Crash, Bang, Wallop!

Before I start I will say that the fact that I'm able to write this means I haven't lost the use of my arms, or hit my head so hard that all my food from now on has to come via a blender. For a brief moment yesterday this outcome was not a certainty.



The day had started regularly enough; I had packed my stuff into my rucksack and was trying to sort out various things in the clinic before flying out for my holiday. This involved sweeping my arms across the desk and depositing all the paperwork I still had to do into a large metal trunk. It can wait until the New Year…probably.



The roar of engines overhead indicated an immediate arrival and departure. The aeroplane thundered across the barren ground billowing sandy dust in its wake. Soon we were bumping along the runway before a roaring departure from terra firma and into the brilliant sun and bright blue sky. After a stop at another project to pick up some passengers we were skimming across the clouds to the missions base.Flying here is so standard it has become a little like a bus or a tube, I have become a bit blasé about the whole enterprise.



The plane slowed as we approached the tarmac of the airfield, the only place we land with tarmac. The flaps wirred into life, the ground rushed to meet us. I really wasn't paying attention. My book ('Rubbish' by Richard Girling) was very diverting and we would soon be on the ground and taxiing, and I would soon be off on holiday. So to summarise I really wasn't prepared for what happened next.



As the plane touched the ground there was a very loud bang. When I say loud, I think some of you in the UK might have heard it and wondered what it was. This was followed by an equally worrying 'wararah wararah wararah' noise. The plane shuddered violently and lurched across the tarmac. Up front, the pilot flicked a few switches and was engaged in a struggle with a plane intent on leaving the tarmac and becoming intimately acquainted with the airfields perimeter fence. As we careered onwards the aircraft adopted a sort of strange diagonal position, a bit like a bad skier trying to parallel turn.



Eventually, after a further loud bang, and more violent shuddering we began to slow down. By this point my skin that had turned the colour of Tip-ex and my eyes were the size of large frying pans. If I had had rosary beads (and, perhaps more importantly, been Catholic!) they would have been a pile of sawdust.



When a tire blows on a big plane like a jumbo jet you don't notice, there are loads of other wheels able to take the strain. Sadly I don't work in place that would accommodate your average 747. In small planes it is a big deal! We had lost one of the three wheels. As we got out of the plane, the damage was clear, a tyre, flat and shredded a landing gear that was sitting at an angle that made the plane look like it had been designed by a drunk four year old. There was also a very nasty new groove in the tarmac of the airfield. Nobody seemed to care about this.



My huge thanks, obviously, to the pilot whose skill prevented a much worse situation, but defiantly something I don't need to repeat.



Anyway, safe and sound, I'm off for a break until the 5th of January. I'm also having a holiday from blog. I'm sure you will all be too busy to read it anyway. Thanks for coming with me in 2006 and hopefully pick up where we left off in early 2007. Happy Christmas and New Year one and all.

---

Find Singles In Your Area Now With Match.com!

Triumph and Disaster

So a week at base camp, and the place that I would call ‘home’ out here.
With no outreach buddy anywhere to be seen I have been kept busy in the
inpatient department. A variety of staff holidays and, what in the business
is called a ‘high patient flow’ (i.e. clinic busting at the seams!) means I
haven’t exactly been idle. The basic figures are as follows. Discharge - 43,
died - 7, admitted - 58. Behind every number is a story, some tragic, some
remarkably uplifting; one of each to follow;

Yesterday we tried to resuscitate a twenty-eight year old man who had
advanced tuberculosis. He had been sick for some time. Sadly there was
‘something else going on’ which is what we term any condition that we cannot
diagnose due to a lack of facilities. Basically we went for hit and hope
treatment. Take an educated guess as to what it is and cross you fingers.
Inevitably we sometimes we get the calculation wrong.

The man was showing signs of acute liver failure and had begun bleeding
heavily internally. I managed to site an IV line and the blood that flowed
was very dark and thin, indicating he was not getting enough oxygen and the
iron level in his blood was dangerously low. A lab test confirmed as much
(Hb of 1.5, yes, I know, 1.5 for the medically minded).

Blood donors only come forward at the last moment and the only
people who donate are members of the immediate family. Sadly none of this
family matched the patients’ blood group. His condition nose-dived in the
mid morning. We struggled to rescue the situation, for every problem we
addressed another two would crop up. In the end the man became very
distressed and agitated, sensing, I think, that time was short. We gave him
a generous dose of diazepam and he gurgled, foamed and convulsed until he
was finally gone. Our national staff were magnificent, considering that the
patient was a personal friend of some of them. I can’t say it was anything
other than horrendous.

Earlier in the week we had seen a child with cerebral malaria.
He was very lethargic and didn’t flinch when we put IV lines into him, which
is never a very good sign. Round the clock observation and high doses of
antimalarials seemed to be getting us nowhere. I decided to have what is
referred to as ‘the chat’ with mum and dad. The chat can basically be
paraphrased, as ‘unless there is some sort of miracle your relative is not
going to survive this’. It is useful in preparing the family for, what is
often, the inevitable demise of a loved one, but it is not exactly easy.

Slowly, very slowly, the little boy began to show signs of
improvement. He began by moving an arm and sighing (as if he found the whole
thing a bit boring). By the next day he had opened his eyes and rolled over
onto his side. Today he was playing with his siblings, and grinning from ear
to ear, my whole year is worth it just for that.

Whilst the individual success stories are, personally, the most
rewarding many more lives are saved by prevention. This week there has been
a much-needed push to improve the care we give to pregnant women. The
newborn fatality rate here is astronomically high. Pregnancy and childbirth
are a leading cause of death in women. It is not difficult to see why. Most
babies are born at home with only a village wise woman (without any training
but lots of experience) in attendance. The babies are delivered onto a muddy
floor, they often aren’t kept warm enough, they may be two days walk from a
health centre should problems develop. The vast majority of mothers have
received no antenatal care whatsoever, and are very anaemic. A consequence
of this is that they bleed heavily and often die.

