tables. Seeing it, my modest expectations were very hastily exceeded.

As I tentatively explored my new environment I became aware that the waiting area was rapidly filling up with a steady stream of patients. Mostly women, they were immaculately dressed in a myriad of colours and sported a selection of hats that wouldn’t have looked out of place at Ascot. As they settled themselves into their seats, the chatter of Setswan quickly filled the air.

One of the luxuries of WSC is that we have dedicated healthcare assistants provided by the Ministry of Health. Doubling up as translators, the female duo of Marcia and Malebogo were on hand to attend to our every need: directing patients, scheduling appointments, administering data questionnaires and keeping the atmosphere positive and upbeat as Geoff and I worked through our respective lists.

As well as providing treatment to under-served communities, World Spine Care also collects and collates valuable patient data. Meticulously designed, the WSC protocols ensure that high quality primary spine care is delivered to all patients and regular questionnaires measure outcomes and produce valuable statistics. Sessions of care at WSC are therefore not simply about providing treatment but also involve gathering a huge amount of information about patients in its four global locations.

The Batswana, as they’re known, are wonderful people. Ready smiles are accompanied by hearty greetings, meaning that meeting each one on that first morning in Mahalapye was a real delight. All came in clutching their medical life histories in the form of a glorified exercise book into which blood test results, x-ray reports and every other bit of medical paperwork had been stapled. Each book was as unique as their owners; covers were adorned with everything from the Spice Girls to sports cars and memories quickly returned of carefully covering  our precious school books to protect them from splashes, scratches and scrapes..

As I tried quickly get up to speed, aided by WSC Clinic Co-ordinator Geoff Outerbridge, Marcia and Malebogo, I was gripped by the realities of healthcare in Africa. The succession of patients taking anti retroviral drugs reflected the extent of HIV across the continent, while the wearing of red and white loom-like waist bands signified the persistence of traditional belief systems. Some had travelled three hours to get to the clinic for treatment, getting up at 5am to make a long hot journey to and from the clinic in order to receive the spine care on offer.

As for that brief rainy season? Leaving the clinic on my first day, small droplets of rain began to fall. Those small droplets quickly became huge globules and within five minutes the heavens had opened. A terrific thunderstorm followed, instantly creating small rivers, obliterating visibility and slowing traffic to less than walking pace, Dashing to the local store got us soaked and it was not long before the power failed and the we were plunged into paralysing darkness.

Somehow, however, none of this mattered. Who cares if it rains? The local farmers certainly welcomed it and experiencing such terrific downpours is all part of being in Africa. The bronzing of my ample frame can wait until another day.

Already, this is proving an unforgettable experience. As we head to the rural Shoshong village later in the week,I anticipate being further humbled by the resilience and fortitude of those for whom life is so very different from my own. It is a privilege to be here in Botswana.

A New Face at Plot 79

The Mighty Prado

Stepping off the plane at the Sir Seretse Khama International Airport in Gaborone, the wave of intense heat created by the unforgiving African sun welcomed me to Botswana. Punctuated by a stop at OR Tambo International Airport (Africans clearly have a penchant for naming their airports after their great and good), the trip had been relatively uneventful with periodic visits to the Moving Map interrupting the tedium of long haul flight.

Immigration cleared and cases collected, I was greeted in Arrivals by Geoff Outerbridge, the Director of Clinical Development at World Spine Care, who himself had not long arrived from WSC’s other project in Tanzania. Geoff has been instrumental in setting up the project in Botswana and his familiarity with the country was reassuring.

The familiarity was clearly demonstrated when he placed my overpacked suitcase into the back of the WSC’s resident vehicle, a chunky Toyota Prado, and proceeded to wrap a heavy duty chain around it before securing it to the inside of the truck with an enormous padlock. Advice to keep anything of value with me in the front footwell completed the pre-flight security briefing before we roared off into the centre of the city.

With the Toyota’s air conditioning manfully, but unsuccessfully, trying to keep up with the stifling heat of the 37 degree African summer, our first stop was to the Botswana Ministry of Health. Armed with my bundle of certified copies of certificates, letters and photographs, we headed up a darkened flight of stairs to the office of the Registrar. Minutes later, my registration with the Health Professions Council was confirmed and I was officially the holder of an all-important Blue Card. I was officially in.

Back in the Prado, we headed west to the town of Mahalapye. The two hour trip took us out of Gaborone and through the flat Botswanan countryside. Passing small villages of primitive huts, the roadside was littered with vendors, sheltering under multicoloured umbrellas and selling Coca-Cola, fruit, vegetables and whatever else could generate a living.

