In Sierra Leone

The door flies open. Lele peers in. "You must come out here and see. They are doing a play!" I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without. "What is going on?" I ask. "It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something." The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me. "She is saying that this is a very important day. 10 years ago people were dying. And 10

The next patient is in her mid-20s. She sits gracefully on the edge of the chair and looks at me. "How can I help you today?" I ask. "It is this," she says, hands clasping her belly, "I look like I am 4 months pregnant!" "And are you? Have you checked?" "Oooh! Yes. MANY times - and always negative. I have been talking to my friends and they say it could be the HIV treatment." "Yes - that is true. You are on one of the older drugs, the one called Stavudine. That can make fat appear in different places on your body, and sometimes disappear from other places. Some people find that it makes their face thin." I suck my cheeks in briefly. She laughs. "I used to have a VERY round face, now it is thin!" "I suggest that we change that drug then. We have more drugs available in the public clinics than we did when you started and the one I will use has less side effects. Is that what you would like?" She nods enthusia

I lean across the reception desk and catch the attendant’s eye. “Sawubona,” I say, dusting off my rusty Zulu. I see you. “Sawubona, ninjani?” she replies. I see you, are you well? “Ngiyapela.” I’m fine. She grins at me. “You must be a doctor.” “I am! How did you know?” “It is only the doctors around here who use Zulu. Even if it is only the greetings.” She arches an eyebrow. “I used to work here, at Hlabisa hospital up the road. I have a few other Zulu words, you know like ‘Does it hurt?’ and ‘Take a deep breath’.” She laughs. And then launches into an excellent impression of an elderly Zulu lady rattling off a series of complaints, waddling across the reception area clutching her back in mock agony. She gets it exactly right. I have come up to KwaZulu-Natal for a few days. Tonight I am staying in the Hluhluwhe-iMfolozi game park, 20 minutes or so from where I used to work. Awarded my entry ticket, I drive into the park. The sun is low in the sky, the kills bathed in amber light. I ta

"The T-shirts are here!" I am in the clinic room with a patient but hear the cry go up from next door. The floor of the flimsy prefab building creaks and gives with the sudden influx of nurse and counsellors to the room beyond. Today is World TB day, and everyone who is anyone has a special T-shirt. Swing a cat in the clinic waiting room and you would hit half a dozen different NGOs: feeding groups, research groups, patient support groups, medical charities. And today each has their special T shirt and we are no different. I sign off my patients paperwork and they wander off. I slip next door and join the throng looking for a shirt. "Here, these are mens. Try medium," says Thandi. I do. It hangs rather loosely below my waist. Sister Manke eyes me critically. "Ah, Ed. You are but a small man." I glare at her but she does not notice. T-shirted up, we load into the cars and head off in convoy through Khayelitsha to the soccer stadium for the World TB fayre, h

The waiting area is full. Children are running up and down between the benches, their mothers (and some fathers) watching them as they wait to be called into a consulting room to see a nurse or counsellor. A woman stands in front of them talking loudly in Xhosa. She bangs her palm with the edge of the other hand, as if emphasising her point. She appears to be delivering a lecture. As I get closer I recognise her as the sister in charge of the HIV clinic. I slip into one of the consulting rooms used by one of the clinic Sisters. “Molo Sister Sibisi” “Molo Doctor. Ninjani?” She has just given a vaccination to one of the anti-retroviral patients – a flu jab. She applies a dressing, and the man thanks her and slips out. “Sikhona,” I exhaust my meagre Xhosa. “What is Matron talking about out there Sister?” “She is giving them a talk on disclosure.” “Disclosure to their friends?” “No doctor, to their children. This is parent-child clinic day so the HIV positive parent comes with

The city is quiet. The sun, just up, bathes the mountain side warm orange. I pull the bike out of the car and pull on my borrowed cycling shoes. A large 4 wheel drive pulls up behind me. The man leaps out and lifts his racing bike off the back. "Good luck," he grunts at me in Afrikaans accented English as he cycles off. I climb on the bike and wobble precariously down the street as I try to figure out how to lock the cycling shoes into the pedals - and then promptly over balance as I try to work out how to remove them at the traffic lights. "Guess the whole idea of the race is not to stop," I mutter, embarressed. Wobbling through town I head towards the Civic centre. I join a stream of professional looking cyclists - all in the full kit, with expensive racing bikes. There will be 44000 bikes on the route today - am I the only idiot on a mountain bike? As I turn the corner the starting area comes into view, the atmosphere electric. The dawn light is grey here, but th

