In Sierra Leone

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Survivors

The hills of the Freetown peninsula fade behind us into the morning haze. Before us the road snakes through a panoramic landscape of palm trees and villages. As we pass through one village – marked only by an increase in dwellings and people by the side of the road – our driver slows, and shouts a greeting to a passerby. “This is my village,” he says as we pull away. An hour later we slow and stop at an elderly single lane bridge spanning a wide slow river. Congregating traders gravitate towards the vehicle. “Chips?” says one, 30 plastic bags of fried plantain slices upon a platter balanced on her head. “Apple, banana?” says another. “Water?” “Popcorn?” We get bananas. Another hour and we arrive at our destination, a small hospital where we are to meet survivors of ebola. This part of the country was devastated by the virus. I am told of entire families who died and houses that still stand empty. But the staff we meet are inspiring. Doctors who have cho

Commuter

The car is stationary in the busy morning traffic, the queue snaking down the hill in front of us and up the slope beyond. The windows are open, the humid morning breeze carrying upon it the shouts of the street traders, and the never-ending hoots of Freetown’s bikes, tuk-tuks and cars. “Tissue, tissue, tissue!” cries a man carrying a metre-high stack of tissue boxes as he weaves between the queues. The sky above us is hazy – the sun a dull red disc just rising into a white sky above the city hills. It is harmattan, they tell me: Saharan dust caught on the trade winds and carried high across West African skies from November to March. “You think this is hot? Wait until after harmattan!” Weaving inbetween the lines of traffic, a fleet of wheelchairs ascends the hill towards us. People affected by polio, I wonder. Several have a weak or wasted arm or leg. Their family push the chairs from car to car and gaze impassively at the occupants. The car begins moving again an

The plane comes to a stop and everyone stands. Between the jumble of shoulders, heads and arms reaching for overhead lockers I catch a glimpse through the window – outside, flood lit and stark in the darkness, a building bears the uneven label “Lungi International Airport”. We all move slowly to the exit, the conversation a babble of Krio, European and Chinese languages. At the plane door, a blast of heat and humidity as the West African night assaults us and my shirt is wet by the time I reach the bus that takes us the fifty metres to the airport building. I strike up conversation with the person next to me – a European doctor returning from holiday. She was present throughout the ebola epidemic and talks passionately of the country. We walk past an unmanned health screening station – a piece of post-ebola heritage – for a quick passport check. Beyond, behind a dirty glass screen, men shout out offerings of currency exchange. I hand over £100 and in return receive several hun

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

The next patient is in her mid-20s. She sits gracefully on the edge of the chair and looks at me. "How can I help you today?" I ask. "It is this," she says, hands clasping her belly, "I look like I am 4 months pregnant!" "And are you? Have you checked?" "Oooh! Yes. MANY times - and always negative. I have been talking to my friends and they say it could be the HIV treatment." "Yes - that is true. You are on one of the older drugs, the one called Stavudine. That can make fat appear in different places on your body, and sometimes disappear from other places. Some people find that it makes their face thin." I suck my cheeks in briefly. She laughs. "I used to have a VERY round face, now it is thin!" "I suggest that we change that drug then. We have more drugs available in the public clinics than we did when you started and the one I will use has less side effects. Is that what you would like?" She nods enthusia

Otherwordly isolation

I lean across the reception desk and catch the attendant’s eye. “Sawubona,” I say, dusting off my rusty Zulu. I see you. “Sawubona, ninjani?” she replies. I see you, are you well? “Ngiyapela.” I’m fine. She grins at me. “You must be a doctor.” “I am! How did you know?” “It is only the doctors around here who use Zulu. Even if it is only the greetings.” She arches an eyebrow. “I used to work here, at Hlabisa hospital up the road. I have a few other Zulu words, you know like ‘Does it hurt?’ and ‘Take a deep breath’.” She laughs. And then launches into an excellent impression of an elderly Zulu lady rattling off a series of complaints, waddling across the reception area clutching her back in mock agony. She gets it exactly right. I have come up to KwaZulu-Natal for a few days. Tonight I am staying in the Hluhluwhe-iMfolozi game park, 20 minutes or so from where I used to work. Awarded my entry ticket, I drive into the park. The sun is low in the sky, the kills bathed in amber light. I ta