In Sierra Leone

James eyes the huts of mud and wood that line the landscape through which we are driving. “I hadn’t realised that it would be so great – this difference between rich and poor.” I glance at the village and then at him, guility. It is not that I do not notice poverty anymore but it no longer seems strange. And, shamefully, it no longer bothers me that South Africa’s great tourist destinations are almost without exception positioned in rural areas of equally great deprivation. The first time I came here to the mountains I could not understand how it was possible to go on a hiking holiday in a park in which the chalets had satellite television but the people just outside walked daily to the communal pump for their water. Now however I feel self-righteous indignation because the camp is experiencing a 1 hour power cut – and I want tea now . James is however just off the plane. He is seeing South Africa for the first time – an Africa “virgin”. And he is my younger brother. I am giving him a ...

I stick my head out of my consulting room into the corridor. Chair line the walls and they are occupied by Desmond Tutu’s rainbow people: Indian, Zulu, Chinese, White – all are represented. “Who’s next?” A little old lady who look, for all the world, like my granny totters to her feet and, stick in hand, creaks slowly into my room. I show her to a chair and pick up her notes. I flick through them pretending to read – but the reality is I am stunned. My year working in South Africa has so far been a year of rural Africa. The catchment area of our hospital included a town with a small white community but we never saw them. Almost without exception they would have had private health cover and I suspect many would have chosen death over Hlabisa Hospital if it came down to it. Pietermartizburg is however a small city and in the apartheid era had three hospitals: a black hospital (in the township of Edendale) and white hospital (Grey’s) and one for all the rest (Northdale). Grey’s was opened...

“Why don’t you sit in the cockpit?” asks Dr Dawood. I look at her sharply. “Can I?” “Sure. Do you want to?” “Do I ever!” I respond, sounding ever so slightly like an American teenager. “Excuse me. Stefan,” she shouts at the pilot, “can he come up front with you?” Stefan nods his agreement and I clamber over the seats to the co-pilot chair. Stefan is doing his checks, meticulously noting things down in a book as he points at instruments and switches with his pen, his lips moving silently in his pre-flight safety mantra. I look out at the tarmac of Pietermaritzburg airstrip. The haze and mist that covered us when we arrived early this morning has lifted and it is safe to fly. Our destination is Dundee. That is Dundee, KwaZulu-Natal – a small farming and tourist town. I am joining Dr Dawood, the infectious disease consultant at Grey’s Hospital in Maritzburg for her “outreach visit” – a trip she makes monthly to support and teach at two rural hospitals. I met her at a conference and she ag...

I stand in the middle of the room and look. This place has been my home for the last year and in 4 hours I have stripped it of me, and packed myself into a suitcase and 3 cardboard boxes. A last minute check in the bathroom – site of many untaken baths (for much of this month turning the tap produces a blast of air, silence and a stony absence of water. The borehole has run dry). Nothing. The cupboards – oops. My Drakensberg mountain maps and compass. The bedroom – site of many sleepless disturbed nights (“Doctor please hold for maternity”) – empty and ready for the next doctor. I walk slowly out of the flat, locking the door behind me. I drop the key with Magnus next door. His new adopted daughter, abandoned on the paediatric ward 8 months ago is clinging to his neck. We embrace, awkwardly as blokes do, particularly given the mechanics of avoiding a small child. I was not very effective at work today – my heart was not in it. Feeling a little wistful, little sad. My ward rounds mostly...

I am leaning over a patient listening to their chest when I become aware of a presence. I straighten up. Sister Nene is standing behind me. She is looking even more serious than normal. “Doctor. I saw the rota for the high care doctor for next month today.” “Mmm?” I reply in as casual manner as possible. “And I looked up, and I looked down but I did not see you name.” “No.” “And then I looked at the other wards and I did not see your name anywhere.” “No.” I look at my feet guiltily. “Where are you going?” I cannot look her in the eye. “I am leaving Sister Nene.” She says nothing but shakes her head sorrowfully. I feel like I have disappointed some aunt. A severe aunt of whom I live in fear but nurture a secret craving for her approval. She studies me silently. “I was allowed out of my job in the UK for 1 year but I must return.” She says nothing. “I might come back one day.” Sister Perumal joins her. “Ahh – they all say that. Don’t t...