This situation is compounded by some damaging health beliefs that are
commonly held here. The babies’ umbilical corn is cut with a rusty blade and
the stump is often smeared in cow dung, leading to tetanus and infection.
For the first three days the baby is fed on goats milk, as it is believed
that colostrums is bad for the child. Establishing breast-feeding after this
is very difficult.

We only see deliveries in the clinic when all other avenues have been
attempted. The traditional healer, the old ladies and a multitude of wise
women have had a go at getting baby out and failed.

By this time the mother is often tired, the baby more often than not is dead
and there is precious little we can do about it. Destructive delivery is
often the only feasible option, and I can’t begin to describe what an
unpleasant business that is.

As an attempt to stem this lethal tide we have been constructing and
improving home delivery kits. These are kits given to pregnant mothers for
use in delivering their child. They consist of string to tie off the
umbilical cord, a razor for cutting the umbilical cord, soap for mum and
baby, cloth and blanket to wrap the baby in, gloves for whoever is helping
in the procedure and a large plastic sheet in preference to a muddy floor.
Simple but, all the research indicates, very effective

Their construction rivals Wembley stadium in terms of length and problems! A
committee of a few of us (being the only children’s nurse got me mired in
this particular adventure!) have met to discuss various aspects of the kit.
What do we include, what not to include, how to train mothers and so on. The
‘do we need a plastic bag for the placenta’ argument dragged on for weeks.
Finally resolved we began to give out the kits this week.

Obviously first on our hit list was the clinics staff. I held a large
teaching session for all the staff that wanted to come. I proceeded to open
up a kit, mime having a shave with the razor, I blew up one of gloves like a
balloon bouncing it up and down and took a bite out of the soap (which was
stupid).

My point being that if we don’t teach mothers how to use the kit we may as
well not give them out. It at least got a laugh and hopefully made the
point. I finished by telling them that as there were twenty of them there if
they each told five pregnant women to come and collect a kit that would help
to save the lives of one hundred babies and one hundred women. Back to
numbers again

So health interventions in there mega and nano versions this week, what will
happen next? Your guess is as good as mine.

All change please, all change

To grossly misquote Wilde 'to lose one outreach partner could be seen as a
misfortune, to lose another smacks of carelessness'. Of carelessness I am
clearly guilty. The revolving door that is the outreach nursing team has
sprung suddenly into life again! Francis has decided outreach really isn't
where he wants to be. This coupled with a very attractive masters degree
offer has led to him beat a hasty retreat. From resignation to departing
took less then ten hours.

It's obviously very disappointing but this isn't the sort of work you can do
if you aren't fully committed. In honesty he wasn't happy about the set up
here from the moment he stepped off the plane. And towards the end of our
time together it began to show. It has been a bit difficult, but everyone
has been really supportive and reassured me that it isn't my fault I was
beginning to wonder!

I've been keeping myself busy by helping out in the base clinic which is
starting to resemble an Accident and Emergency waiting room with patients
almost sitting on each others laps! The edited highlights of my week to
follow in the next few days.

A, now much needed, holiday is fast approaching. I actually escape next
Friday for a few weeks, though plans are a little fluid at present.

Are You Chicken?

I want to honour a food that I’ve grown to loath. It’s the perfect fodder
for aid workers toiling in war torn areas, such as this one. Arriving in its
own bulletproof vest, know commonly as a tin. It has tried to make its mark
on the culinary landscape of many a project.

In fact there is only one thing holding this great food back from global
domination, at least when it comes to feeding those who have little option.
It is practically inedible. I refer to chicken luncheon meat.

Even the name is misleading. Luncheon is the term that, the queen and
well-to-do pearl encrusted Daily Mail readers use to describe the meal in
the middle of the day.

This food would not exactly be on the menu at Buckingham palace. It would
struggle to get a look in at the workhouse in Oliver Twist. Certainly if it
was, Dickens great masterpiece would have taken a very different direction.
Young Oliver, carted off, lethargic, green and vomiting, to hospital after
managing to finish a portion of the offending item. ‘Please sir, can I have
a stomach pump?’

Created by Regal of Mauritius it is 260g of pure bile. It arrives in a
cylindrical tin an inch tall and two inches in diameter. If I had my way it
would go straight from factory to landfill without ever being offered for
human consumption.

The picture on the front of the tin displays what appears to be a large,
pinky-orange, sliced sausage surrounded by, rather tired, looking lettuce
and tomatoes. It even has the audacity to site this as a ‘serving suggestion
’. What exactly are the manufactures suggesting? Remove from tin, cut into
bits and put with fresh food in an effort to make it look appealing, not
exactly Jamie-flippin’-Oliver is it?

The ingredients listed, thankfully, include chicken meat, which I must say
came as a bit of a shock. Red rice and phosphate E451 are present which I
would feel happier about, if I knew what they were. Finally, in this
concoction, is the sinister sounding MSG E21, which sounds like the sort of
thing used to kill off dissident Russians.

I made the mistake of bringing a tin to outreach with me. By the end of the
week we were running a little short of grub and I decided to try an
incorporate it into a lunch (eon). I felt this was particularly important,
as I had just had a bit of a go at the clinics pharmacist for letting a few
boxes of drugs expire and the luncheon meat was a month of expiry.

I broke the tin open with a rusty opener and dug in with a spoon in the way
a normal person might eat yoghurt. I could just about see the rings of the
base of the tin when I began to feel very sick. Even as a student I was
never driven to try cat food, however chicken luncheon meat is as near as I
ever want to get. I fed the rest of the tin to an emaciated passing dog, who
didn’t finish it.

The fact that a poor animal has had to sacrifice its life in the creation of
this product makes even this carnivorous bloke come over all Linda
McCartney. I’m sitting with a tin in front of me as I type this; (funnily
enough we have stacks of the stuff in the store!) and I’ve just noticed one
slightly redeeming feature. The product claims to be Halaal, meaning that a
huge portion of the world’s population is able to see exactly what I’m
talking about for themselves, multi faith excrement indeed.

