In Sierra Leone

OK, so I admit it. I should have known better. There is no excuse. Every medical student knows that the smallest thing you should stick in your ear is your elbow. But I was proud. I thought I knew what I was doing. I had done it before and crazed with the flush of success I did it again. I syringed my own ear. Let me explain myself. It first happened back in December. Newly arrived in South Africa the heat dislodged some ear wax and I lost some hearing, common in new arrivals I was told. After several miserable dinners in which I was incapable of joining the conversation I took the bull by the horns, bought a syringe and spent 20 minutes flushing out the ear. Imagine the joy of seeing the numerous bits of waxy debris fill the basin and the relief as the last rubble of draining soapy water brings with it the crystal clear high fidelity hiss-free noises of the world around for the first time in days. So when last week I awoke unable to hear out of said ear unless, bizarrely, pu...

Mathonsi looks up as I walk into the outpatients procedure room. “Sawubona Doctor, what do you want?” “I’m looking for someone to help me see patients.” He turns to the three student nurses dress in white standing by him doing nothing and eyes them thoughtfully. “Which one do you want?” He takes my hand and pulls me closer. He grabs the hand of one of the nurses. “Here, this one. She is a fine woman. She will do you well. I think you will both be very happy.” He places my hand in hers. Everyone bursts out laughing as we walk arm in arm to the consulting cubicle. The morning goes briskly. A man with hypertension, a few probably TBs, a gastroenteritis, diabetic reviews, an acute severe pneumonia. The nurses change at 11 for coffee. My betrothed’s replacement is not so enthralled with my work style. She yawns noisily and pointedly whilst I am examining a patient and as I write the treatment card, disassembles her biro and taking the plastic ink tube, sticks it in her ear. “Are you allergi...

I slowly inject the anaesthetic through the needle I have just placed into the lower part of the woman’s spine. She is sitting on the edge of the operating table leaning forward into the arms of the large operating theatre sister who embraces her, holding her in a slightly hunched position to ease the insertion of the spinal needle. Did I say ease? It still took 10 minutes of sweating and stabbing on my part. I am the third person asked and I confess to succeeding not so much by skill as necessity – everyone else is stuck in Monday morning’s outpatients. The drugs flow easily and I remove the syringe and long spinal needle. We give her a couple of minutes and then the surgeon tells her to lie down. Dr Kekana has been on call all weekend and only had a couple of hours sleep last night. I even inadvertantly overheard her bed calling her. I busy myself at the “head end” of table. I am, for want of a better term, the “anaesthetist”. I was called in at the last minute I forgot my book of...

The phone only rings twice before someone answers. “Lidiko Lodge, can I help you?” answers a heavily Afrikaans-accented lady’s voice. “Hi, yes,” I say. “I’m phoning from Hlabisa Hospital . I want a bed, a telly, a hot bath and a swimming pool. Do you have those?” She bursts out laughing. “Yes, yes we do. When do you want to come?” “Now. 2 nights” “Now? Yes, we can do that. What’s the name?” I give my details and hang up. It is 3pm on Friday . I am standing in a hectic outpatients department and feel an overwhelming need for restaurants and hot water. The resort town of St Lucia is only 75 minutes drive away and is an ideal bolt hole for Hlabisa doctors. My flat has been without hot water for 3 weeks now – the boiler elements keep burning out due to their unexpected and repeated attempts to heat air each time the water runs out. My reluctance to wash in cold water has lead to me smelling pretty bad. I jump in the car at 6pm and head out of the hospita...

There is a satisfying give and I feel the rush of hot brown pus over my gloved finger. I work my finger a little more, widening the hole I have made in the man’s chest. He winces a little but the morphine and diazepam given a few minutes ago have spaced him out somewhat. As I injected them he said to me, “Doctor, what makes this fluid in my chest.” I told him it was the same bug that had caused his TB. “So it is not my food or drink?” "No," I said, "that is very unlikely." He nodded and dozed off. As I enlarge the hole the pus runs faster soaking the sheets. Sister is watching and looks a little put out, but says nothing. She hands me the drain tube and I push it through the hole between his ribs until 15cm or so of tube has passed into his chest cavity to drain the TB-infected fluid that has been sitting around his lung. Sister connects the tube to a bottle on the floor. I start suturing the tube to the man’s skin to prevent it dropping out and he begins to wake...

I know what to expect intellectually. I have heard about it. I have seen it in photographs. I have read about it. Still, it is a quite different matter, the emotional impact of seeing for yourself: a ward with 30 beds holding 45 people, some on the floor, others sharing mattresses; the nurses stepping over a 30-something year old man, demented as a consequence of HIV, as he crawls on the floor smeared with his own excrement; the wizened, emaciated bodies of those with multi-drug resistant TB; the crowd that masses each day at the outpatient department, some waiting 2 or 3 days before they are seen. The hospital main entrance - the sign on the right proclaims the hospital "baby friendly". I am spending my first week shadowing the doctors that are here already. Each morning begins with a 7:30 gathering in the medical director’s office. He is an enthusiastic South African Indian obstetrician. It is impossible not to like him. Each morning he gives a run down of the day’s hurdle...