Kutama Clinic, Venda, South Africa – late 1980s

One of the small rural clinics served from Siloam Hospital. The photograph was taken during the early period when I travelled regularly between the clinics and the hospital. The waiting patients, the dusty roads, and the ambulance nearby capture something of the quiet rhythm of those days.

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By Paul Alexander Wolf

The house stood beside a single acacia tree, the only tree in the open landscape. In the heat of the day its branches cast a narrow patch of shade on the red earth. Beyond the low hills the distant line of the Drakensberg appeared almost blue in the afternoon light.

This was meant to become our home.

In those early months I travelled regularly to the small clinics scattered across the countryside. At first I visited them weekly; later more often as the work slowly expanded. The clinics were mostly run by dedicated nurses who carried remarkable responsibility with limited resources. My role was to support them, see difficult cases, and help where I could.

Before driving back to Siloam Hospital in the evening I would sometimes stand for a moment beside the acacia tree. The heat of the day slowly faded, and the landscape became very quiet.

At the time it simply felt like the ordinary beginning of the work.

Inside the clinic the waiting room was often silent except for the occasional movement of people shifting on wooden benches. One morning an old man sat there with a walking stick worn smooth by years of use. Deep lines marked his face.

When he briefly looked up I noticed that his eyes did not carry much light anymore. After a moment he turned again toward the doorway and watched the landscape outside while waiting.

He did not speak. For reasons I could not fully explain, that quiet presence stayed with me.

The work unfolded in the steady rhythm of rural medicine. Patients sometimes travelled long distances to reach the clinic. The nurses knew their communities well, and the sense of shared responsibility carried the work forward.

The roads between the clinics and the hospital soon became familiar. Occasionally patients who needed further care travelled back with us in the ambulance.

One evening the ambulance was stopped on the road by a group of young men carrying spears. Their anger was clearly directed toward me. The driver closed the door, opened the window slightly, and spoke with them calmly.

I could not hear what he said. After several minutes the tension softened and they stepped aside, allowing us to continue.

Later he told me that he had explained to them that I was the doctor working in the clinics, helping their people.

What remained with me afterward was not the danger of that moment, but the quiet trust that existed between us.

For a time the work continued in that steady way. The roads, the clinics, and the people gradually became part of everyday life.

Then circumstances began to change. Family concerns and uncertainty made it clear that we would need to return to the Netherlands for a time. With a young family the decision was not really a choice. Responsibility required another path.

The road bent.

Life unfolded in ways I could not have imagined during those early days beside the acacia tree. Public health work in the Netherlands was followed by training in England, rural practice in Scotland, and many years as a general practitioner in Australia. Much of that work took place in small communities where medicine carried the same broad responsibility I had first encountered in Africa.

The geography changed, but something of the original spirit remained.

I still think occasionally about the acacia tree beside that house.

Trees remain where they grow. They witness the passing of years without asking where the people have gone.

Perhaps the tree still stands there today, its branches wider now, its shade falling across the same red earth as the seasons pass.

Life did not unfold there as I once imagined beneath its branches.

Yet whenever I think back to that quiet place – the fading heat of the day, the distant hills, the old man waiting silently in the doorway – I realise that the road which began there never really ended.

It simply continued.