So here's to you Regal, creators of a food that even people who are really
hungry would rather chew on broken glass than eat. Chicken luncheon meat I
salute you!

Ten Things I’ve learnt Since Being Here.

I’m nearly at the halfway mark and I’m in retrospective mood. So I thought I
’d write down a few truths that have become apparent since my arrival. In no
particular order here we go……..

1) The notion of ‘sterile’ is a relative concept.

2) Any medical device, including IV lines, Naso-gastric tubes,
catheters etc can be made to attach any other medical device if you push the
two ends together with enough vigour!

3) Any food in a tin (cheese, mackerel, peaches etc) can become
strangely addictive.

4) Chicken farming is much more complicated than it would first appear.

5) People will work through the most extraordinarily difficult
circumstances with, almost nothing, to keep a clinic open. And save hundreds
of lives in the process.

6) How the western/‘developed’ world deals with the African ‘problem’
leaves an awful lot to be desired.

7) Having said that foreign aid CAN make a difference if (and it’s an
oft forgotten ‘if’) it is directed in the right way. When this does not
happen it often does more harm than positive good.

8) The IPOD solar charger is beyond criticism.

9) Sometimes even the simplest improvement in practice can yield
fantastically impressive results.

10) The world isn’t fair. I think I knew this already, but the last few
months have confirmed it.

Cometh The Hour, Cometh The Man.

Moses (of bible fame) was a very interesting bloke. His ability to cast
asunder large bodies of water would be particularly useful to many an
outreach expedition. Whilst his namesake, as far as I’m aware, is unable to
do this he did manage to save both the clinic and my frayed nerves!

One of the staff, David, had mentioned that there was a health worker who
lived not far from the clinic. He hadn’t worked for a few years and had been
doing other things (attending theological college for one) but he was
currently not working. David hadn’t finished his sentence by the time I had
written the letter to this man inviting him for an informal chat.

Moses, the health worker (Not the bible bloke, otherwise I really would have
something to write about!) strode through the early morning mist. He greeted
me with a bone-crushing handshake. He was a tall man, with a short beard and
voice ten octaves below baritone. It wasn’t so much as voice as a low
rumble. The sort of tone that could really put fire and brimstone into any
sermon.

As we spoke the sun broke through the clouds and cast the clinic in a
brilliant white light. A heavenly sign? I hoped so. A few moments later all
was well, the clinic had a new supervisor and I had stopped at least some of
my hair turning charcoal grey. We had been eight hours from closure. I never
want to be that close again.

Moses started the next day and whilst there were a few bits that had lodged
somewhere near the back of his brain they seemed to jump easily enough into
his working memory. I am sure he will be fine.

Very pleased with ourselves we half walked half skipped back to base, where
I am now, chilling. The next few weeks’ movements are a little up in the
air, but a holiday is defiantly on the agenda.

Spot The Healthworker

Regular readers of my musings on this blog will be aware that about a month
ago I had an outreach visit that involved a human resources nightmare. I had
hoped that the whole thing had rather blown over and I wouldn’t need to
discuss it again. It didn’t so much blow over and blow up!

Our outreach clinics are overseen by a supervisor who has been given nine
months training in all things medical and sent out to run the clinic and
treat whatever falls though the door. The rest of the staff effectively
operate in support of him, doing malaria tests, giving out medicines,
fetching water etc etc. Anyway, to say this member is crucial to the clinics
survival is to say money is reasonably important to Donald Trump. Without
this health worker the clinic does not open. Full stop.

A short version (the long version might put me in therapy) is that the
supervisor of this particular clinic managed the following during the last
visit;

He picked an argument with us for absolutely no reason at all. Then, when
informed in the most reasonable voice I could muster, that this was
unacceptable and that he should consider his behaviour in future he walked
out in an overly dramatic, eye-rolling strop. Walked out, I might add
straight into the arms of another NGO and a near tripling of his salary.
Just be glad there weren’t any large or sharp objects in the immediate
vicinity. I was a tad peeved.

So this left two outreach nurses playing an increasingly frantic game of
spot the health worker. Initially we solved the problem by dragging a
substitute on from another clinic. The problems really started when he also
(for valid enough reasons) had to leave very quickly too.

We found ourselves hot footing it back from one outreach site and straight
onto a plane to rescue another. Things didn’t go quite according to plan
from the outset when the pilot keyed the wrong coordinates into his GPS and
flew us in totally the wrong direction. Thankfully Francis was much more
awake than I was and pointed this out. 12,000 feet is not the sort of
environment that facilitates easily stopping to ask for directions. After
scrambling around with maps we resorted to flying to somewhere near it
(which we had the coordinates for) and circling until we spotted the
village. This accomplished the plane was onto the dusty savannah in a matter
of minutes.

The first thing to do was to hold a staff meeting. We informed all the staff
that we would be seeing the patients ourselves for the week and sorting out
the health worker vacancy at the same time. In truth it had all gone (to use
the south London vernacular) pear shaped. We hadn’t a clue where we were
going to find someone. The situation was looking bleak. Clinic closure and
redundancy loomed large. I don’t think either of us slept very well.

Some very sick patients compounded this state of affairs. The worst was a
two-week-old baby who attended the clinic and had been seen by both of us.
He looked very well, he was feeding well and mother had few concerns. She
had actually attended with her other child, for her to be seen. The next day
the mother came back, this time with just the baby in a basket. As I took
the covering off the basket it was obvious that things were very serious. A
confirmatory listen with the stethoscope was the evidence. The babies’ heart
rate was extremely slow and the breathing was shallow and gasping. Fifteen
minutes of frantic efforts were not enough and, sadly, the baby passed away
as I held him.

There was no temperature and the child seemed well nourished and cared for,
I have absolutely no idea why the baby died. Infant mortality statistics
look a whole load different when you see them in flesh and blood. The
parents took the child home in the same basket that they brought him in.
Another Tuesday morning in Africa.

