In Sierra Leone

The nurse and I study the baby hopelessly. Just 5 months old she was admitted last week with severe diarrhoea and breathlessness and has been going steadily down hill. She is almost certainly HIV positive and probably has a severe pneumonia related to that. Over the last couple days we have been adding various drugs for the purpose of treating various conditions she probably doesn’t have but there is nothing to lose. “I don’t think there is anything else we can do,” I say to the nurse. The child is semi-conscious with a heart rate of over 200 and a respiratory rate of 70. She will soon exhaust herself. I could put in a breathing tube but there are no paediatric ITU beds available at our referral hospital. I sit by the phone and work through the Durban hospitals. “Any paediatric ITU beds?” and it is the same story. None. Sometimes because they are full, sometimes because the beds are closed due to lack of staff. They suggest things I could try (but I have done them already), and if “she...

The Hlabisa Docs Christmas dinner Merry Christmas! Hope you had a wonderful day. We had the weirdest (for a northern hemisphere junkie) Christmas: 35 degrees, in the game park. Saw elephant, cheetah, rhino and buffalo - and all before breakfast. Not a single carol. Thanks for dropping by and reading over the last 10 months. Only 6 weeks to go. Do you have the stamina to make it to the end? Do I? Stay tuned.

A couple of photos for those who like to just look at the pictures: Anna with the mobile clinic crew on their way to some tree too far from the usual clinic buildings. Marlene, the nurse driving arrived at Hlabisa in her 20's when it was still a mission hospital and has lived here ever since. The Game Park wilderness burning towards the end of the dry winter. The ominous crackling could be heard from the road and the smoke spread for miles.

The sun is low in the sky by the time I turn off the highway and join the road to Hlabisa. All around me the hills are basking in rich yellow light, in front of me the road drops in and out of sight as it follows their undulations to the horizon. Along the grass verge people are slowly making their way home, stray dogs bark lethargically at each other and minibus taxis hurtle past me, defying death for at least one more day. It is rather like one might imagine the closing scene of Mr Benn, had it been made in Africa. It is dark as I pass out of the game park and into Hlabisa itself. A hot wind blows the occasional coke can skittering across the town’s wide, and only, street. There is a curious multi-coloured glow up ahead and as I pass the shops it resolves into a small illuminated sign strung across the road: “Happy Christmas!” And behind it another, “Welcome to Hlabis” – the “a” is broken. I grin – there are also illuminations on the lamp-posts – a multicoloured candle, Father Christ...

The queue is moving slowly and I look out of the gangway window at the ground crew as they scurry around the plane. I spot my bag being loaded into the hold – a cause of some reassurance. Finally I enter the plane and flash my pass to the stewardess. I am back in South Africa and have been killing a few hours at Jo'burg airport before now, at last, catching the short flight to Durban. My heart sinks as I approach my place – the seat next to me is occupied by a classic African Mama – not much of my seat remains. I greet her with a cheery hello. She grins and we strike up a conversation. "What are you doing here?" she asks when she finds out I am British. "I live in Hlabisa – a small village in KZN – I work there." "At a hospital?" "Yes." "Ah! Thank you. Thank you. Thank you for leaving your pound for our Rand! The Lord will bless you for that." I smile at her. "Well, it isn't that bad. It is a bit of an adventure." ...

I am back in SA. Apologies for speaking to so few people - it was a hectic few days. In response to feedback I will attempt to increase the photographic content - apparently many people just look at the pictures. And to think of the time I spent carefully crafting the words. For starters allow me to inflict just two wedding photos upon you. Mother, Sister bridesmaid and Sister Bride Aidan and Sally

I am in the UK for my sis's wedding for a week. From 31 to 3 degrees in 10 hrs 50 mins. Sala kahle.

The phone in outpatients has been ringing stridently for several minutes. Everyone walks past, oblivious, but I finally crack. “Hello?” “Hi? Who is that?” says a unexpectedly Englishly accented voice. “It’s Ed.” “Hi – it’s Steve.” Steve is one of our elective students. “We’ve run into a bit of a problem.” “What?” “Well, I went with Emma to clinic and we were sort of stopped by the police. And I think we have been arrested.” “What?!” “And Emma is quite upset. I was wondering whether you could send someone down to get us?” “Where are you?” “Mtubatuba police station.” Hours later we hear the whole story from Emma herself. “We were driving to the next clinic when the police pull me over. And they looked at the Hospital Transport Itinerary document and see that Steve is not on it. ‘Who is he?’ they asked. ‘One of our students.’ ‘Why is he not on the itinerary?’ ‘I didn’t know he had to be. I can put him on now.’ ‘No you can’t – that is illegal. You are using this car illegally. You cannot u...

“That girl is in again, Doctor Moran,” says the nurse. There is resignation in her voice. I look to where she is pointing and recognise the patient immediately. She has been in four times over the last 4 weeks. “What is it this time?” “Cough.” Barely out of her teens she is 6 months pregnant and like nearly 50% of such patients, HIV positive. She started anti-retroviral drugs 6 weeks ago but has been failing to take them. And she keeps coming back to hospital: diarrhoea, breathlessness, cough – an array of trivial complaints which we have never actually seen first hand and improve within 48 hours of admission. “Why do you not take your drugs?” I asked on that first admission. She looked at the floor. “If you do not take them there is a good chance your baby will get HIV and become very sick and die.” She muttered something and the nurse gave an exasperated sigh before turning to me and saying, “She says she does not care – she wants the baby to die.” So I have to admit to some relief w...

A recent batch of students watched us for a week and then created these 10 rules governing our behaviour, based upon their observations. 10) Bring your own TB mask. 9) Even doctors can’t read doctor’s hand writing. 8) Almost anything can be diagnosed by ultrasound. 7) Rubber boots are not just useful on rainy days. 6) Triage is an unappreciated art form. 5) Gloves are required when handling clinic cards. 4) It’s probably TB – and if it’s not, treat them for it anyway. 3) Abbreviations are not an international language – especially the one you just made up. 2) A good translator is as hard to find as a sharps container. 1) Tea time is at 11am – unless you just managed to obtain an outside line to Durban.

The phone rings. I am lying on the sofa in the dark squinting at the laptop screen: someone has lent me series 1 of Spooks. I struggle up and bump across the room to the phone. “Hello?” “Moran!?” “Yebo.” “How are you?” “I am fine.” “I am fine too.” And then those four dreaded words. “Please hold for maternity.” The line goes dead for a second and then a midwife comes on the line. “Moran?” “Yes.” “How are you?” “I am fine. “I am fine too. I have a 22 year old primip. She is in labour but I cannot do a PV. She has a Bartholin’s abscess.” I ask a few intelligent questions and then, pausing only check what exactly a Bartholin’s abscess is (an abscess of the Bartholin’s gland apparently) I head for maternity. On arriving I am taken to the woman concerned and, yes, sure enough there is a large abscess in the position that I imagine a Bartholin’s gland might sit if I knew exactly what it was. “I cannot do a PV to check the cervix because it is too painful.” The abscess blocks the way. “Right....