Two Old Friends

I have just returned from a conference. I have never been a big fan of conferences, but I guess they serve a purpose. As far as I can see they are often just an excuse to generate a lot of hot air, spend a lot of money, eat too much and drink too much, and pass a lot of impractical resolutions, after which everyone goes home and resumes living their lives and doing their work as they did before. On the other hand, they can be useful for meeting new people and staying in touch with old contacts, friends and acquaintances. So I was delighted to bump into an old friend who in fact was the first person ever to hire me. He must have been reasonably happy with what he got because he repeated the exercise not once but 3 times, as I came and went to various other jobs and postings.

He crept up behind me when I was standing at our booth and softly said “Hello”. I turned around and was confronted by a middle aged man, slightly shorter than me (and I am not tall), with grey to white hair, a ruddy complexion, a bit of middle aged spread, a pleasant smile and kind eyes. I think it was the smile and eyes which saved me from embarrassment and I was able to greet him by name without too long or pregnant a pause. We exchanged some pleasantries and agreed to meet the following day for brunch during the final plenary (which he wasn’t keen on attending as he said he is allergic to politics). The next day he duly found me at 10.30 and we made our way to the cafeteria. I had fallen foul of some food poisoning and he wasn’t hungry, so we made do with a Coke (for me) and black coffee (for him). We found a seat on the balcony, not too far from the restrooms.

When I first met him he was 29 and I was 23. I had just graduated. He had recently been appointed medical superintendent of the large secondary level hospital, the previous incumbent having just retired. Before that he had done some paediatrics (in the absence of a paediatrician) and community medicine – teaching primary health care nurses, servicing the hospital’s 15 or so district clinics. This was at the height (or should one say the depth?) of apartheid. We were working at a hospital designated “black”, by which was meant that white patients went to the smarter, better resourced hospital in the town and black patients came to us. I think that better off black patients went to private hospitals. What Indian patients did I can’t remember – I don’t remember them coming to us.

For an 800 bed hospital, we had 12 interns (I was one of them) and 24 medical officers, many of them just out of internship themselves. There was a wonderful, hardworking, good-humoured, fulltime physician (I hope they have canonised him by now), but no paediatrician (despite a busy paediatric outpatient clinic and a 200 bed paediatric ward). We had a part-time private paediatrician who would willingly dispense advice over the telephone but who only occasionally come out to the hospital. The surgery department had one fulltime specialist and a number of fairly experienced medical officers. Surgery was popular at the hospital – in fact most of the doctors who came to work there did so for the surgical exposure and experience – they weren’t particularly interested in clinical medicine or paediatrics, just in learning how to fix a broken femur or do a hemi-colectomy. Obstetrics and Gynaecology had one rather old, semi retired fulltime specialist, who repaired to the doctors’ overnight rooms for an extended siesta every afternoon, and a number of part timers who “covered” after hours. Lastly, a very grumpy part-time radiologist. That was it, as far as I recall. No orthopaedic surgeon. No psychiatrist. That is what my friend was trying to manage, with little or no relevant training apart from his basic medical degree, and on a salary of maybe 3000 rands a month, when his private GP colleagues were making at least double that and private specialists more than three times as much. One day I shall write about my own time there, but this particular blog is not about me, but about my friend.

Over the years, as I came and went as an employee, he rose through the ranks to Senior Medical Superintendent, then Chief – I half expected them to make him Minister of Health or insist that he move to a bigger hospital. He was good at his job – hard working, meticulous, a good administrator, good people skills. He had a vision for the hospital and despite years, decades of obstruction and underfunding from the Afrikaner Nationalist government’s Health Department in Pretoria and it’s satellite offices and lackeys in the provincial capital, he succeeded in getting funding for hospital improvements, some of them very major. Under his management, doctors came and went, but some senior and excellent ones came and stayed and as a result, decent medicine was practiced and, I believe, a great many lives saved and/or improved. What set him apart from many of our colleagues, to me at least, was that he actually seemed to care about the individuals who came in and went out of the hospital – 60 000 outpatients and 30 000 inpatients a year when I was there. It is so easy to become callous when one is confronted with that much suffering and simultaneously denied any decent tools to try and alleviate it. He didn’t – he just did what he could and returned the next day to do the same. He had compassion, and that made him different. I am not aware that he was in any way religious, although he confessed to having been a member of one or other Student Christian association when at university. So I don’t think it was his faith which motivated him or underpinned his humanity. He was just, as is just, a decent person.

