The Good Doctor by Damon Galgut

Doctor's battle with a nation's brutal legacy

It's no wonder that the South African novelist Damon Galgut has won a place on the shortlist for the Man Booker Prize.

The Good Doctor, the Pretoria-born writer's fifth novel, is his dark tale of a physician's struggle with his conscience in a rural hospital. There are echoes of Doris Lessing, Nadine Gordimer and Joseph Conrad, all of whom have written with an exacting emotional precision about the European's place in Africa.

Galgut writes from a new fictional space: post-apartheid South Africa, where the "homelands" have been given fresh names but little has changed. The landscape and its people still seethe with violence, locked in a battle with the brutal legacy of the country's recent history.

Galgut's story of a doctor attempting to carve out his place in the run-down local hospital vibrates with an eerie sense of foreboding. He beautifully paces the unravelling of Dr Frank Eloff against a background of quiet desperation among the rural population, and the faint stirrings of military insurgency.

This is a place without hotels, shops, restaurants, cinemas, a place devoid of hope. "For the few of us still remaining, life went on between two poles of banality and violence," Frank writes of the skeleton staff who run the hospital.

Whatever expectations are raised for rebuilding the country, they are poisoned by the realities of political corruption and the terrible economic disparities which still exist.

Frank, raised in South Africa under the previous regime by a celebrity doctor turned entrepreneur, has fled Cape Town to work here after his marriage fails. Galgut explores the limits of Frank's ability to understand the local people through his affair with Maria, an African woman who sells souvenirs to tourists from a road-side shack.

"The coins and notes that I stuffed into her hand on my way out the door were a symbol of a separation between us that couldn't be measured: it was a disjuncture between our very lives. Money couldn't close the gap; it was the gap." Neither is there a common language that can form that crucial bridge.

Whatever place Frank has found within this new country is disturbed by the arrival of Laurence Waters, a young idealist with visions of running an outreach clinic in Maria's bush village.

In contrast to Frank's deeply ingrained scepticism and awareness of complex local politics, Laurence is a bumbler, outraged by petty corruption. He insists on trying to close the yawning racial gaps between the hospital staff. Moreover, Laurence becomes Frank's room-mate and the men begin what is a subtly homoerotic friendship, which Frank finds repellent, disturbing and attractive in equal measure.

Their relationship, like everything else that Frank encounters in this desolate location, meets with disaster. And yet it remains possible that the good doctor of the title is indeed Frank, who comes to realise that perhaps his only act of conscience is to remain working in the hospital where "the situation is dire and the prospects not good".

The Good Doctor offers a gripping read, laced throughout with powerful emotional truth and Damon Galgut's extraordinary vision.