The people here accept child death as a norm, of course losing a child is
unimaginably painful, and I know they feel grief just as acutely as anyone,
but
children dying here is also greeted with a sad resignation, rather than
surprise.

A deeply depressing few days indeed, to depress myself further I looked
through the clinic records and found that many of the patients lived hours
walk away from the clinic and that its closure would cut a swathe of them
off from any healthcare at all. Furthermore the clinic was seeing patients
who were critically ill. I estimated that closure could cost 150 lives a
month.

The land where 'yes' is 'no' and 'no' is ......um...

“Yes” he said, “no, lets just get this clear, you are saying the pump is
fixed and working well,” I said “yes, yes” he said, “new pump, put in by
UNICEF. very good”. These words were still ringing in my ears as Francis and
I stood by what was a very new but (as might have been guessed) very broken
water pump.

The meeting with the tribal chief had been a useful one in that none of what
he had told us about the outreach clinic accurate. In fact in almost every
case the reverse was true. The people weren’t getting sick from drinking
dirty water (they were), the clinic fence had been repaired (it hadn’t) and
there were no military forces in the area (again, a bare faced lie!!).

The walk to the outreach site was uneventful, gone is the mud, replaced by
rutted tracks and smooth sandy paths. The sun is burning the vegetation away
from around us, with all the delicacy of a blowtorch. Not much has remained
unaffected and everywhere is yellow and dying.

As we walked along we passed though a village where the population seemed
very pleased to see us. Laughing could be heard in various houses and from
behind trees and bushes. In the distance men danced around and fell over. It
became obvious; as we got closer that everyone in the entire village, over
the age of four, was drunk.

The harvest season has just finished and the people here are able to make a
sort of wine homebrew. Clearly this village had enjoyed a bumper crop. Even
more impressive that they had managed to reach this level of alcoholic
stupor by nine thirty in the morning. It was like Liverpool on a Saturday
night. In some ways it might have been fun to stay and see what happened
when the party really got going! Another time.

The outreach clinic was running very well despite numerous problems. The
most comical was a difficulty experienced with weighing the children. In
order to do this we use a pair of dungaree shorts hung from what looks like
a butchers scales, suspended from the branch of a tree. Unfortunately the
bloke
doing this had a nasty habit of hanging the scales upside down. This led to
some babies weighing in at a stonking 25 kilos. A marker pen and a ‘this way
up ‘arrow soon solved the problem.

Statistics will, if you believe them, tell you anything and in this case I
can tell you exactly what date the pump broke (Wednesday November 3rd just
in case you’re interested). Why can I tell you this? Because three days
later we had an 67% upsurge in cases of gastroenteritis, we saw 33% more
wounds that week, caused by having to walk through a swamp to get to the
deeper drinking water, and a whooping 56% increase in eye infections, from
washing with, yes, you guessed it…filthy water.

The patients were drinking their medicine in the clinic with water that
looked like the sort of stuff found at the bottom of the sink after washing
up (for those of you who’ve lived with me, yes I am aware of what washing up
water looks like!). Putrid is the only way I can describe it. What is
particularly ironic is that we are giving them medicine to treat, amongst
other things, diarrhoea. And then we get them to knock it back with water
that you wouldn’t wash your car with in the west. I’m beginning to bore
myself about the water so I’ll stop now. Point, exhaustively, made.

The saddest case we saw involved a little girl who had been shot in the hand
during fighting four days earlier. The bullet had taken away a chunk of skin
at the base of her thumb and blown one of her fingers clean off. She wore an
expression of confused bewilderment, too young to understand the nature of
what had happened to her. As I lay awake that night listening to the
sinister rattle of machine gunfire I wondered what would turn up at the
clinic the next morning. Nothing did arrive, the optimist in me would like
to think that’s because no one got hurt. The realist thinks it’s probably
because they were beyond our help.

The staff themselves were all doing various jobs with an impressive degree
of efficiency, which considering we hadn’t visited in months, leads me to
think that actually it would be better if we just stayed at home and stopped
interfering. We were even able to promote a few which was fantastic for
them, and, I hope the clinic.

The high moral was shattered with dreadful Mozart cover version - the ring
tone on the satellite phone, which I can’t manage to change.“Hi Marcus, it’s
me (the boss). Listen there’s a bit of a problem, we’ve had to close one of
the clinics, the supervisor has resigned” “Resigned? You’re kidding.” “No”
she said. And, she meant it.

H2 oh!

I am going to have a Geldorf moment, it is my first for a few months. I
think it's really in important, and I don't mean 'I think it's really
important' in a David Cameron 'I'll say anything is really important, just
as long as you vote for me' kind of a way. By all means ignore my rant and
come back in a few weeks when I've done some more outreach.

The chances are, as you read this, you are sitting fairly near a tap. And if
you were to get up and get a glass of water it would not cross your mind
that the water you are drinking could kill you.

Envisage for a moment that the water company decided one day to stop
supplying water to your house. (For those of you who pay vast sums of money
to Thames water every year for truly appalling service this won't require a
giant leap of imagination!)

Now picture a scene where, not only do you not get water to your home, but
not to the street where you live or even the distance between you and your
place of work.

And now imagine your nearest source of clean water is three hours walk away.
And you can't drive because there isn't a road. And even if there was, you
haven't got a car anyway. Part of the route involves crossing a swamp.

If you think this situation is bad, we haven't really started yet.

So the water pump is three hours away, and obviously it's not just you in
this predicament. So, you spend vast parts of your day either walking to the
pump or queuing to use it. You also need to carry the water you've collected
back, in a cracked, plastic container that splashes your precious clean
water across the countryside. Full, it could weigh up to twenty kilograms.
Oh, and did I mention that it's forty degrees in the midday sun?