During my last stint of working for him, which is about 15 years ago now, I took over the community doctor post and spent my time running the TB clinic, visiting the TB hospital and visiting and supporting the district clinics. It was the best job I have ever had – a wonderful combination of teaching (the primary care nurses), practising clinical medicine and doing some administration and management. There was even ample scope for research, which I sadly didn’t capitalise on. I gave it all up for better security for my family, better education for my children and a better climate.

He is now 53 and I am 47. I have gone my own way, which I am happy with, and he has stuck by the hospital he helped build up. A few years back he stepped down from being superintendent – a younger, black doctor has taken over. My friend has become the chief medical officer in charge of TB. He spends his days seeing TB patients and I expect teaching the other doctors and nurses about TB. I asked him whether he is ever consulted on institutional management decisions – he shrugged his shoulders and said “If they ask, I am happy to advise, but they don’t often ask”. Which is sad – 30 years of experience apparently going to waste.

As we sat and sipped our drinks, I was reminded of a Magna Carta song which I have long enjoyed. One of the verses goes like this:

Two old friends of mine
Is this all life has left of you?
Who took the laughter, the times
We said what we were going to do?
When we were grown and ready
To take on the world, with a song
And now the tune is one
You can't remember

I remember some of those times with him – we shared a love of the outdoors and a love of fine wine, and I have good memories of evenings spent with him and others at campsites in remote corners of game reserves, chatting around an open fire under the stars, sipping at a glass of Cabernet Sauvignon. In those days it was a question of what we were going to do when we had gotten rid of the white supremacist Afrikaner Nationalist government. Then we would be ready to take on the world, not with a song, but with primary health care, with access for all, with a whole host of other idealisms and impracticalities. Democracy came in 1994. 17 years later, lots has changed. On the other hand, lots hasn’t. One of the things that hasn’t is the quality of medical care available to average black South Africans living in areas such as those served by this hospital. My friend told me of a current and province-wide freeze of medical posts. Also a moratorium on ordering equipment and supplies – this because they overran their budget last year. Essential drugs (such as TB drugs) are now often in short supply or simply out of stock. They still have a paper based TB register. It still takes 6 weeks to get a TB culture result from the laboratory 200km away.

I asked what his plans were. Did he plan to move? When did he plan to retire? Well, he said, he could retire any time from 55, but he is relatively happy and he thinks he’ll stay on, doing what he is doing, making what difference he can. What about the problems with the hospital? He said that one learns to just shrug one’s shoulders like many others have done for so long who work in the SA Public Health Sector. One just says, “Sorry, it is out of stock” or “Sorry, we haven’t received the result” or “Sorry, your child has died.” Because there is really nothing else one can do if one is to remain sane.

Maybe that is what our efforts come to in the end. A shrug of the shoulders. A slumping of the shoulders. A roll of the eyes heavenwards. A sigh of acceptance – acceptance of mediocrity, of the less than ideal, of second best or third best or worse. We let the years of head bashing wear us down until our ideals are blunted, our outlook cynical and whatever energy and motivation we still have, turned inward towards preservation of self and kin.

The song ends:

Two old friends of mine
A dripping tap
And a broken old chair
And if I read between the lines
Someone's lonely
Someone doesn't care
If it's all gone by tomorrow
For tomorrow's been and gone
Like a bird
That has no home

How sad. We can’t remember the tune with which we planned to take on the world. We have lost our ideals, our vision, our dreams. Our Brave New World was stillborn and the tomorrow we envisioned was left stranded with nowhere to land – a bird with no home. How sad.

America

America

It has been over 2 years since I was in the USA, over 2½ since we left. I think that is mainly a function of the distance. It really is a hell of a long way: 12 hours to Europe and then 7 across the Atlantic plus lead time, layovers and delays on arrival. Getting through it in less than 24 hours in the exception. Or you can do 2 hours to Johannesburg and then the mind numbing 17 hours to New York or Washington, plus 2 hours in Dakar to refuel and to offload/onload passengers and cargo. That’s no better – also 24 hours plus. I prefer the European connection – it just gives you a chance to stretch the legs, get a shower, unwind a bit, have something to eat that doesn’t shout “airport” and “airlines” at you from the other side of the room.

I almost didn’t get there. The day before I was due to leave the UK the Icelandic volcano (she whose name cannot be pronounced) belched forth some more ash and it was touch and go. In the end we left about an hour late, and they had to take us right up north, over Iceland itself (weird as that may sound – the plume was blowing southwards). We got into Dulles, Washington at 8.30 instead of 7.30, which meant that the individual passport control areas had closed for the day and everyone was being channelled through one. I was being picked up by colleagues. As soon as we landed I emailed them (we both have Blackberries), and then periodically emailed updates – when I saw the length of the queue at passport control (6 deep, 90 minute wait), when I got to the front of the queue, when I was waiting for my baggage off the carousel and finally when I got through to say where I was standing. No sign of my friends. It was only then that I noticed that none of the emails had been sent – the hourglass symbol was merrily rotating. The joys of connectivity. We finally found each other and headed off to White Flint, Rockville, where they have an apartment.

