In Sierra Leone

The relative solitude of the resuscitation bay is abruptly invaded as the doors from the waiting area slam open. A trolley bursts in, surrounded by people dressed in the white and red garb of the Emergency Medical Rescue Service, KwaZulu-Natals ambulance organization. They look a little bewildered. One of them is squeezing a breathing bag attached to the tube that issues from the mouth of the body that lies on the trolley. The door opens again and a big man in an orange jump suit strides in. His label identifies him as a member of AMS, the Air Mercy Service – the charity that runs the air ambulance and other high tech services. He catches my eye. “Hi doctor. So this lady came to clinic with 3 weeks of breathlessness and I happened to be visiting the clinic when the ambulance came for her. I thought she looked bad so I followed them.” He grins. “Just as well because she stopped breathing half way through the game park. I tubed her and gave her adrenaline.” He looks around. “Where ar...

It is the end of the day. The weather has turned – it has been raining and we have all worn jumpers for the first time this year. I amble back through the residences. The nursing Matron is standing in the doorway of her flat chatting to a couple of teenage blokes – perhaps family members. She calls me and waves. I wander over. “Sawubona. Gunjani?” I say in my broken Zulu ("Hello, how are you?"). She smiles benignly. “Siyapela!” she replies (“We are fine.”) “Dr Moran, you are learning Zulu?!” I confess that I try a couple of words a day but my progress is poor. “But,” I say with some pride, “I worked out how to ask whether the babies were drinking well: ‘Uyaphuza kahle na?” “Hauw! Good! But you need to ask whether they are sucking well.” She rattles off a phrase and illustrates it by grasping her own breast through her clothes and waving it to illustrate her point. The family members grin at me as I repeat the phrase a couple of times. It does not stick in my ...

The Hlabisa Hospital Heliemetry I am in outpatients. Abruptly a roaring, vibrating sound fills the air and thunders over the building. “What was that?” I ask Mr Zulu, the nurse in charge of OPD. He does not know. I wander outside but can see nothing to explain it. Shrugging mentally I return to my consulting cubicle. Half an hour later I am walking back to my flat for lunch. The road to the residences is lined by a high wall. The wall is new, built in the last couple of years. I have never really thought about what lies behind it. Today however rising high above the wall are the blades of a helicopter rotor. I walk around the corner and find an open gate. A strange and incongruous site greets me. The helicopter dominates the grassed area the wall contains. It is new, painted in the classic colours of the emergency medical rescue services across the world. And it sits in the middle of a grave yard. The wall has clearly been built to hide the hospital cemetery, a facility whi...

It is my last day on T ward. The doctor I have been covering for these last weeks is back from the UK on Monday and I will be moving to outpatients. I am working my way around the male half of the ward with Sister Hlabisa. Surnames are often taken from the location and there are a lot of Sister Hlabisas. I call her Sister Amen on account of her involuntary exclamations of praise. I examine the chest X-ray of a 20-something man admitted with pus in his chest as a result of TB. I put in a drain last week and after the initial 2 litres drained only a few millilitres drain each day now. The X-ray confirms that the pus is gone and the lung fully re-inflated. “Very good,” I tell Sister, “this drain can come out today.” “Amen!” proclaims Sister. She explains to the patient who grins, gives me 2 thumbs up saying “Sharp sharp!” which apparently means “Cool”. The next patient has completed 2 months of inpatient TB therapy which required injections – he lived too far from his loca...

I am standing at the mother’s head in the theatre. I have given the spinal anaesthetic and the surgeon is cracking on with the Caesarian. My mind is wandering a little – it is late in the evening and I have yet eaten. The mother needed the Caesarian after it became clear the baby was becoming distressed with a high heart rate and meconium appearing in the mother’s liquor. I am broken out of my reverie by the midwife. Like me she is dressed in surgical scrubs with a blue theatre cap and mask. “Dr, will you help me with the baby?” She is clutching a sterile sheet, ready to take the baby from the surgeon when the time comes. I throw off my daze and nip over to the Infant “Resuscitator”, a small mattress with a heater, oxygen, suction and set of airway tubes. I have never seen one this close before. I nervously open drawers, pretending to check for things which I think should be there. I have, of course, no idea what. I spot a laminated A4 sheet stuck to the wall, obviously place...