In Sierra Leone

Got a few hours on broadband - so let me give you a couple of short videos from the strike in June.

Perhaps it is rubbing off on me, or maybe it is the cabin fever – living in a closed community with few distractions – but suddenly birds seem quite interesting. For example, even I stood for hours, well OK, not hours but several minutes.. 5 at least, watching these Weaver birds. Stripping fibre vigorously from the palm leaves they then flew across the garden to the tree in which they were building their nest colony and got weaving. Amazing.

Olstein and our guide, Amy. The thing about Olstein is that he is not only a twitcher. He is a Twitcher . His tally of individual bird species seen in his 6 months in South Africa stands at over 250. He can tell you not only what he saw but where exactly in South Africa he saw it. So when he hands me a pair of binoculars as we head out for a guided walk on the Lebombo hills of Northern KwaZulu it is not a casual gesture. It is akin to being handed a Bible by the earnest friend who invites you to church. In fact, I realise, walking with Olstein visits upon me the exact sensation I spent my earnest years visiting upon others whilst in the University Christian Union. It is like visiting church and standing next to a fervent Charismatic when you yourself are “just interested”. “Look! Over there!” he exclaims. “Where?” I look in the direction of his pointed finger. “There – it is a blurdy blurdy blur [substitute some South African bird] !” “Really?” I lift my binoculars to my eyes and sin...

Sister turns to me. “Doctor. I have an idea. A way to stop HIV-AIDS.” “Really?” “Yes. The problem is the men. It is the men that give us the HIV.” “Yes?” “So what the government must do is kill all the men. Kill all the men!” She slices her arm vigorously through the air in a chopping kind of gesture. “The less men, the less the HIV.” “It is a good idea,” I reply. “You should write to the Provincial Government.” “Of course, after a while when the country had no children there would be problem. But we women could have a few good years before that. I will write to the President!” She storms off muttering to herself.

As I finish my ward round on High Care one of the nurses pulls me to one side. “Doctor, can I see you?” “Certainly.” She drags me into the small nurses office and begins describing her symptoms. I try to listen earnestly but find it difficult to concentrate. In the background there is what can only be described as the sound of gentle gobbling. I look around. It seems to be coming from behind the nurse. I try to look over her shoulder. She moves to block my view and carries on describing her symptoms. I nod seriously a couple of times and edge to one side. She moves again, but not before I succeed in localising the sound to a plastic carrier bag on the floor. I bend down to look and tweak the bag open. There, looking up at me, is a small white chicken. Unlike most chickens I have encountered in carrier bags it is not skinned, cling film wrapped and indeed, dismembered. It clucks at me, as if to emphasise the fact and then shits industriously. The nurse glances at me, l...

We are struggling on the ward. We have discharged 3 patients so far but as fast as the beds are vacated new occupants take up residence. They have spent the night on the floor in OPD, and OPD wants them out. I glance at the benches lining the wall of the ward – another 4 people sit there clutching the yellow admission papers, awaiting a bed. There are already another four people using mattresses on the floor. Sister is getting stressed, and my colleague and I are also getting a little twitchy. We turn to the next patient. He is virtually moribund: unresponsive, eyes rolled up into his head, breathes slow and gasping. “Ah!” says Emma, “Brilliant - we will soon have another bed!” She slaps her hand over her mouth, looking shocked at her own words. Sister hoots with laughter and points to another patient across the ward. “Yebo! And there is another over there!” We follow her finger and turn just in time to hear the death rattle of the other imminent corpse. This week at least ad...

As I cut through his skin the young man turns to look at me. He is lying on one of the couches in Resus, panting and groaning in pain, his face obscured from my view by his oxygen mask. He reaches out his hand to touch me and then rests his arm across my shoulders in a clumsy embrace. Just one hour ago he watched as his girlfriend was killed by the same gunman who shot him through the chest. I work rapidly. The bullet entered just right of his sternum and exited in the right loin – ripping through the lung and liver on its way. From my quick assessment when I was called it is clear his chest cavity is filling with blood impairing both his breathing, and as the heart is compressed by the pressure, his circulation. As I enter the chest cavity there is a gush of blood over my hand. I insert the tube and connect it to the drain bottle. The blood pours out – 200mL, 300, 500. A litre. “Someone run to the lab and get all the blood they have,” I bark. “Someone else, get some fluid running in t...