It was strange seeing the old familiar sights, US road-signs – no turn on red or the flashing pedestrian crossing indicator with the countdown in seconds next to it,  Washington’s road names – Old Georgetown Road, Rockville Pike, the avenues named after states which fan out from the Capitol like the spokes of a bicycle wheel, the streets in downtown DC very sensibly named “G street” or “F street”, the 495, the 270, route 28, and the names of the Metro stations which I had come to know so well over the course of six months of commuting – Friendship Heights, Medical Center, Bethesda, Strathmore, White Flint, Twinbrook, Rockville, Shady Grove: it all started coming back. The next morning my hosts had to go back to the airport and I took the opportunity to explore the neighbourhood. I eventually found the White Flint Mall, after some difficulty, and the Borders Bookshop. The US has 2 great book shop chains – Borders is one, the other is Barnes and Noble. They tend to have multilevel, well stocked shops with coffee shops attached where one can literally spend hours – and lots of money. I found a book by Karen Armstrong I have been looking for. There were lots of others I looked at and could easily have bought but was thinking of the weight of my suitcase going home so restrained myself. Just as well, as it turned out. I got a cinnamon bagel (another great US institution) and cream cheese for the way home. Only problem was there was no knife and the cream cheese came in a tub, so I was reduced to digging it out and licking it off my forefinger in between taking bites of my bagel. Too much detail. It was delicious.

Sunday night we did sushi at a Japanese restaurant on Rockville Pike. Always amazes me how filling it is – those little delicacies which look like a mouthful are really much more than a mouthful. And if you add a bowl of meso soup for starters, it really is a full meal.

The weekdays were full. I was jetlagged and waking at 3, 4, 5 – so it wasn’t much fun. By the end of the week my clock was coming right but by then it was almost time to leave. I think I ate in on only 1 night out of the 8 nights I was there. Thrice I went to friends, once we went to Teeters for pizza, once to Panera’s, once we ate Thai and once Japanese. And then there were lunch dates as well. Twice they bought in pizza for work functions, twice we went out for pizza (once I had crab-cake), once we had curry at the Bombay Kitchen down the road. It was wonderful to see old friends, catch up, share a meal, drink some good red wine ...

The weather played ball and gave us some glorious spring days. It rained once or twice but not for long. I had intended doing some running but got a bad cold just before I left the UK so that messed up my plans. As a result I expect a shock when next I get on the scale at gym, but a few good workouts should sort it out. Can’t wait to get back to it – I feel like a toad! [Post script: I actually lost 3kg!]

I think Saturday was my best day. I started off with 2-3 hours of work, just clearing the desk so to speak. Then I took the metro through to Bethesda where I was going to meet a friend for lunch. We ended up going up to Montgomery Mall to look for a rug (for her) and an iPad (for my brother). The Apple shop was abuzz with people looking at the iPad and there were plenty salespeople trying to sell us one. The only problem was ... they didn’t have any in stock. Not in the shop, not in the city, not in the country, it seemed – sold out! Well I guess that is what you call a successful product. We grabbed a pizza and then she dropped me off back at Bethesda. I caught the metro (I had a day pass) through to the mall and wandered around for an hour or two renewing my acquaintance with the Capitol building, the Washington monument and a host of other fine buildings, but mostly with the vibe of the place – the Mall has a unique atmosphere which is hard to describe – sort of mixture of national pride and joie de vivre. One sees groups of youngsters and not-so-youngsters playing handball, soccer, people jogging, cycling – all in this superb setting with the Capitol in the background. George Washington University was having its graduation ceremony there the following day – right in the middle of the mall, with that magnificent backdrop. Michele Obama was scheduled to speak.

Then I took the metro back to Friendship heights and met some different friends for a sandwich / bowl of soup / cafe latte at Panera’s – something herself and I did I don’t know how many times in our six months there. Before I left I collected a half dozen assorted bagels, two of which I selected to take home – not sure what they will taste like after 20 000km in the hold but the thought is there.