However there is an alternative. Just near your house is a moderately sized
swamp. Obviously, the water isn't clean (in fact it's the swamp you use as a
toilet) but it's much easier to get to and you can get much water everyday.
So you decide to use this water instead. Dirty water is obviously not ideal,
and lo and behold your children become sick, and so do you. So your walk to
fetch water is punctuated by regular bouts of infective diarrhoea and
vomiting. Furthermore because you didn't get any type of formal education
you are completely unaware that it is the dirty water that is causing all
this.

In order to solve this problem you hear that the advice from the health
service (which consists of a single clinic two hours walk away) is to err.
drink more water.

If you live on planet earth you have a one in three chance of drinking water
from an unsafe source. That a situation like this should be the case in the
early twenty-first centaury should shame us all.

I'm away again tomorrow so no blog for a few weeks. Sorry that was all a bit
heavy. Go and have a glass of water.

A Bugs Life - The Story of Atomic Geckos.

I was actually going to write about something else this evening, but my mum
e-mailed this afternoon and said she wanted to know about the wildlife. I
realised I hadn’t scribbled much on the various creatures that inhabit this
area, a glaring omission indeed. So here in short is the low down on the
various aspects of wildlife here. (Chickens and cows excluded)

I think the real reason I haven’t mentioned anything about the animals here
is that it’s a bit like asking me about modern art. I haven’t got a clue
what I’m supposed to looking for or at! There are birds here of various
shapes and sizes but I haven’t the slightest inkling what they are called.
During the last walk we did I commented on the goats in the clearing next to
us. I was informed they were, actually, sheep. In short you’ve asked the
wrong bloke. But anyway, here goes!

As well can be imagined this is not the sort of place that people come on
safari. I don’t spend large parts of my outreach walks standing on the side
of the road watching open topped Landrover Discoveries with kaki clad
tourists, speed past.

The water situation prohibits and of the big five - Elephants, giraffes (I
can’t remember the other three…. is one of them skunks?) from being here.
The land simply isn’t stable enough to support large numbers of lumbering
animals (Apart from me!). It fails to support human life adequately.

We do a good line in snakes, of the toxic and non-toxic variety and the
clinics sees a fair few bites from both types. Before this the only bite
from an animal on a human I’d ever seen had been a woman who had been bitten
by a squirrel. Curiously we also see a high number of people who have had
snakes spit in their eyes, which I’m told feels like someone has just thrown
boiling water in your face.

However where this area really excels is in the realm of insects. At primary
school this group were referred to as mini beasts. Less of the mini here
sadly. You only need to leave a torch on for a few moments to see swarms of
various different creepy-crawlies congregated round it. As I’m sitting here,
a lamp on the table near me has hundreds of creatures buzzing around it as
if at a rave.

By far the most feared of these are, of course mosquito. Responsible for
more deaths than all wars in history combined the mosquito wreaks havoc
daily. The particular variety here seems to have the ability to treat
repellent as a mild inconvenience and punch through two layers of clothing.
In fact nothing, proves any deterrent at all and you get the feeling they
could probably bite you if you were dressed in a suit of Kevlar.

To say this area has a fly problem is to say George Bush is a slightly
incompetent president. I’ve just about got used to them crawling everywhere
except my face. Maybe in a few months I won’t care about that either. The
local people here seem able to ignore them completely. They adorn the
childrens faces like bizarre jewellery. Occasionally on a walk I’ll swallow
one by accident, which I supposed provides me with some much-needed
sustenance, but isn’t to be recommended if you can avoid it.

The other much feared bug here is the scorpion. Able to punch so far above
their weight it’s laughable, they are a real problem. No bites for me yet
but I’m told when it happens you know about it. Thankfully actual fatalities
are rare, though it does paralyse the limb affected for a while, which can’t
be a pleasant way to spend an afternoon.

The way Iâve found to deal with them is to encourage them to the floor and
place my foot on top of them and then scrape backwards in the manner of an
irritated donkey, they tend not to recover from this method.

Speaking of our sad grey friends, donkeys are also abound in number, though
it’s difficult to work out exactly what they do all day apart from wander
around the place looking melancholy.

And finally the humble gecko, possibly my favourite animal of all time, for
two reasons.

Firstly they eat flies and so in many ways we don’t have a fly problem but a
gecko shortage. Secondly their use of Van-Der Waals theory of atomic
attraction to climb walls and ceilings. Yes, I’d never really thought about
it either.

For those of you unfamiliar (as I was until it was explained to me last
night) it goes as follows. All atoms exert a small amount of attraction on
every other atom. Geckos have microscopically fine hairs on their feet and
an excellent weight for surface ratio meaning they literally stick
themselves to the wall at an atomic level. So that’s one for the pub
tonight.

On that note, the various arachnids that were finding the lamp attractive
are now beginning to congeal around the light from this laptop so it’s time
to leave you to type gecko into Google and see if I’m right.

Causing a fence

Bad, bad pun, not a good way to start, oh well never mind. I suppose really
this is a tale of two clinics (a better title).

The week started well, (after the slight hiccup over English speakers). The
walk to outreach site number one, which had been so torturous before (See
‘Take a walk on the wild side’) was now much dryer and the travel time had
halved.

The first site is stuck in a rather unfortunate geographical position.
Firstly it sits on an artery route to a major city. (Not that there is
tarmac or anything, it’s a path, that could just about accommodate a quad
bike) and secondly it has the only hand water pump for three hours walk in
any direction.

Naturally the clinic attracts a significant amount of its patients from
those who were just passing through on other business and fancied having a
health check. This issue was one of the hardest things to understand
medically since arriving. Having done a load of courses and reading (OK,
well a bit of reading!) I expected everyone who walks for hours to get to
the clinic to be at deaths door. It has taken me months to appreciate that
(long pause, for the sake of drama) some of the people who come to clinic
aren’t really very sick at all. As in the UK a good number of people turn up
with colds and minor ailments. The first few patients I saw like this got
every test I could come up with, on the assumption that they can’t have come
all this way with a snotty nose. But people, apparently, do.

