Saturday, June 10, 2023

South Africa is just the cure for the burned out doctor to revive the mind and body

A burnt-out case needs some ‘escapades’ to invigorate the mind and body writes Dr Chris Luke

I’m not a psychiatrist, but it seems to me that one of the least remarked-upon features of burn-out is an aversion to ‘excitement’ or ‘novelty’, or indeed anything that might threaten a comfortingly dull routine. I suggest this as one who’s making a good-ish recovery from a ‘siege mentality’ born of years spent in emergency departments that resembled refugee camps, grappling with an insane workload of ferocious intensity and head-spinning complexity.

In truth, as a medic in his mid-sixties, I’m immensely grateful to have retreated from clinical medicine into a more ‘public health’ direction, including advocacy for healthcare. Some might describe the latter as ‘ranting’ but it’s my way of saying I still care passionately about the sick and the needy, and it has at least allowed me to dream of getting my mojo back. And I know I’m recovering, partly because I no longer feel quite so embarrassed telling phone-callers that I’ve almost zero influence when it comes to ‘getting a bed’ or in any other way expediting someone’s emergency department care.

But, setting aside that new sense of limited ability, a separate encouraging metric of recovery reflects my renewed enthusiasm for ‘escapades’. And I don’t mean the annual lads’ walk in Iberia. In fact, I’m talking of my first real ‘adventure’ in years, one which involved a – minimally fraught – trip to South Africa. Now, I know some readers will shake their heads and say, what’s the big deal about a trip to Cape Town, in this day and age? To which I respond: it’s all about one’s perspective.

Once upon a time, I was a seriously boundary-disregarding youth, happy to hitch rides from total strangers around Europe, to sleep rough, and ‘fall in’ with all sorts of colourful or dodgy characters.

That sort of inclination to risk-taking and appetite for novelty probably propelled me into an all-consuming devotion to emergency care but, alas, the infinite queue of new cases, endless battles for resources (beds, staff, and space) and the dwindling supply of the milk of human kindness (that affects even the saintliest of older emergency physicians) eventually meant that every adrenaline rush – indeed every late-night phone call – became a harbinger of angst rather than a neurochemical wave to surf.

Anyway, like so many, I muddled along for years in the routine anarchy of the medical frontline, and it has taken me a while to realise quite how much I was battling a feeling of accelerated ageing. But it is only lately that I’ve begun to address the core issue for a burned-out old medic, which is actually that narrowed horizon reflecting the frozen and anxious mindset of a grim survivor.

So lately, I’ve been ‘loosening up’, and I’ve even started to sympathise with the narrator of Northanger Abbey, who famously remarked: “If adventures will not befall a young lady in her own village, she must seek them abroad.” Those bons mots apply to all genders, of course, and I followed her advice last month, when I took my beloved and long-suffering wife on a surprise (roundy birthday) trip to South Africa. The choice of destination was hers (it had been on her bucket list for years), although I had serious misgivings, based on a cocktail of headlines, hearsay, and my own experience.

The latter was the real issue, however. In 1981, as a medical student, I spent an elective period in Zambia, and I’d been able to explore that beautiful country, as well as the two neighbouring countries, which had, until 1964, constituted a ‘federation’ of Rhodesias, as it were, i.e., Northern (Zambia), Southern (Zimbabwe, as it became known officially in 1980) and Nyasaland (Malawi), and I’d been struck by their different stages of post-colonial evolution, economic development and tribal cooperation.

I’d also met European aid workers who were furious at alleged misappropriation of their government’s funding for these developing countries, and I’d seen the extraordinary differences in terms of infrastructure, which varied according to the levels of corruption and poor governance.