On Sunday I took the Metro to Shady Grove and met some different friends again, who took me to their church nearby. I have been there once before and find it similar enough to ours to suit me. Even knew some of the songs! After church we drove through to Frederick which is about 30km north west. It has a historic town centre, dating back to the 18^th century and the days of the War of Independence and the Civil War I guess – must look it up. Anyway, there are some stunning old townhouses, lots of churches, court houses and the like and, best of all, some really great restaurants. I was told the quiche was wonderful – in the end I opted for tuna salad, thinking about my cholesterol and my girth, but they were both delicious.

Then it was over and I was sitting in the Super Shuttle hurtling toward the airport at some ungodly speed, driven by a guy from West Africa who didn’t seem to know the meaning of “slow down” or “turn down” (the volume). We survived, but I have had better taxi rides. I guess this was half the usual price so I shouldn’t complain. A last cup of Starbucks latte for old time’s sake and then we were boarded and heading out over the Atlantic.

I am not sure when I shall see the USA again. I hope this won’t be the last time. I am fairly sure I don’t want to live there but I certainly enjoy visiting the place. And there is so much more to see – we barely scratched the surface in our time. Didn’t get to the West Coast, nor Florida – didn’t even get to New York. Will have to pull ourselves together.

A site familiar to any Washingtonian: the Metro station. I have heard many Washingtonian friends complain about it - I think it is magnificent, both as an architectural and engineering accomplishment and as a public amenity. A ride costs between $3 and $4 depending on distance and time of day. It is safe, clean and comfortable. What more do they want?

The well known "Smithsonian Castle" in the Mall, the headquarters of the Smithsonian Institute to which the visitor to DC owes so much for free access to magnificent museums and other attractions like the zoo. I have never actually been inside this particular building but have always loved just looking at it and photographing it.

Another of my favourite buildings on the Mall - and this one I have been into. It is the National Museum of the American Indian (www.nmai.si.edu/). I just love the design of the place - the curve of the walls, the stone, the shadows that are cast, the water features, the exhibits. The family didn't particularly bond with this place, but I did.

Is this the best known landmark in the world? Whatever your politics, it is a magnificent building. For me it brings back many good memories of days spent walking around the Mall, eating hotdogs, or ice creams. Or in the heat of summer simply drinking as much water as possible.

Or maybe this is. The Washington Monument. I have always had mixed feelings about it. No doubt it is impressive. One really needs to get up close and intimate to get a true sense of that. In its own way it is beautiful - in its starkness, its sterility. I expect the Freudians and the Jungians have written books about it. What does it signify? Strength and might undoubtedly. Solidness. Massiveness. Uprightness? Last man standing? Loneliness? The odd one out? I don't know - I don't really get it, but it certainly does something to me, even if it doesn't do much for me.

England

England

There is something very comforting about MacDonald’s. Ja, Ja, Ja - I’ve also heard that the Big Mac has virtually no nutritional value at all and that MacDonald’s French fries are just fat plus salt and that their Diet Coke is mostly chemicals, possibly carcinogenic ones. But here’s the thing. At least you know what you are getting. And you don’t feel ripped off. At least I don’t.

At home I hardly ever go to MacDonald’s. No more than I go to Kentucky Fried Chicken or Steer’s – we make the occasional sojourn, usually at the instigation of the princesses. But somehow when I travel I end up at the MacDonald’s. Like today. I had an overnight flight from DC to London. So I was up early yesterday, worked the whole day, caught a 10 pm flight and didn’t sleep very well. Result: not feeling wonderful when we touched down at Heathrow. Add to that waiting for an hour for my luggage, which never came, only to be told that the United Airlines check in lady in Washington had got it wrong: it was booked through to Cape Town (she said I would definitely need to collect it and recheck it since my onward flight is SAA). 

I have an 11 hour layover. Not great but there are worse places than London to spend 11 hours. Actually it is more like 5 hours now. Anyway, I saw a sign to “SAA arrivals lounge – by invitation only”. To be frank, I didn’t expect they would let me in, but I thought I’d try my luck anyway. “No,” I was told, “you have to be Gold”. “Thank you, I understand completely,” I said, aiming for a bit of thinly veiled sarcasm, which I think was lost on the lounge staff. OK, so no airport lounge. Don’t like them anyway. Try a hotel – all I really want is a shower, change, possibly a sleep, and somewhere to work for the day until check in time.

I caught the U3 bus up to Bath Road in Drayton West. This is a trick I learned from my boss. You can take the National Express Hotel Hopper but it costs four pounds and they drive you about 1km. Nice work if you can get it! But here’s the secret – the buses which leave from the Central Bus Station are free for the first three stops – something to do with the fact that it is impossible to walk to Heathrow so they have to provide you with free public transport.