I am at the head of the pack, with three other blokes. We have been running for over an hour now. I feel a warm glow of achievement – I am keeping pace with real trail runners! They are chatting animatedly. One of them turns to me, “So do you run often?” “No...” I gasp. “Well...” “In...” “Summer...” “Maybe...” “Twice...” “A...” “Week.” I think I am about to die. “And is this your first time with CRAG? How did you hear about it?” Crag – Cape Runners Against Gravity – is a trail running group that meets each Wednesday at different parts of the mountain for a 90 minute run. “My...” “Old...” “Boss.” We are nearing the end now – we can see the car park. My three companions reveal their extra gear and storm ahead. I slow to a stagger. 10 minutes later the entire group has re-gathered and – you have to love this about South Africans – chilled beer is produced from the cars. Conversation turns to other outdoor Cape Town activities. This weekend is the big bike race, the

The coffee has been served and people are making their excuses and heading off. We shuffle around the restaurant table, closing the gaps. I am sitting next to Sister Nene. "How are you doing? Did you enjoy the food?" I ask. "Oh yes - and all the better for it was free." The evening has been a work social gathering. A waiter comes up with a glass which he hands her. "What are you drinking?" "Whiskey," she replies, a little indistinctly. "What kind?" "Normally I like Jamesons. I don't know what this is like. It is something called 'Glenfiddich'." "That's very good." "I know. It is a single malt." She reaches for the water jug and eyes me conspiratorially. "I like a little water with it," she whispers and pours half a pint of water into the glass. I watch in horror. "It takes the edge off it and brings out the flavour." As she lifts to drink the light catches the drink - not

I am driving back along the beach front towards the city centre. It is late and dark but the air is warm, the window down and I hold my arm out relishing the 70km salty breeze that rushes over it. I am returning from dinner with new friends from work. Dinner in a Mexican restaurant on the African coast - or the "Atlantic seaboard" as locals call this area of the city which makes it sound like Florida. And it could be, superficially. The BMWs, the beautiful people jogging along the promenade, the high end restaurants. The elevated roadway curves around, brushing the city centre. I glide down to a six lane junction. There is a queue. I cannot see quite why - the lights are green. The car in front of me moves slowly forward. Then, illuminated by its headlights I see a withered figure in a crumbling, bent wheelchair. The chair is in the middle of our lane. On either side cars hurtle past to join the Freeway up ahead. Unperturbed the figure reaches up to the window of the car in f

“You will have to sit in the back,” Rachel says as she opens the car. She grins ruefully. “The front door is stuck. I keep telling my husband we need to sort it out but he is Johannesburg a lot at the moment.” I clamber into the back seat. The interior of the car is like a furnace; my shirt clings to my back. It is 7:30am but already hot. Rachel revs the engine and we move out of the parking lot. “Where are you from Rachel?” I ask as we pass the boom-gate of the medical campus and onto the highway. “Zambia. I came a few years ago to study at UCT. And then I stayed.” “Why did you leave?” “I did my medical school in Zambia but there are not many opportunities for graduate study up there. And my husband had more opportunities down here.” “Do you think you would ever go back?” She smiles and shrugs. “I don’t know. Its home but what would I do up there? And the children are in school here. They didn’t like it much at first – it took a while but now they are happy.” “What made

We step out of the air conditioned halls of the airport into a blast of Cape heat. It is nearly 30 degrees and I am wearing jeans and walking boots. I have been met by three friends from Hlabisa days, gathered in Cape Town for a wedding. We are chatting animatedly in the car as we leave the airport complex - developed massively for the 2010 World Cup – and I am struck by how glitzy and new everything looks. 10 minutes later and we are hurtling down the freeway towards the city. Table Mountain looms ahead of us, cloud pouring over its edge like the head on a hastily pulled pint. As the road curves the towers of the city centre buildings bristle at the mountain foot. I turn to look at the road side – I had seen it before but I am still startled: the glass of the airport buildings has given way to the shacks of the Townships and informal settlements that line the freeway. Thrown up with scraps of wood, corrugated iron, and plastic sheeting these are no temporary shanty towns. There are st

After 3 years back in the UK I am returning to South Africa. This time to help with a research project in Cape Town. Kick off next week.