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.