A few significant events...

The stars have aligned and it's time once again for my increasingly irregular blog... The stars in question are slowly tracing their arc over Table Mountain just outside my window as the full moon illuminates Table Bay beyond the orange sodium glow of Cape Town's city bowl. I'm in Cape Town for a long weekend and loving everything about it at the minute. Everything just works in a way things don't seem to in the Eastern Cape. I left yesterday on the motorbike heading for Durban, and even there, as you cross the Mtamvuna river into KwaZulu-Natal, you notice an immediate change. The roads are better, the towns are better organised, the fields are divided into regular units with orderly crops, and there aren't random huddles of semi-domestic animals blocking the roads when you come round a corner. And then you arrive in Cape Town which has a well-signed road network, a much more acceptable ratio of kamikaze minibus taxis to normal traffic, decent customer service in shops and cafes, and of course an absolutely stunning setting. Even racial integration seems to have taken hold in a much more solid way here than what I have witnessed elsewhere in South Africa - although that is admittedly based on quite a short acquaintance with the Mother City, and perhaps comparisons with the Transkei, for example, are far from fair.

Anyway it's great to be in such a beautiful city, and it does throw into sharp relief all the things which don't work back in the Eastern Cape, but that's not to say I don't also love the Transkei wholeheartedly. Just more of the incredible diversity with which this country is blessed. Of course a major part of the Transkei's charm is it's lack of development. You can't fail to laugh when you see "BP machine O/S" (O/S = out of stock) written to explain why the nurses haven't taken a blood pressure. But then, it's more tears than laughter that I've been moved to the last couple of weeks as our X-ray machine has been "O/S" because the stores department failed to renew its maintenance contract. Now we have to wait while they get three quotes from different companies and then get the Provincial Department of Health to rubberstamp the cheapest of them - before anything can happen to repair this one machine on which we are quite dependent.

So last time I blogged I was preparing to come home for job interviews. The journey home was somewhat eventful in that about an hour after I set off for Durban the rear tyre on my motorbike blew. It wasn't really a surprise - the tyre was pretty nigh on bald as a coot. I'd actually arranged to leave the bike at a garage in Durban for a full service while I was in the UK, and had pre-warned them it would need a new tyre. Sadly, however it never made it that far. Thankfully some friends were in Port St Johns with a pickup, and rescued my bike while I hitchhiked to Mthatha. I was picked up by a senior nurse who travels the province following up patients with multi-drug resistant TB (MDR-TB). Really interesting guy, and really kind of him to pick me up. When I got to Mthatha I'd missed the last bus leaving for Durban, and the bus to Johannesburg was fully booked. There is another bus company, but their ticket office was closed so my only option was to wait for 7 hours until 2am at the N2 truck stop until the bus came and hope there was space on the bus. Anyway to cut a long story short I did get that bus and got to Durban in time for my flight, made it home but not in tip-top condition given that I'd had two pretty much sleepless nights, one in a truck stop and on a cramped bus, and the other mostly in Dubai airport.

In spite of that, the interviews went ok, and I ended up getting offered a job training in Anaesthetics in Edinburgh, which is what I'd eventually decided I wanted. But the major highlight was that I asked Miss Gemma Cunningham if she would be prepared to marry me, and she, unbelievably, agreed! We got engaged on Gullane beach just to the east of Edinburgh in a beautiful spot looking across at the Lomond hills in Fife where we'd had our first date. The ring is a South African diamond which I'd bought in Port Elizabeth back in December, hence the need for the (somewhat ambitious, or even foolhardy, as some have suggested) motorbike trip to PE in January to pick it up. We had a great time just enjoying being together again, sharing the news with my family back in NI, and a very brief but beautiful trip across the border to Donegal for a bit of rest & relaxation. We're planning to get married on the 10th of September so we're keeping the ambitious (possibly foolhardy) theme going - but seriously, how hard can it be to organise a wedding? Even if you do live in the middle of nowhere on a different continent with somewhat unreliable lines of communication? (I can almost feel the scorn from my married friends who have been through all this before...) Thankfully Gemma's family are more than up to the challenge, and I (bravely) seem to have taken on more of a consultant role. Hmmm...

It was a bit of a whirlwind though, getting engaged and getting offered and accepting a new job, all within the space of a week. From having a fairly nebulous concept of the future, it suddenly gained a location, a career, and above all, a face... All very welcome changes. In comparison, life at Isilimela has seemed quite routine and even, at times, a little mundane! It has been a fairly quiet season at the hospital the last few weeks in any case, though. The general adult ward which I look after is rarely operating at any more than 50% capacity, which is very unusual, whereas we have had a real spike in paediatric malnutrition cases and our Paeds ward is full to overflowing.

I'm not sure if I'd mentioned before but since Christmas we've also started regular outreach visits to the primary healthcare clinics, supporting the work of the very hardworking nurses and midwives there. I have been visiting two clinics, each for a day once a month. The day after I arrived back from Scotland was my second visit to Ludalasi clinic where they had 51 patients for me to see! And I thought GP's had it tough back in the UK with their 10 minute appointments. No real time to explore ideas, concerns and expectations anyway. I was back there again this week where I had a much more manageable 35 patients to see, although 4 of them were acutely unwell and required transfer to hospital. Despite requesting the ambulance at 0930, it still hadn't arrived when I was leaving the clinic at about 1530 so I bundled the patients into the back of our little pickup - a veritable African tiny white van - and rumbled my way on the dirt road back to Isilimela. So I can now add ambulance driver to the list of the many roles that I have had to take on out here!

I was also very touched when at the end of the day the nurses invited me to come for some food which they had prepared - chicken and bread. After the meal, one of them said to me (in slightly guilt-ridden tones), "You know, doctor, this is your chicken." I had no idea what she was talking about so asked her what she meant. It turns out a patient from that village had been an inpatient in my ward before Christmas with cryptococcal meningitis, and had been very close to death before making a fairly miraculous recovery. When he heard that I was coming to the village clinic that day he'd brought a chicken to say thank you and given it to the nurses who'd promptly got one of their assistants to cook it up as a snack!

It's little things like that which remind me that yes, I am still in Africa. I also had a beautiful experience while out running on Sunday in the early morning running through little villages, hearing the cockerels crow and seeing the bananas ripening on their palms, and just thinking how bizarre it is that I do in fact live in Africa. My parents had come to visit and we were staying in the luxurious bungalows at Umngazi, just along the coast from Isilimela. It's so beautiful there and it was really fantastic to have a bit of time with my folks. But also bizarre to realise that once you step outside the boundaries of the resort you're in a rural African scene which could almost be any sub-Saharan African country.

We've been busy at the house as well and Annelieke (my housemate) has built a large wooden bench outside where we can sit and watch the sky darken - we don't really see the sunset as it sets behind the hills. But it's been great for G&Ts and we had an inaugural braai (barbecue) last week. I also spent my last weekend on call constructing a dog house for Sushi which I'm quite proud of. He was pretty skeptical for the first few weeks, but all it took was one serious rainstorm and he's a convert. So now he's sleeping outside and barely acknowledges you as you go out to answer a call at 2am. I've decided I'm definitely going to take him back to the UK as he's totally dependent on us and I can't be sure that there'll always be someone happy to look after him. So he's booked in for 6 months' quarantine in Scotland in July - he won't know what's hit him once the Scottish winter sets in!

Well I'm going to take advantage of the full-speed internet connection here to upload this blog without (hopefully) several hours of waiting and false starts when my uploading is thwarted by "attempting to connect" error messages. Thanks for reading, and keep in touch.