Because so many patients live far from the clinic, or are just passing
through, there is no chance of bringing them back for a review and
complaints that require a repeat visit, The notes on dressings, meningitis
treatment, and therapeutic feeding are littered with people who turn up for
the first visit and never return, what happens to them, we are unable to
determine, but its not good news.

To further make things difficult, recently, the clinic fence was dismantled,
for reasons too laborious to go into. The staff now spend a large percentage
of their time herding cattle, dogs, and sheep from the clinic compound,
rather than actually doing what they are supposed to be doing. The odds are
therefore very much stacked against this place operating with any great
success at all. In fact it is the best of all four sites by some distance.

The cattle were causing untold damage to the clinics buildings. Priority
number one….build fence. I’m not sure I went to the ‘how to build organise
the building of a fence’ lecture at university. Must have been on a Monday
morning.

So not a problem I’ve faced before, my dad is an engineer though, so I hoped
the genes might help... they didn't. We convened a meeting with various
village
officialsand others, including a large cow, who wandered though the clinic,
over the reamains of said fence to hear the discussion. Through them,
(except
presumably the cow) the village was alerted to the fact that we wanted
construction materials, primarily sticks with which to build.

It was about six thirty the following morning when I heard the loud crunch
of a pile of sticks fall from their position atop a ladies head onto the
ground. I stirred, rolled over and went back to sleep. By the time I
actually got up it was eight thirty and the clinic compound was filled with
hundreds of bundles of sticks. The task of ascertaining who brought which
bundle and haggling a price began in earnest. After an exhaustive two days
we had enough materials to begin construction. It’s funny, seven months ago
if someone had said I would be spending my days organising a fence in
deepest Africa I don’t think I would have quite believed them.

We left the clinic four days later with a whole load of construction
projects well under way and having treated some very sick people into the
bargain. It will be very interesting to go back and see how they’ve got on.

Walking away into the early morning sun, the staff waving us off I had a
great feeling of a job well done… unfortunately the walk led us straight
into a human resources hurricane.

Before all that, the walk to the clinic was fascinating. An anthropologist
might have exploded with excitement. We passed through tiny settlements of a
few mud huts and, invariably somewhere cleared for cattle. Hushed whispers
of ‘white-face’ (obviously in the local dialect!) could be heard as we
passed. The children greeted us with curiosity and mild terror, so strange a
creature were we. This was a place that had not changed significantly for a
thousand years, was totally self-sufficient and won’t see either running
water or electricity for a generation at least. At one point we had to cross
a large, deep river. I regretted accepting small‘runners’ to carry our
equipment
and drugs. A few of them almost had to start swimming!

The clinic was surrounded on all sides by green, flat, grassy savannah. It
looked like a becalmed emerald sea; in fact, apart from the odd acacia tree
and mud hut it could have been rural Holland. A group of vultures spiralled
overhead as if on some invisible helter skelter. You would think a place
like this would feel peaceful actually the only word I can use to describe
it was desolate.

From a stress point of view, this was far and away the most difficult
outreach visit I have done, and not because of any of the patients, in fact
I barely clapped eyes on one for the first two days.

I don’t want to go into the whys and wherefores because frankly it’s not
worth any of your time, or anymore of mine, discussing it. Suffice to say
that I’m not sure a bloke has had to deal with so many problems, all at the
same time, since Steve McQueen got stuck at the top of the Towering Inferno.

The clinic was seeing a great number of patients from surrounding
settlements, though the length of time people travel to come is
unbelievable. Seven or eight hours is not uncommon. After one particularly
hard day I came back and began idly fiddling with the communication radio we
have. As I channel hopped further up the channels a loud, clear voice
brought the machine to life. “This is the BBC, here is the news” And so a
brief contact from the outside world. The top news item? The removal of
Donald Rumsfeld, the day had improved immeasurably, only the rest of them to
go!

At least, now, most of the issues have reached a conclusion and we can look
forward to going back in the future and actually doing something patient
related, ever the optimist me.

Finally seem to be getting into the swing of outreach, and, despite the
aforementioned stresses finding it a fantastic challenge. I didn’t want an
easy assignment, and I’m pleased I haven’t got one.

A few days chilling in the base (though I rather stupidly volunteered to be
on call tonight! Duh!) Then off for some more.

Back in Business 2

The airstrip was full of people; boxes unloaded then put back on again, a
goat or two, children running in all directions. There is a word for this
type of manoeuvre. The word is chaos. Luckily most of our outreach stuff was
unloaded without due incident. Even more fortunate was the fact that the
only box that was accidentally left on the plane was full of all our
paperwork. So I don’t have to worry about that for a couple of weeks. We'll
catch up with it at the other base.

Its great to be back here, and working after the stagnation of last week. We
are all packed and ready for an outreach exertion tomorrow. The boxes we are
taking litter the floor around me. Again chaos is a predominant theme(Maybe
it's me?). Hopefully we will get to two outreach sites, which means I’ve
been to every site at least once. Considering I’m a quarter of the way
through my time here I’m not sure that is anything to be particularly
pleased about. A lot of it has been unavoidable, but it still isn't very
good.

Anyway I’m sure they’ll be lots to write about on my return. I hear the
water may be waist deep for a few hours. (So much for dry season!)
Thankfully I’m absolutely recovered from the fun and games of last week so
here's hoping I only make an appearance in the monthly medical statistics
once! No e-mail so no blog for a week or two.

Contact!

I realised that there was no method of Rhonda (or anyone else for that matter) who doesn't have my e-mail address contacting me. This may have inhibited the responses to my plea slightly. In view of this I have set up an e-mail address just for you.

So if you are reading this and fancy dropping me a line please feel free! I won't be able to check it very often (internet cafes are limited in the middle of the sand pit I call home) but whenever the chance arrives I'll do my best and who knows, I might even reply to a few of them!

You can contact me at email year_africa@yahoo.co.uk

The best laid plans of mice and men….