Making our way westwards, occasionally passing trucks crawling and groaning under the weight of their bizarrely overloaded cargo, the conversation turned to road safety. A large crack in the windscreen of the truck bore witness to an impact with either an animate or inanimate object – nothing to worry about, assured Geoff, who then proceeded to tell me of the dark night when an ancestor of the Prado had demonstrated its full collection of airbags courtesy of a direct impact with a cow that had suddenly appeared on the highway. The obituary of Prado mark one did not make for a happy story.

As we passed a sign announcing that we had just crossed the Tropic of Capricorn, another told us that Mahalapye was close by.  Minutes later, we were in this bustling town and sweeping into what is to be my home for the next four weeks. Passing an area of shrubland, Geoff casually mentioned that I should not really think about taking short cuts across it when walking because of mambas, spitting cobras and adders.

Just as I was coming to terms with the thought of deadly snakes, for good measure Geoff also threw in a couple of other warnings. “We’ve seen a few tarantulas and there are some scorpions around, so do shake your shoes before you put them on.” Yikes!

My home for the next month is Plot 79. Apparent postcodes don’t exist and unless you happen to know where you’re going, you’ll never find anywhere in Botswana. Anyway this comfortable WSC residence is a real home from home. Contrary to my expectations, it’s spacious, the shower is fabulous and there’s WiFi! Who could ask for anything more.

As we sat outside and talked until the sun went down, it struck me where I was and how lucky I was to be here. Five and a half thousand miles from home and embarking on the experience of a lifetime.

The real work starts today. Mahalapye District Hospital is 5 minutes drive away. With a mix of excitement and some trepidation, we’re ready to go!

An Exceptional Case Study

Meatballs. IKEA. Volvo. Names synonymous with Swedish culture. They capture the very essence of safety, efficiency and functionality.

So it is with transportation in the capital. Arriving at Stockholm’s Arlanda airport, one of the best ways to get into the city centre is by train – the Arlanda Express. In just 20 minutes, passengers can be whizzed comfortably and quietly into the very heart of one of Scandinavia’s finest cities.

There is one catch. Catching the Arlanda Express involves descending from Terminal 5 to the station platforms. Somewhere, I’m told, there are elevators. But located right next to the ticket machines, passengers are irresistibly tempted to take advantage of one of a bank of gleaming, stainless steel escalators.

These are, quite possibly, the longest escalators in the world. In one, long, unbroken descent, they extend from Terminal 5 down to the railway platforms. Not only are they unbelievably long, they are remarkably steep.They are definitely not for the vertiginous or faint-hearted.

And so it was that, one dark evening in November 2014, I arrived in Sweden on an early evening flight from London Heathrow. The occasion necessitating my trip was the Fall meeting of the ECU General Council and I was accompanied by my faithful and very tolerant travelling companion, Claire Wilmot. We were both laden with paper-filled folders and files, not to mention all of the other paraphernaila related to this important meeting.

All had been quite uneventful. We had taken off and landed on time. We had been reunited with our luggage and we were set to make our way to Stockholm’s very impressive Radisson Blu hotel. Following advice from a number of sources that the fast rail link was undoubtedly the best way to travel the 37km into the centre of Stockholm, we purchased our tickets. Glancing to our left, bold yellow signs steered us towards those amazing escalators.

Having since looked at the Arlanda Express website, there is an instruction that advises passengers to use the lift instead if you have baggage.

Alas, I had not visited the site. With my Samsonite in one hand, carefully packed to the very maximum allowable weight, I carefully manoeuvred it onto the escalator, pulling my cabin bag behind me. My cabin bag wasn’t quite on the step of the escalator, so confident in the knowledge that my trusty Samsonite was stable and secure I momentarily let go of it to reposition the second bag.

Big mistake. To my horror, 23kg of pink (well, cerise) suitcase took on a mind of its own and toppled. Helpless, I looked on in horror as my oversized case picked up speed and swept down 300 metres of escalator. 40, 50, 60 kph – my laden Samsonite became a deranged missile as it hurtled towards the bottom of the escalator.

Within seconds, the case, now to us just a far-distant pink dot, hit the end of the steel staircase and took off at the same angle as it had descended, and at the same speed. Through the doorway it flew and disappeared from sight. It was followed by a deafening bang from somewhere beyond the aperture. There was an eerie silence, broken only by the steady whirring of the escalator’s unperturbed machinery.

Clutching my remaining piece of luggage as though my life depended on it, Claire and I helplessly descended, transfixed to our respective steps and hardly bearing to imagine what carnage lay beyond the doorway. Claire’s face was white and she had fallen strangely silent.