“Yes,” said the check in clerk at the Heathrow Sheraton, “we do have day rooms. They are 85 pounds plus tax so that will be around 100 pounds plus 15 pounds for internet access for the day.” And of course there would be food – I think the lunch is about 20 quid. So about 150 pounds or nearly R1800 for the privilege – that is 6 tanks of petrol in our cars – a month’s supply for both cars. Which is how I ended up at MacDonald’s, just across the road. Four quid bought me a Big Mac, fries and a large soda. I got to sit at a comfortable and clean table where I could do some work in peace at no extra cost. The guys next to me have their laptops out as well. They are babbling away in what sounds like Portuguese but I am not sure – anyway it doesn’t bother me. Every few minutes there is a roar as a plane takes off – we are right next to one of the main runways. It doesn’t worry me – I can see that if you lived here you might eventually stop hearing it. Not just because of hearing loss – I think you would become accustomed to it.

It has been a long trip – 2 weeks away from home is not my preference but it seemed to make sense this time. It was foul when I left Cape Town – the weather I mean – one of those winter frontal systems which really remind you why it was called the Cape of Storms. I sat in the business lounge at the airport (Silver was good enough there), with the rain pelting the windows and obscuring the view across the apron and runway, struggling to hear what was being said on the telecom I had dialled in to. My travel agent had secured me a decent seat – don’t ask me which one but I had a wall in front of me not a seat with the result that I could stretch my legs a bit and there wasn’t anyone kicking back and tilting theirs into my French salad dressing.

I had a couple of meetings in London – I was staying at the hotel where the meetings were being held, the Heathrow Sheraton. The meetings were ... meetings. What can I say? I got a chance to have a look around the area though – I went for a run one afternoon up to the nearby village of Harmondsworth. This is the crazy thing – here you have one of the world’s busiest airports, with 40 planes landing / departing every hour, I am told. Surrounding it you have the usual array of warehouses, businesses and hotels, which feed it and feed off it. But just beyond that you have fields of lurid yellow flax, sleepy villages, old stone churches, manor houses and quaint little pubs ... it is all a bit unreal ... and then beyond that again the motorway.

The White Horse pub, just up the road from the Sheraton Heathrow. It was quite cold the night we went so we elected not to sit outside. Inside it was warm and welcoming. The ceiling was quite low and I expect the building is a good few hundred years old. I asked for a “local beer” and was given a Foster’s! Ah well, I tried. I don’t mind Foster’s. The one negative was the Juke Box - looked and sounded really out of place, but I guess the publican has to keep his clients happy.

Flax fields: The bright yellow field just behind the hotel. I have called it flax. I shall have to find out whether that is correct. It is certainly striking. Is this what Sting was singing about in his song “We’ll walk in fields of gold”? I wonder.

Harmond House and Harmondsworth Hall: These are all shots of what I took to be the Manor House of the village of Harmondsworth. I know nothing of their history but I thought them quite pretty, especially the flower baskets.

Harmondsworth Church: This is the church in the village of Harmondsworth. I forget the name – St Peter’s, maybe. The vicar’s name looked Nigerian. Certainly not English. I wandered around the adjacent graveyard for a while. Many of the gravestones were illegible on account of weathering and erosion, but some I could read – they seemed to be mainly 19^th and 20^th century. The church, on the other hand, looks much older. There was no sign of life in the place – in fact the pub across the road was a lot more lively than the church, which I guess is about par for the course.

Harmondsworth Moor: I thought this was quite charming – wedged between factories and warehouses, a little bit of heaven – Harmondsworth Moor. But the interesting thing is that it is reclaimed landfill. I walked around, took some pictures, wondered whether I should buy some property here ... until I found out it is owned and managed by British Airways ... but quite delightful. Full marks to the worthies who created it.

Do I like England? Do I feel drawn to the place? There is definitely a lot about it that attracts me. Maybe it is just that I feel like I better understand the people here – not totally – they are not South African and I am not British, despite my passport, but I think they are that little bit closer to us (by which I mean English speaking white South Africans, my “home base”), than Americans are, which is strange given that America is also 350 years out from being colonised by England and other European powers. I watched the UK elections on BBC and then I listened to American political debate on National Public Radio in the USA and I have to confess that I understood the former and not the latter. The same applies to sport – try and I might I just cannot fathom American football, struggle with basketball and can just about figure out baseball. On the other hand football (soccer), rugby and cricket, which dominate the English sporting scene, are the stuff of my youth, like second languages to me. And of course the British drive on the correct (not the right) side of the road. Maybe we should spend some time here. It is just the climate that is a bit of a killer. I have a dream of spending the UK summer here and the SA summer in SA. We have friends who do that. Best of both worlds – never have to be cold or wet!