I’ve discovered a few truths since being here. The most important so far is as follows; How an outreach jaunt goes doesn’t depend so much on the plans made, or the place you’re visiting, but on factors totally out of your control. In fact you could spend days and days in planning meetings trying to organise everything to the finest degree and still find something like the weather, or water waiting with an enormous spanner to throw gleefully in the works at the last moment. Anyway, I’m getting ahead of myself.

The week had started with a nasty jolt. The team opening the base clinic had been working very hard to get things moving again, with great success. After the initial rush of opening, things were starting to settle a little, though the pace of work was still frenetic. As I was kicking my heals a little I offered to cover the night shift. This didn’t mean very much except that if any of the patients deteriorated overnight I would be summoned by one of the national staff. I had just drifted off to sleep when I was woken up.

The three month old little girl was lying under a mosquito net on the examination table. She had been admitted for malnourishment and a slight chest infection but had begun to feed. She lay motionless as I approached the table. I lifted up the mosquito net and was confronted by a still warm, but sadly departed, baby. With only a head torch as light I conducted a fairly rudimentary examination. No chest movement. No response to pain. A few murmurings from the heart but nothing that could be called a 'heartbeat'. In Europe this would mean action stations with state of the art intensive care facilities and assorted paraphernalia and, if I’m honest, probably the same result, just a bit delayed.

Here anything like that isn’t an option, so I removed the feeding tube, the IV line and closed the baby’s eyes. I then took a deep breath, emerged from the mosquito net and sat on the floor with the mother and the health worker. I began, what has become a now oft repeated paragraph, starting with my condolences, the sickness of the child she had lost and it being Gods will (which is how things are viewed here). Oft repeated but it doesn’t get any easier.

The next day we assembled the runners who would help us carry the things we needed to our outreach location. It’s only recently that I’ve discovered that the word ‘runners’, when translated, actually translates as 'woman of ill repute', which goes some way to explaining the quizzical looks I got when I asked someone to organise eight of them to turn up at the compound at six thirty in the morning.

This theme of the seedy continued when we arrived. The front door of mud hut we were staying in had the words “Welcome Brothel” scribbled in felt tip pen on it. Closer examination revealed the ‘L’ of brothel to be a poorly written ‘R’. A huge relief all round as I’m not sure that the former is the kind of image that any aid agency would want to portray.

The walk to the clinic had been uneventful except for a very large river that required wading through with my worldly possessions held above my head. To everyone’s huge amusement I was savaged by a leach as I emerged. The only method of dealing with this effectively was to stamp on my own foot where the annelid was making very successful efforts at veinapuncture. This, in a single effort, scattering the unfortunate leach in three different directions.

The fact there was a clinic to visit at all was remarkable, the fact it was actually thriving was humbling. It was another that had been looted and damaged by fighting and hadn’t had a visit since May. In fact no-one I knew had ever been there. Many of the staff had ‘run away’ (a term used rather, in the same way as Chile's 'Disappeared') and it was operating with half the number of workers that it should have been. One member of staff was doing three jobs all at once (My friends still working in the NHS are entitled at this point to exclaim “... and ?”) staff were running from one hut to the next and then back again in a giddy whirl.

First job; Employ more staff which was easy until we came to the job that required the person to count the drug tablets into bags for the patients. We weren’t able to find anyone who was able to count above fifteen in the village, who wasn’t already working for us. A work in progress that one. We'll try again next time.

The week was spent rebuilding the clinic fence, seeing a variety of patients and having meetings with various chiefs, headmen, and village elders (and yes there is a BIG difference between them!). I’ve become more attuned to the body language they will adopt if they like what I’m saying and when they don’t. Generally, spitting on the floor is good news, clicking with the back of the throat is excellent, and falling asleep means their bored. I’m not surprised if some of them fall asleep as they always insist on having the meetings outside, in the middle of the day and they always go on for hours.

However at the end of it all we’ve normally agreed something and we normally get something for the clinic out of it. Generally, the longer meeting, the more things the clinic aquires. The marathon meeting of Wednesday, which lasted nearly three hours yielded help with a fence and airstrip clearance. But at times I found myself trying to avoid joining some of the junior headmen in blissful slumber.

The week took a bit of a downturn next. The water quality in this area is abysmal, leading to many of the diseases we treat at the clinic. Despite the fact that the water we drink is filtered, boiled, chlorinated and blessed (OK, I lied about the last bit!) occasionally some little nasty can slip through.

Unfortunately it did on this occasion and I became another health statistic. Hence the week was cut a day short and I find myself back in the missions’ headquarters on a few antibiotics and replacing what the week has taken out. Did the man who invented oral re-hydration salts get a noble prize for science? If he didn’t, it’s a fallacy!

I’m much better now looking to get back into the thick of things early next week. It is all a bit frustrating. But I guess you can’t work somewhere with so many diseases wafting around the place and not expect to pick up one or two along the way! Still no contact from Rhonda.

‘I Helped Rhonda Celebrate The Big “40”

To quote a character from the film ‘Shooting Dogs’ (an excellent, if difficult, film about the Rwandan genocide) I sometimes feel I’m starring in my very own Oxfam commercial! With this in mind I thought I’d scribble a little bit about some of the clothing worn here, and it’s not quite what you’d expect. (I’ll explain why it is that I have enough time to sit and muse, and at such length in a later blog).

The ‘average’ citizen of this country spends very little of their outgoings on clothing, primarily because they have very little ‘outgoing’ at all, this is a very much subsistence based economy. So many of the clothes are repaired, recycled and in many cases re-adjusted to suit the needs of whoever happens to be wearing them at the time. Football shirts are a predominant theme. I remember a big charity campaign a few years ago for football fans in the UK to donate their old team football strips to Africa.

Well, to all those on windswept terraces across the nation, you can rest assured that, at least some did indeed arrive as intended and are being put to good use. The fact that the clubs have only recently signed some of the players whose names appear printed on the back of the shirts proves two things. How quick the global distribution structure can be, even to the most remote places. It also proves that football clubs are just as tight fisted as ever and change their strip before you’ve even had time to put the last one on!