Finally, I too reached the bottom of the escalator and, with a terrifying sense of foreboding, crept through the doorway. There, wedged into a corner and lying slightly askew, was my case, being examined with some bemusement by an elderly Swedish couple who had witnessed the arrival of the flying projectile. The husband, a white-haired, bespectacled, smartly-dressed man, was holding half of what remained of the case’s handle. Almost apologetically, he passed it to me, nodded his head and made his way silently to the platform.

Despite my certain knowledge that everyone on the platform could hear my heart thumping at 250 beats per minute and now knew that England’s number one village idiot was clearly in Sweden for the weekend, I casually picked up the case and strolled to my designated platform in the same way that someone who has just toppled over on the dance floor jumps up and carries on as if nothing has happened.

I’ve never heard of ‘hit by flying suitcase’ on an autopsy report as a cause of death, but this could have easily been a first. I had been in Sweden (my first ever visit there) for less than an hour. The serenity of this respectable and peace-loving nation had almost instantly been smashed to smithereens by my arrival.

On our return to Arlanda two days later, the site of where the suitcase came to rest was bedecked with yellow cones and protective tape. Clearly marked as the scene of an untoward incident, it was like a grisly scene from CSI.

There are no doubt many morals to this true story. With the exception of one, I shall not list them here. However, I can hear you all asking, what happened to the contents of the suitcase? Answer – absolutely nothing. Every single item remained intact.

The moral: buy a Samsonite – they’re bloody marvellous!

Spinal Universe – More Perpendicular Than Parallel

Welcome to the Spinal Universe! Let’s get one thing straight right at the start. This isn’t going to be one of those cerebral, let’s-contemplate-the-universe sort of blogs. It’s also not going to be stiff science and rigid research. It ought to be, perhaps, but after a quarter of a century of straightening cervicals, disentangling dorsals and loosening lumbars, it’s time to write about other stuff.

I’ve long held off writing a blog. Not just because I didn’t really know what one was, but because so many bloggers I saw were taking themselves a bit too seriously. Don’t get me wrong, I can have a serious side but this blog isn’t going to be the forum for showing any sort of underbelly (believe me, you don’t want to see mine). What I want this blog to provide is a light-hearted look at the world of a chiropractor and the adventures that global travel can bring.

For years I’ve lived in the Cotswolds. It is one of the those most picturesque corners of Britain that features on three-day coach trips, where enthusiastically-snapping American and Japanese tourists fill 50 gigabyte memory cards in under an hour and relentlessly cram themselves into tea rooms and souvenir emporiums.

Stroud is famed for being the home of tennis ball covering, green baize for snooker tables and the Stroudwater Scarlet of the uniforms of English soldiers past. It is also the birthplace of the lawn mower and has within its boundaries the site of the last fatal duel on English soil. Thomas the Tank Engine’s creator was a rector of a church in Stroud and Laurie Lee penned Cider with Rosie overlooking one of the five valleys into the middle of which Stroud proudly sits.

My universe has centred on Stroud, which along with Totnes boasts the honour of being one of the complementary and alternative metropolises of Great Britain. Here, you can spend weekends learning water divining, crystal therapy and past-life analysis. It has a Green mayor (not literally) and is the home of the massively-successful renewable energy company, Ecotricity. Its Conference football team, Forest Green Rovers (owned by Ecotricity’s founder, Dale Vince) banned meat pies in favour of veggie-burgers at half time and has floodlights powered by wind.

So, all in all, being a chiropractor in Stroud was decidedly orthodox. I wore a shirt (not linen) and tie (not hand-woven) and did not chant while I treated. We saw everyone from everywhere and it was this diversity that made me love my job and the people that made it possible. My twenty glorious years in Stroud saw a small, part-time clinic above a dentist grow to a busy multidisciplinary health facility right on the High Street. That doesn’t make me anything special – far from it – but the old maxim, ‘if you look after your patients, they’ll look after you’ certainly worked in this beautiful market town.

The word retirement always conjured up images of tweed, day centres and Eastbourne. Retiring from formal clinical practice was therefore not a straightforward decision. After all, chiropractic was, as I said, my universe and the thought of no longer treating patients in Gloucestershire was strange to say the least.

But every so often, life gifts you opportunities. With a move to Toronto just around the corner and a job that will take me to every corner of the globe. this was one opportunity I could never turn down. The umbilical cord to the Cotswolds will stay firmly attached and will pull me back regularly like a biological bungee, but 2015 will see my universe moving not just parallel, but perpendicular.

So it is that this blog must come about. I’ve never been a diarist, or a journal writer of any kind but when I’m old and can no longer remember where I’ve left my glasses, let alone where I’ve been, perhaps these words will jog my memory.

I hope you enjoy reading it as I shall undoubtedly enjoy writing it.