The Last Post

5 a.m. on Friday 14th December and I am loading my bags into my car to leave Zithulele.

The previous evening I have experienced some of the warmest, most genuine and touching farewell wishes I could imagine. For what appears to me to have been a period where for much of the time I was more of a hindrance than a help I have had sincere and quite moving expressions of regret that I am leaving.

Even by Zithulele standards the last three months has been a roller coaster period, packed with incident. As I leave, the new Ultrasound machine has just arrived (warmest thanks for the support of Brian Brink from Anglo American for facilitating this). The X-ray machine is to be fixed imminently and the drug supply is starting to be more secure thanks to MSF. The possibility of running a hospital at a ‘normal’ level seems far more achievable than it did four weeks ago.

One of my farewell cards reminds me that I have gained or regained the skills of lumbar puncture, bleeding a baby and, perhaps most excitingly, performing a Caesarean section. Not bad for an old dog.

I have also had the opportunity to work with a truly inspiring team and that is surely what counts most.

I look across the road at the hospital where people are already gathering for the outpatient clinic, joining those who have been waiting overnight, some sitting on the benches just for the lack of an available bed. I ponder on the diverse and constantly surprising nature of the clinical work in that department. Perhaps it deserves another post to do it justice. I have never before had to admit such a high proportion of people from a clinic but this merely reflects the fact that it is a combined acute admission unit for medicine, surgery, paediatric and obstetrics, as well as a routine follow up clinic. When the translator booms out oyalindayo (‘next in line’) to the wide corridor packed with the sick it is a complete unknown whether the next patient in is going to be a schizophrenic, a child with meningitis, a fractured femur, a stab wound, severe asthma, an imminent miscarriage or even a gender reassignment – some babies (presumably home deliveries) are misclassified at birth and need a doctor’s letter to have their birth certificate corrected. It’s the fastest sex change procedure in the world – a quick lift of the skirt or dropping of the shorts, an informed medical peek, and Bob’s your Uncle (or your Auntie). None of this living like the opposite sex for two years and endless psychological assessments.

When you leave a place where you have spent any significant time, whether it is returning home after a holiday or changing jobs it is often hard to envisage that the day to day activities in which you played a part, however small, will be going on, exactly as they did before, after you are gone, and that soon you will be just a (hopefully) fond memory in the minds of those still there.

It is strangely silent in the residence compound and has been for the last week. One casualty of the land grab troubles (see ‘When you come out of the storm’) was the disappearance (consumption?) of my old nemesis, the sentinel rooster and his harem. The nights have seemed uncannily quiet since then. It would be an untruth to say that I missed him, but he was one of the defining characters of the place and reluctantly I have to admit it is a little sad that his diminutive but disproportionately arrogant presence is no more.

All packed up I pull out on to the road outside the hospital and begin the early morning drive to the N2 and thence to East London. It turns out to be the most uneventful of journeys. Butterworth is grudgingly quiet. The beautiful wide green gorge of the Great Kei River is at its best in the early morning sun. With less effort and much less noise than Dr Who I slip through the time warp separating the primeval Transkei from 21st century South Africa.

East London, which seemed like the height of strange when I first drove through it on my arrival, now appears to be a nice normal civilised, clean and functional town. I stop for a coffee in the Mall where a naive and uncertain visitor shopped for his bedding and basic food stuffs three months ago.

This morning when taking a last shower in my flat I was alarmed to feel a lump on my chest and found to my horror that the tick bite (see ‘Hogsback’) had developed into an eschar. This means that various little bugs (Rickettsia) are growing in my skin and have the potential to cause typhus or a related disease. The only answer is some Doxycycline, one of the few medications I didn’t bring with me, but how to get this without finding a private medical practitioner in East London? As I am drinking my coffee it suddenly dawns on me (cue donkey ears) that I am a doctor and I can still prescribe. I take out the certificate from the HPCSA which has not been looked at by a single person since I arrived and it suddenly comes into its own as I march into a pharmacy and flourish it, asking if I can write myself up for a week of antibiotics. No problem, and for 7 Rands I have my drugs.

My last act is to return my car, in which I have driven almost 4,000 miles, to the car rental desk; then I am off to the departure lounge for the flight to Jo’burg.

I have the inviting prospect of spending a week watching wildlife with the Brink family up in the North East with a trip to the Kruger Park thrown in. They are the most welcoming of families and all of them are interested amateur (but extremely knowledgeable) naturalists. A drive through the second largest canyon on earth, the Blyde River canyon, is a thrilling start although sadly the elusive Taita falcon is nowhere to be seen. We successfully hunt down Wattled Crane and Southern Bald Ibis, and the big four and a half – I was on the wrong side of the truck when the leopard was spotted and it had vanished by the time I turned round. Still I had my leopard before.

I have run out of superlatives for this country, but I am also running a bit tight on words of frustration and anger to describe the administration which shackles it and seems to be designed to thwart the efforts of so many wonderful and just simply good people. Perhaps it is the right moment to be going home.

When the hospital staff asked me when (not ‘if’) I was coming back, I joked by saying that Zithulele is like the Hotel California from the Eagles’ song ‘You can check out any time you want, but you can never leave’. And it is true; today for the first time in three months I drove through the security gates knowing that I would not be back within a few hours or days, but part of my heart remains there.

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