Donkeys, monkeys, and whales' tails

Spring is definitely sprung in the Transkei, and everywhere little piglets, goatlets, cowlets and donkeylets (is there a real word for a baby donkey?) are scurrying around trying to fatten themselves up on the new grass pushing through the areas which were burned over the winter. Strangely, there's been a bit of a dearth in human births at the hospital (although we do have two kittens born to our resident cats in General ward) but I am far from complaining. My last weekend on call I only got woken up in the night 3 times in 3 nights which I think is some kind of record here. The garden is also starting to look good - we've been eating home-grown lettuce and rocket in salads for the last week or so, and the tomatoes and peppers are starting to flower.

We still have no access to a car but I have been making the most of my mountain bike. It's now three weeks since I cycled to Port St Johns for the weekend for the first time. It's only about 30 miles but the first half is on dirt road and mostly uphill. I'm no geologist but when the Transkei was formed it must have been squashed inwards from the coast - the land is in deep corrugated ripples. So on the bike you're caught in a never-ending cycle of punishing uphills followed by exhilarating downs - 5mph then 50. The downhill on the dirt road is really fun - especially because the taxis (almost the only other vehicles on the road) have to take it quite slow so you can zip right past them. There's nothing a taxi driver here likes less than being overtaken, especially by a cyclist!

The reason for going to Port St Johns was to go on a whale-watching boat trip. South Africa has (apparently) some of the best whale watching in the world and back when I arrived you could barely look at the ocean without seeing a few plumes of whale breath. But the season is drawing to a close now so I wasn't expecting all that much. However the boat trip itself would be worth the money (about £35 for 2 and a half hours) - the captain stopped to say a prayer before we headed out of the Mzimvubu river mouth into the open sea, and once we hit the waves, it's not hard to see why he does this every time! They get a 20 metre swell in these parts and we were in a tiny little boat - he also has to time it just right so that he goes on the crest of a wave over the sandbanks, as otherwise the boat would ground. The sandbanks are also constantly changing position from one day to the next so it's no joke. Pretty extreme.

Port St Johns itself has a stunning situation. The Mzimvubu (Xhosa for 'place of the hippos') river cuts between two hulks of stone, Mount Thesiger and Mount Sullivan, in a deep gully with native rainforest clinging to the sandstone cliffs. The day we went, there was a fine mizzly rain so the cliffs were draped in soft clouds - it made me think of photographs of China or Vietnam. When you get out to the open ocean, then the hills of the Wild Coast stretch for miles with golden beaches at the river mouths punctuating steep green hills covered in aloes and coastal strelitzia.

The first wildlife we encountered was a school of dolphins who, in time-honoured fashion, came to frolic around the boat. They are incredibly beautiful creatures and I can't think of any other experience where wild animals come so close and seem to want to interact with humans so much. I saw one baby dolphin, probably about two feet long. But it was whales we had come to see and we were all scanning the horizon for twin plumes of vapour (the Southern Right Whale has paired blowholes so the spray comes out in a heart shape). In spite of my very low expectations, after about 20 minutes we did see the telltale spray and sped off in jet-propelled pursuit, following the "footprints" that the whales' bodies leave on the surface of the water after they surface. Incredibly, we must have seen over twenty whales that morning, some only about 10 metres from the boat. At one point, a pair of whales just next to our boat surfaced to exhale - we must have been only about 20m away - the boat captain and I both got a faceful of moist whalebreath. Unbelievable. We then set off towards an area where a large group of sea birds had collected as the captain said this suggested dolphin activity. The birds themselves, cape gannets, are quite beautiful white birds with a streak of bright yellow on their heads and black tips to their wings and tails. When we arrived it was a frenzy of activity with dolphins circling, birds diving and little streaks of silver mackerel darting all around the boat. The only thing I can compare it to is that BBC documentary series about the Sea - I've never seen anything like it. As we got to the centre we realised that about 7 sharks had joined the feeding frenzy - I can't deny there was a little frisson of fear as those dorsal fins circled our little boat.

Back in Port St Johns we were staying at Second Beach (there are three beaches with equally original names) in a beautiful lodge with samango monkeys scavenging in the trees outside the window. It's easy sometimes to forget that this is in fact still Africa. But little things, like monkeys outside the window, or no running water for two weeks, serve to remind me every so often when I'm in danger of forgetting.

