It’€™s not easy getting registered to work in South Africa, but I had a lot of help from Tracey Hudson, a recruitment specialist, who guided me through the red tape.

So, in January this year (2006) I found myself starting work at Nkandla Hospital, for a 3 month contract. It’€™s a rural hospital in KwaZuluNatal, South Africa-in an area beset by HIV/AIDS.

The hospital was founded by Catholic nuns in 1939, but has been taken over by the Government in the 1970s. The nuns in the adjacent convent maintain an active input into the hospital.

At home I work as a locum GP in Cornwall having given up my regular practice in 2000 at the age of 50. It was the death of two friends, both my age, that prompted me to take a deep breath and to actually do what I wanted to do in life, as opposed to what I thought I ‘€œought’€ to be doing.

So, local locums are supplemented by regular trips abroad. My wife always comes and visits, she doesn’€™t stay the whole time. Strangely we are getting on better than ever – Freedom for us both?

Anyway, its strange swapping discussions about smoking, cholesterol and lifestyle for doing spinal anaesthetics or setting fractures. It is satisfying to re-employ skills that were learned many years ago-and even more satisfying to learn new skills.

I am 56 now, and enjoy medical work more than ever before. The stimulus of new work and new colleagues is a powerful one.

In South Africa, two things made particularly big impressions on me. First, HIV and AIDS – I became de-sensitised to seeing death in young adults and babies on a scale I have never seen before. The protocol for treatment with ARV drugs was complex and rigidly adhered to, even though patients were frightened off by the education classes, or died of illness whilst attending ‘€œclasses.’€  

Effective treatment was very limited. The society was beset by hang ups about talking openly about sex, let alone diseases related to sex, and the messages of life threatening danger was not getting through to the children.

It made me realise how much conversations in England on such issues have opened up in my own life time. None the less, hard working people are out there, trying to treat and change things.

Secondly, contact with doctors of another culture is sometimes surprising: South African doctors are required to work in rural hospitals for a year after their first Intern year, post qualifying. They were all extremely likeable young people, with a high practical skill ability, but all had an ability to leave a queue of patients unattended when the need for an early weekend was felt, and to attend a morning 8 am start the day meeting was definitely not on the agenda!

By European standards-and certainly Australian standards where I have also worked, they would all have been sacked! But then life would have been worse! And if they were perfect they wouldn’€™t have needed me anyway, so it rolls on!

There were African doctors from Cameroon and the Congo who worked on a much more traditional European basis, in other words you finish work when the last patient is dealt with.

There were nine of us in all, I was the only white doctor, and our languages were an interesting mixture of Zulu, French, and English.

Now I’€™m back in England, where my wife has already booked up locums for me to do, so it’€™s a rapid transition back to GP work.

I’€™m aiming for the same hospital next year, but in my lifestyle nothing is predictable so I’€™ll wait and see what Tracey Hudson has to say to me.