In Sierra Leone

“So, would you socialise with a white person?” I ask, with the brash innocence learned from my American friends. Sibu looks awkward. “Ahh. That is a very difficult question doctor. It would be difficult to socialise with a white person.” “Why?” “We talk together in class and on the wards. But when you are out of the classroom it is different. We do not even greet each other in the corridors.” “Why?” “Ach doctor. I do not know.” Sibu and I are driving to clinic. He and another medical student are doing a 2 week “family health” placement at Hlabisa Hospital. “But why do you not get on? We get on.” “It is different doctor.” I had assumed that universities and medical schools would be the melting pot of South African culture – where people divided by race and the class of their upbringing would discover each other as they forged their educational common ground. But it seems not. “How many white people are there at your medical school.” He looks thoughtful. “Maybe 15?” There are well over 1...

It's 6pm. Potatoes are boiling, carrots are ready and onions are frying. Then, abruptly, everything goes black. Really black. Not a UK power-cut pseudo-black. Proper black-as-pitch black. I step out into the car port. I can barely see across to the flats opposite. The stars above are just amazing and it is clear that power has been cut to the whole area – not just the hospital compound. Inside the sounds of boiling gradually die away as the hot plates cool. I fumble around for my single candle, cursing. When I arrived there were frequent water shortages and I got into the habit of filling pans and the bath before I went to work. These power cuts are new and I am a poor boy scout – my only torch is a comedy "wind-up" one from Japan that gives light for 25 seconds unless you sustain a rapid, loud and wild winding. Puzzlingly, it also has a built radio. I wander around the residences with my torch (furiously winding) and locate my dinner guests – unless they like partially f...

“So when did the diarrhoea start?” I ask the mother, and then pause. A lone female voice is lifted in song in the outpatients waiting area. Others join in beautiful harmony and syncopation. I look at the nurse who is helping me: “I love the singing – let’s go and see?” “You want to join in?” “May be another time – just watch today.” She leads the way out and there, lined up in front of the doors to the consulting cubicles are the OPD day staff singing songs of praise. The patients who have been sleeping in the department overnight join in. Some may have arrived too late to be seen yesterday. Others had to wait for the morning for transport. The harmonies echo off the high ceiling and reverberate around the room. At the end one of the male nurses, Ziggi, says “Let us pray” or at least I assume that is what he says. A low muttering fills the room as everyone prays under their breath. A couple of the nurses catch my eye and grin. Then, after a brief silence, the line breaks up and it is b...

My phone goes: Maternity unit. My pulse always doubles when maternity call. It is my great area of ignorance (surpassed, some friends would say, only by my ignorance of what goes on before…). Would I please go and assess as lady who is 9cm dilated but the foetal head has not descended. I warily enter the labour ward – I always feel particularly foreign in here. “Thank you for coming doctor. This is the lady.” The midwife hands me a pair of gloves. I am a little more adept at vaginal examinations now but could not be described as slick. I think that is the foetal head, and I think that must be scalp caput (bulging of the child’s scalp as it is pressed against the cervix in delivery), what that is I have no idea at all but I can’t feel a cervix rim. The head feels pretty far down to me but to be honest this is only the second time I have felt a foetal head so I have no idea. I withdraw my hand and try to look thoughtful – like I am an expert with so much knowledge that I am weighing up n...

I am pulled from a contemplative dose by the noise of my mobile phone. I pick it up. “Hello?” “Sawubona doctor. It is Head Office in Pietermaritzburg. It is about your patient who is going to Durban .” “Oh yes?” “Unfortunately we were not able to do it yesterday but I just want to check that you are happy we do it now?” “No problem – thank you very much.” “Sharp! The helicopter will be there soon.” “Fantastic – thanks so much.” I lie back for a few moments and then a thought crosses my mind. I pick up my hospital extension and call the High Care ward. “Sawubona Sister.” “Hello doctor.” “That patient for transfer to Durban …” “Yes doctor?” “Is she still alive?” “Yes doctor.” “Good.” It would have been hard to explain if the helicopter had flown a 600km round trip for the recently deceased. I check the clock: 7:30am. 7 hours glorious sleep. Fantastic! I feel I can take anything the last 24 hours of on call throws at me. I throw ...

I am dragged from my semi-conscious doze by the characteristic triple ring of my flat telephone. I am not really asleep but neither am I awake. The room is bathed in the dull blue glow of early dawn and the tail end of last night’s gale forces itself through the small window pushing the curtains into an awkward embrace with me as I clamber out of bed. I stagger over to the phone. “Hello.” “Hello doctor. How are you?” “I am fine.” “I am fine too. Doctor it is H ward. We have a patient who is gasping.” I pause. They might be dead. They might be sick. It is impossible to tell over the phone. “I am coming.” I hop around the room, pulling off boxers, pulling on socks, pants, trousers and shirts. I walk briskly to the ward. Two nurses are standing over a patient. One commendably bagging and masking and the other doing chest compressions. I look at the notes. A young man with HIV and widespread TB. A quick examination reveals that he is not breathing and has no heart beat. “We gave adrenaline...