So, while I went to Africa as a young and idealistic fan of Dr Franz Fanon, the celebrated anti-colonialist psychiatrist, I came back deeply troubled by some of the realities I’d witnessed, and my disenchantment increased when I read subsequently of the genocide of the Ndebele and Kalanga people, ‘tribal enemies’ of Robert Mugabe, first President of Zimbabwe, by their own army in the months after the war of independence (not far from where I’d stayed in Zimbabwe

Years later, many of my friends talked of their regular wonderful trips to Cape Town, and younger close colleagues, like Professor Jean O’Sullivan and Sister Anne Healy, reported on their inspirational developmental and collaborative work in Zambia, Malawi and Kenya. But I had become ‘set in my ways’, and hypersensitised to the risk of disorder and violence which, unless it ends up in the morgue, mostly turns up on an inner-city ED doorstep. I continued to be troubled by European newspaper reports of misgovernance in the same part of Africa, the ‘collapse’ of Zimbabwe, and frightening violence in South Africa. Add in the shrinking vista of the burned-out older medic, and I had little or no inclination to travel back to the continent next-door. Apart, that is, from that most vital imperative: ‘happy wife, happy life’.

So, unexpectedly casting aside the narrow-minded old curmudgeon, I took my beloved to Cape Town and its vicinity, and we had a genuinely amazing trip; by which I mean ‘remarkable, astounding and astonishing’. In terms of pure tourism, the paramount delight was the glorious Table Mountain overlooking Cape Town, with its spectacular cable car, fascinating rockery flora and fauna, and intermittently all-enveloping clouds. On the eastern slopes of Table Mountain, a few kilometres from the city centre, we visited the enormous Kirstenbosch botanical gardens, with its tree canopy walkway and natural amphitheatre overlooking the city and, ‘around the corner’, the ancient Dutch vineyards of Constantia and the quasi-Californian Camps Bay. Here, in the serried ranks of beachfront restaurants, you can dine regally for the price of a take-away in Dublin.

Back in Cape Town, we had morning coffee in the elegant Company Gardens, afternoon tea in the ritzy Mount Nelson hotel, and delicious dinners in the arty waterfront Silo Hotel and Rick’s Café Americain on Koof Street. And we never spent more than fifty euro! Our final highlight, a catamaran cruise towards Robben Island, encountering whales, sunfish and seals, was enormously enjoyable.

After our few days in the city, we headed to the Aquila Game Reserve, two hours’ drive north of the city, where we got within a few feet of elephants, lions, rhinos, ostriches and hippos, and experienced the semi-desert landscape of the Karoo.

Then on to Franschhoek (‘the French [Huguenot] Corner’), culinary capital of the winelands, where we enjoyed superb street food and coffee, brilliant busking and fund-raising performances by the local karate club, before heading off on the wine tram to Babylonstoren vineyard. This is honestly one of the most elegant and interesting places I’ve ever visited: it’s a sort of organic horticultural paradise, full of farm animals, beautiful greenhouses and woodland, extraordinarily high-end food, fabric and design outlets, ornamental, ‘healing’ and herbal gardens.

And it was in the latter that we found a tribute to Carl Linnaeus, the great Swedish botanist, taxonomist and physician who introduced the modern system of naming organisms, binomial nomenclature; this made sense, given the myriad labelled medicinal plants within the garden, like Aloe barbadensis (aloe vera), Rauwolfia caffra (the quinine tree) and Merwilla plumbea (blue squill for improved male libido).

The most memorable engraving was undoubtedly the botanist’s famous mantra: ‘Omnia mirari etiam tritissima’ (‘Find wonder in everything, even the most ordinary’).

Our trip to South Africa was short and sweet, but it was one of those genuine adventures that leaves a litany of unforgettable lessons. I must mention the ‘dicky tummies’ and a few culture shocks: the shanty towns between the airport and gleaming skyscrapers, the odd crystal meth addict roaming the streets, and barefooted street urchins gathered in a few tourist spots.

The notices of ‘armed response unit – 24 hours’ outside luxury properties were arresting, as was the motorway sign: ‘high-jacking hot spot – next 30km’. And the ‘loadshedding’ (daily electrical outages) were initially inconvenient. But, conversely, the friendliness of every South African we met, the quality of the food and facilities, and the beauty of the country were second to none.

And for someone who grew up in the apartheid era, and admired the peace-work of Mandela and Tutu, the general prosperity and genuine diversity of the ‘middle classes’ were inspiring. I could rant about ‘issues’, but no, one lesson alone matters: an adventure, however modest, involves a little risk-taking, effort and curiosity. And as I have re-learned of late, the capacity of novelty, beauty, and contact with kind strangers to change a cynical and obsolete mindset is extraordinarily powerful and important. I’m already planning the next trip.

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