The hospital too has its share of TIA moments. Not transient ischaemic attacks - I've yet to see one of those here - but the time-honoured foreigner's exclamation, uttered with varying degrees of exasperation, bewilderment, or empathy with another's confusion, "This is Africa." For example, I have an elderly patient who was stabbed in the chest and had a massive haemothorax (blood inside the chest where the lung ought to be) who did quite well after I drained the blood out but was still extremely short of breath. It turns out he had nowhere near enough blood (Hb of 6 for the medics) so I arranged a blood transfusion - of course that takes 4 days as the blood has to go to Mthatha for cross matching and then someone from the hospital has to go to Mthatha to pick it up. Unfortunately after all that, the driver who picked it up decided it was too much effort to actually deliver it to someone in the hospital and so deposited it outside the security lodge at the hospital gates without mentioning to anyone, where it remained throughout the sultry Transkei night until the ward sister found it in the morning. Dilemma - do we give this man the blood which has been outside of the fridge for an unknown length of time and at an unknown temperature with unknown pathogens potentially multiplying furiously? Or do we let him wait, gasping, for at least another week (now a weekend is involved) and get some more, knowing that other, equally improbable, misadventures may befall this second lot? Nothing in my medical training has prepared me for this scenario! Answers on a postcard please.

I read a verse in Proverbs a couple of weeks ago which has been inspiring me ever since as it seems sort of emblematic of what we're doing here. "Rescue those being led away to death; hold back those staggering towards slaughter. If you say, 'But we knew nothing about this,' does not he who weighs the heart perceive it?" (Proverbs 24:11-12) Every so often when I feel what I am doing is insignificant, a bit like Sisyphus pushing that mythical rock endlessly up his mountain, that verse comes back to me. When you see the people I am seeing in our antiretroviral unit in a weekly clinic when I start them on AIDS treatment I really do feel like these people are being carried away to their death - they seem so powerless, trapped in a downward spiral which they have never understood. The treatment we have is far from perfect there have been some truly miraculous recoveries.

My Xhosa is still very limited but beginning to improve. Every so often I understand a little of what the patients say - I can recognise quite a few key words like cough, vomit, night sweats, blood, sputum, painful etc. I can tell patients to sit, lie down, ask them if it hurts where I'm pressing and tell them to breathe in and out. Pretty much the basics I need if I am going to examine someone. The clicks are difficult but I think I'm starting to get the hang of them. It makes the whole ward, and all the nurses laugh every time I do it though! There are three main clicks - x is like the sound you make when you want to make a horse giddy up, at the back of one of your cheeks. Q is the sound you make with your tongue against the hard palate when you want to make the sound of water dropping, or the clip-clop of horses' hooves. C is a sucking noise with the tip of your tongue just behind your front teeth, a bit like a "ts" noise or when you tut at someone (which of course, we all do regularly). I can make all of them now but it's difficult to integrate them into words especially when there's more than one click in a single word. Or difficult consonants are juxtaposed with the clicks - like when c is preceded by g or even ng in words like Ngcobo.

Anyway I'm pretty excited as both my medicine and my Xhosa can take a short rest for a while. I have annual leave for the next 12 days as Gemma's coming from Scotland - we're going to be hiking in the Drakensberg then relaxing at the coast for a few days. It's the first time off I've had since our last expedition, to the Western Isles back at the beginning of June. I've rented a car (a Kia Picanto - we shall see how it handles the road back to Isilimela tomorrow) and am currently relaxing with two of my colleagues in the Maloti mountains, just south of Lesotho. We're staying in a backpackers lodge next to a beautiful waterfall run by two kayakers who have renovated an old farmhouse. No electricity and all the water is collected rainwater! Really nice. As I type I'm on the verandah looking out over the river gorge with huge black clouds drifting off into the distance after they have deposited their cargo of rain. It was totally dark about 20 minutes ago due to the clouds and the heavy rain, and now, as it's brightening up, the cockerel is crowing - must think it's dawn again. Driving here last night was the worst visibility I've ever seen - about two metres at times. We were driving in second gear, navigating using the lines on the road which I could just about make out at the tip of my bonnet (although the line on the nearside of the road was usually obscured by the beam from my headlight in the fog so I mostly had to use the line in the centre of the road). Crazy. The sun's coming out now so perhaps it's time for another foray into the outdoors. I'll leave it here but thanks once again to all for writing, texting, phoning, praying. Whale watching season runs April to October so now's the time to start booking for next year...