“See you, Ed. Good luck!” shouts Olsetin as he heads out of OPD. The sinking feeling in my belly drops at little lower. It is Friday. 5pm. Everyone is leaving. Except me. I am starting my weekend on call. I started work at 7:30 this morning. I will finish at 5pm on Monday. As I look at the receding back of my colleague heading off on a Weekend Of Fun (how I hate them all right now) it seems like an eternity. That I have just finished 7 weeks of my Weekends Of Fun (a considerably longer period than in any UK rota) counts for nothing. I turn back to the OPD cubicles. Give the colleagues credit. They have worked solidly and there are only 6 or 7 people still to be seen. I get going and see 2 chronic coughs (“query TB”), an elderly gent with arthritis, a young child with a chest infection, and a 2 day old baby whose mother was sent to the hospital by her local clinic because they thought it was “too big” (birth weight 4.3kg). Sure it looks a big baby but it takes some conversing to est...

“Where is Stefan?” someone asks. We look around the table – it is 7:45am, our morning meeting; the hour in which we exchange news, frustrations and attempt catharsis before leaping up to carpe diem. Stefan – the longest serving member of Hlabisa’s medical staff at a grand total of 11 months – is not there. “He won’t be in today,” says the medical manager, “he’s feeling a bit sickish.” We all murmur our commiserations. I secretly feel a little envious. I wonder whether what he has got is catching – I quite fancy a day in bed. A few hours of rigors would be a price worth paying. The following morning Stefan is still sick. Apparently he had swinging fevers all night. Someone mutters “malaria”. I grab some blood tubes and needles and wander over to his flat. It is locked and the curtains are drawn. I call his mobile. There is no answer. I imagine him lying in his bed, shivering and delirious. How could his girlfriend have left him in such a state? Has she no heart? My mobil...

I breeze on to High Care ward for my morning ward round. Well, I say High Care. What I mean is it is the ward in the hospital where patients have their blood pressure measured and urine output charted. More a sort of Care Care ward. The nurses here went to nursing school and ask questions. Perhaps most strikingly of all when they call you to tell you a patients “is gasping, Doctor” it generally means they are still alive but very sick. Nomfundo was called urgently to a ward last week for a “gasping patient” only to discover they were cold and had clearly been dead for a few hours. The ward is strangely quiet today. Sister is hunched over the desk, her arms wrapped around her head. The other nurses stand nervously round her muttering. I go to the desk. Sister’s shoulders are shaking and she is clearly crying. I ask what is wrong. She does not answer. I sit next to her and ask again. Slowly it comes out. She was placing an IV line into a baby with severe malnutrition and dehydratio...

It has been a fairly mellow day and there can be only one reason. I haven’t been working at the hospital. I have been visiting one of our outlying clinics at the settlement of KwaMsane. It is one of our busiest – even more so this week of all weeks: National Polio Vaccination week. Just as I was about to leave the hospital site this morning the Transport department shoved 2 nurses, 3 cool boxes of vaccine, numerous needles, syringes and sharp bins into the Department of Health vehicle I was using. It was complete mayhem at the clinic: hordes of children for vaccinations, hordes attending the anti-retroviral clinics and about 20 for me. I drive back to the hospital through the game park at d usk . The sun is blinding red on the horizon in front of me. The animals are out in force this evening. A herd of zebra grazes on the roadside to my left. A few minutes later a herd of buffalo on the right. Then I spot a small group of cars stopped in the road. I round the corner and there, bu...

Nicky twitches the curtain of the cubicle in which I am seeing patients. “Ed, can you come and have a quick look at this knee?” I excuse myself from the patient I am seeing (another “query TB”) and go to Nicky’s cubicle next door. On the couch lies a man, his left leg slightly bent, the other extended. The entire back of his knee has been ripped open. I can see tendons and layers of muscle. When I ask him to move the leg I can see them move over each other. “He was hunting in the Game Park ,” Nicky tells me, “and a warthog attacked him from behind!” I admire how gross it looks but cannot think why Nicky wanted me to look. I am not an orthopaedic surgeon. I ask why. “No reason. Just looks gross,” she smiles. Later that afternoon I am asked to see a man who has been brought in unconscious. I walk into the cubicle. The stench hits me immediately, almost to the point of making me gag. I don’t do smells. The man is indeed unconscious and his left arm is swollen and cover...