Mental stealth act

I am not sure what to do. The man is standing, shoulders hunched and eyeing me with an expression that can only be described as “baleful” – one of those terms you read in books as a kid and of which you develop a visceral understanding but could never explain in words to someone else. Abruptly he hits out at me – I jump back but not before his fist has closed over the pen with which I was about to write up his anti-psychotic.

When he arrived with his wife a couple of hours ago he was quiet and settled. He was describing three weeks of delusions and hallucinations, particularly severe at night. He was hearing drums and his ancestors were apparently speaking to him. I have come back from theatre to find him aggressive and agitated.

We are now at something of an impasse. 4 security guards stand behind him – but they are not trained for this sort of situation. I am loathe to approach him with my needle until he is restrained. He hits out at me whenever I approach. Nomfundo walks past and eyes it up. “Have you got a death wish?” she says, giggles and walks away. Thanks.

Sipho, one of our younger go-getting OPD nurses walks past. He eyes up the situation. “Need some help?” he says, and without a break in his pace walks into the cubicle, throws his arm around the man’s neck and in a flash has him pinned to the floor. We all stand, momentarily dumbfounded. “Well come on then!” he calls from the ground. I jab my syringe into the guys butt. Sipho stands up and then helps up the man who appears as stunned as we are by his abrupt change in circumstance.

“Boy, I am glad you chose to use your powers for good.” I tell Sipho. He looks rather pleased with himself.

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Abscess

The phone rings. I am lying on the sofa in the dark squinting at the laptop screen: someone has lent me series 1 of Spooks. I struggle up and bump across the room to the phone. “Hello?” “Moran!?” “Yebo.” “How are you?” “I am fine.” “I am fine too.” And then those four dreaded words. “Please hold for maternity.” The line goes dead for a second and then a midwife comes on the line. “Moran?” “Yes.” “How are you?” “I am fine. “I am fine too. I have a 22 year old primip. She is in labour but I cannot do a PV. She has a Bartholin’s abscess.” I ask a few intelligent questions and then, pausing only check what exactly a Bartholin’s abscess is (an abscess of the Bartholin’s gland apparently) I head for maternity. On arriving I am taken to the woman concerned and, yes, sure enough there is a large abscess in the position that I imagine a Bartholin’s gland might sit if I knew exactly what it was. “I cannot do a PV to check the cervix because it is too painful.” The abscess blocks the way. “Right.

10 years on

The door flies open. Lele peers in. "You must come out here and see. They are doing a play!" I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without. "What is going on?" I ask. "It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something." The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me. "She is saying that this is a very important day. 10 years ago people were dying. And 10

Ceza Hospital

I am woken with a jolt. The 4-wheel drive has left the tarmac and we are on dirt road. I look ahead into the hills – the road wends its way high up into the distance. “How far?” I ask Amos, our driver. “About 40km.” I settle back and watch as the settlements become less and less pseudo-bungalows and more and more mud rondavels. The road to Ceza It was about a month ago that our medical manager first mentioned that we had been asked to help out at Ceza Hospital – a remote rural hospital about 2 hours away. Its medical staff (only 8 at the best of times) had been steadily departing and only one remained. He was leaving at the end of May and they were desperate. Desperate enough to accept help from us. As I said – a month ago – but it was only last Thursday that I found myself agreeing to go. Two of the others had been that week. I phoned them to ask what it was like. “There are no words to describe it,” said Nomfundo, “speak to Dr Kekana.” Dr Kekana comes on the line and after humming an

In Sierra Leone

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