The normally sleepy tourist town of St. Lucia has been transformed. We drive in, cautiously avoiding the scores of intoxicated, denim clad, beer bellied, grey haired, helmet-clutching Afrikaaners. A sign strung across the street proclaims the annual Harley Davidson gathering. We brake for a string of low slung bikes, each emitting unnecessarily throaty roars. On the way back from the beach we stop for a drink in a hotel bar. The bar itself is serving as a prop for a number of bikers. I order my coke precipitating howls of disapproval – I am not sure whether it is my uncompromisingly posh accent, or the coke. I smile sheepishly – “I’m driving” I say foolishly. They look at me blankly – too late I realise my words would be something of a non-sequitur to this gang. My mate orders a beer and stays under the radar. Standing next to me is a 50 something lady with long grey hair. Her denim jacket is covered with fabric badges from around the world. “Where are you from?” she asks. I tell her. ...

I wheel the trolley to the next patient and look up. She is giving me a hard stare. Paddington bear-like. In fact, scrub that. She is not looking at me. She is glowering. Glowering balefully. “Sawubona,” I say nervously. “Kunjani?” Her only answer is to turn away and sniff at me. “What is wrong?” I ask the nurse. “She wants to go home. Why don’t you let her go home?” This lady has a condition called lactic acidosis, I explain. She has been on anti-retroviral drugs for a year. One of these drugs in particular has the potential to cause a few unpleasant side effects, one of which is the build up of the acid lactate the blood. She was admitted 2 weeks ago with severe vomiting, abdominal pain and breathlessness all of which were due to the acidity of her blood as a result of the high levels of lactate. Her levels were in fact dangerously high and we had to stop her anti-retroviral medication. “But she is better now doctor. Why can she not go home?” “Well I know she feels better. We have gi...

Me on the medical ward round There is a curious atmosphere at work – a sense that the party is nearly over. The 2007 intake of doctors has begun its exodus and I am back on the medical ward this week. Sister looks at me in surprise as I walk on. “Where is Dr Riddick?” “She has left.” “Hauw – why?” “She was only here for 1 year and the year has ended. She has gone to her next job.” “And Dr Janssen, and Dr Mkhwanazi?” “They have left also.” She shakes her head sorrowfully. “It is terrible. All our doctors are leaving us. What will happen? Just as we get to know each other, you leave. Are there new doctors coming?” “A few.” I don’t expand my answer for her. For 2008 will be a more difficult year than even normal for South Africa’s rural hospitals. For several years now a good fraction of doctors working in places like Hlabisa were “community service” doctors. After qualifying doctors did a 1 year internship and were then required to work for a further year in a understaffed institution be...

My mobile rings. It is switchboard. “Could you go to theatre doctor urgently!” Offering quick apologies to the patient I had been repeatedly stabbing with a spinal needle I drop everything and sprint to theatre. Ok – brisk walk. It is hot. We have had a couple of near misses in theatre recently – “urgent” and “theatre” in the same sentence should be taken seriously. I bang through the door to the male changing room and pull on the green trousers (much too small), top (voluminous, of the order of Queen Victoria ’s nightie) and surgical wellies. I barge through into theatre. Sister instantly sends me out to get a cap – always forget that. I am reassured – it cannot be that urgent. Inside theatre things are calm. A naked pregnant teenager is sitting on the operating table looking tearful. It turns out that she has become a little hysterical and is refusing to let anyone give a spinal anaesthetic. They have tried light sedation but she is determined and flails around enthusia...

Happy New Year! I was working but if you try hard enough even fizzy grape juice can give a significant headache the morning after. The people of Hlabisa went crazy at midnight with terrifying 5 rand Chinese fireworks. Looking forward to those burns tomorrow. Have a wonderful start to the New Year!