The phone rings and I open my eyes blearily, attempting to focus on the clock: 3am. I stagger over and answer. It is Andrew – there is a Caesarian. I pull on my shorts and step out of the flat into the cold night air. The sky is clear and the stars are burning bright and splendid, the Southern Cross hanging directly over the hospital. I walk down the dark road to theatre, the wind blowing cool and dry across me, whistling slightly in the palm leaves above. The patient has just arrived. “She had grade 3 meconium in the liquor,” Andrew explains. That is a sign of significant foetal distress and in our setting an indication for Caesarian in most cases. I stick in the spinal anaesthetic – I am having a good run at the moment, it takes only one stab. I turned one poor lady two weeks ago into a veritable pin cushion – I could not feel any of her spinal bones through her ample skin. This lady is significantly thinner. “Do you want to cut?” asks Andrew. I have done four Caesars under close s...

The man walks onto the ward and makes a beeline for me. He talking loudly and expressively in Zulu, his arms waving dramatically to emphasise whatever point he is making. He is a little unkempt but not obviously drunk or high. He sees I do not understand and switches to Afrikaans. “I don’t speak Afrikaans. Try English.” He obliges instantly. “Doctor, I am here for my medication. I need my medication. Can you write me for my medication? I have run out and I need more.” “You must go to outpatients sir. They will help you with you tablets.” “I need haloperidol, chlorpromazine and epilim. You can write me up for them can’t you?” They are antiepileptic and anti-psychotic medications. “Go to outpatients sir. They will sort you out.” “Ah yes. Thank you doctor.” He pauses and watches me. I turn back to the patient I am seeing. He begins talking loudly to the nurse. “Could you keep your voice down sir? It is hard to hear the patients!” “Of course! Of course! It is very irritating isn’t doctor w...

I wind down the window and stretch my bare arm out into the onrushing wind. The heat and humidity are testament to the arrival of Spring and I open my hand to catch the breeze as it hurtles by at 120 kilometres per hour. I reach the crest of the hill – the highest point of the highway as it traverses the game park – and the landscape rolls away into the haze on all sides. Vervet monkeys leap out of the way as I head down again. I turn up my (you might say cheesey) African themed music. As I round the corner the car in front slams on his brakes, as I do in turn. An elephant is crossing the road. We both watch from our vehicles. As I pass the driver he turns to me and gives a broad smile and gestures animatedly to the elephant beside him. I smile and wave back and then pull away. You gotta love this country.

Sister on C ward I am half way through my round on C ward, the female medical ward. Out of the corner of my eye I become aware of two well dressed women standing a couple of metres away and radiating that powerful aura that so effectively says “I am waiting for you” to your subconscious. I have never learnt how to ignore it and within a few seconds find myself completely incapable of concentrating on the task in hand. I turn to them. “Can I help you?” They step forward, clutching the familiar bulk of the death certification papers. “Yes please doctor. Could you sign these?” says the first in perfect English. I take the papers. There are several of these most days – my record is 7 deaths (20% of the ward but that was over a weekend and shouldn't be counted). They must be signed by a doctor to confirm the cause of death before the body leaves for the undertaker. Half the cases we have no idea what actually killed the patient and write “Pneumonia, ?HIV”. A GP in a town 50km away did a...

It is dusk as we pull in through the gates of the Ghost Mountain Inn in Mkhuze. It nestles at the foot of the Lebombo Hills in KZN and is one of our more luxury getaways – we are using it as a stop over on the way back from the conference. My mind turns to our first visit here a couple of months ago. We were in the bar in the evening and got chatting to a pleasant Scandinavian couple. He was Swedish, she was Norwegian I think – both incredibly snappy dressers. Since we had a Swede and Norwegian in our gang conversation flowed fast and multi-lingually. “What are you doing here?” I asked them. “I am setting up a football academy,” he replied. “Here?!” Mkhuze is not exactly the centre of the world. It is a small town in the middle of a large rural area with few services and little employment. He was, I imagined, some kind of social-conscience development type, using his football skills as a means of community development and empowerment. “Yes, but we live in Durban.”. The girlfriend broke...