Obviously the bigger clubs sell more shirts and by default more end up here but I did have the unbridled joy of seeing somebody wandering round in a very old Bristol city top. It is also an interesting comment on how remote, and cut off from the world this area is, that none of people wearing them have any idea what they are. None of the children playing football on the airstrip have ever heard of Ronaldo or Beckham let alone seen them play football.

To say it stops at football shirts would be to do the others of you who donate things a disservice. Whoever played Wake College netball team ’95 and didn’t feel the need to keep hold of their commerative t-shirt, sleep easy in the knowledge it is being well worn here in Africa.
Somebody spends every day expressing to the world his love of Paris and another, his devotion to 'Kid Rock'. A place and a person unheard of here.

Which leads me to conclude with perhaps the most bizarre of them all. A pharmacist in the place I work spends a large percentage of his days wearing a red t-shirt with ‘I Helped Rhonda Celebrate The Big 40’ emblazoned in large white lettering across his chest.

I sometimes lie awake at night with the questions this throws up, spinning round my head. Who was Rhonda? When was she 40? Why did she feel the need to have t-shirts printed? Why did she need ‘help’ to celebrate? Was her ‘Big 40’ a party to remember or just a few mates and a bowl of twiglets affair? Primarily of course, how on earth did that T-shirt get here?


At this point I’m going start sounding like someone from the national missing persons help line but anyhow, if you were at Rhonda’s big 40, of better still, if you are Rhonda herself, please get in contact, and tidy up some very loose ends.

Back in Business

So after a long flight, and then a pause for a night stop and then more
flying...... I'm back. I'm currently in the second base that we operate
from. It
has only just been re-opened and everything is still very much in it's
infancy. As for the outreach locations I've only visited one (see 'out on my
own') and that was a while ago, so the simple and most accurate answer is
that your guess is as good as mine as to what state we will find them in.

I'm pleased to report that rainy season is drawing to a close. It still
rains but the gaps between each storm has widened considerably even in the
time I've been away, (It last rained on Wednesday). This should make the
walking easier under foot but the heat will now be a problem. In fact in
many ways it seems we have swapped one set of problems for a whole load of
new ones!

The ground is starting to resemble what I thought it would be like here all
the time. Slowly the greens are turning to browns, soon to turn to scrubby
dessert conditions. A long hot 'summer' stretches out before us.

The other thing to report is that we have also had a change of personal. My
first outreach buddy has decided outreach really wasn't for her and gone to
work on another project. So Suza the German has become Francis the Kenyan.
Luckily for me he's done a few projects before (though never outreach). We
are the first bloke outreach team anyone can remember here, so we had better
do our gender proud!

At present we are stuck in the base, the reason for the delay? A satellite
phone that doesn't have the right SIM card. So 21st centaury technology
is being rescued by a medieval solution. A man is
running from another base with one! It will take him two days.

Still, as can be imagined, I don't think I will be sitting twiddling my
thumbs doing nothing, as the task here is the wrong side of enormous.

Thankfully on my return I've found most of the problems that I left have
indeed been sorted out by somebody else, perhaps I need to go on holiday
more often!

All Guns Blazing

Well, I thought the last entry was going to be the ... er ... Last (!) for a little while. But the saying about other plans and life happening is becoming more pertinent every day.
I was taking a bit of a stroll in Nairobi, through the downtown area, full of high rise buildings and the normal sights and sounds of any modern metropolis. At this point, and quite close to me, there was a commotion by the side of a bank. People began running in all directions. Not long after this I heard the very loud, very close, unmistakable sound of gunfire.

It's perhaps an indication of how long I've been out here that this didn't particularly worry me, and, really rather calmly, I simply popped into the first shop with an open door, as the shooting continued. As I cowered with everybody else behind the counter I looked around me I realised I had made a fundamentally bad choice when it came to a choice of venue to hide from armed robbers. Being, as I was, in a very large jewelry store!

Another few shots and it was all over. As I emerged back onto the street (having first got a new watch battery from my new found sanctuary) it was as if nothing had happened. Apart from some men walking around with unfeasible large machine guns. I later gleaned more information on the evening news. The police had apparently simply shot the three robbers dead. Which saves on all those messy things like criminal justice.

Anyway after all that excitement it's time to go back to a place where I half expect events like this. I'm just sat in a internet cafe at the moment, using up the last of my cash, and listening to africas favorite crooner... Yes that's right.... Billy Ocean's musical empire seems almost infinite! I wonder if I've enough cash left for an album?? (note to 'self, don't even THINK about it!)

Here And Back Again

‘Oxygen cylinders and fire extinguishers’ said a very important looking sign on the cupboard in front of me. As our aircraft made its descent into Nairobi I hoped the firstly we didn’t have need for either and, if we did, that it was easy to tell which bottle was which!

So my time in Lamu has come to end and (to quote a famous wit whose name I can’t remember.) I’ve completed the forth corner of my triangle. Back, almost, to where I started. The last day in Lamu was spent walking along almost a third of the island along a glourious beach. For at least half an hour the only other people were vague spots on the horizon. Brilliant blue water and warm sand as far as the eye could see. As previously stated, if Lamu is somewhere you want to visit the time is now!

So tomorrow will be a mad dash round the best in shopping Nairobi has to offer before heading up up and away again and back to work. I may not be able to blog for quite a while now as I may go straight back to an outreach site. But as soon as I can I will let you know how it is all going.

Lamu

The sight of Mombassa in the rear-view mirror was indeed a relief. There are only so many times someone can try to sell you junk or drugs before it becomes a bit irritating. We took a detour on the way to the airport, to the ruins of an old Arab settlement. The name of this area was so memorable I forgot it almost instantly.

The guide, who again seemed to invite himself along, came out with such pearls of wisdom as “we have found the remains of three mosques this proves … (dramatic pause)…the people here were Muslim”. I was unable to prevent myself laughing out loud at this point.

After paying a sizeable bribe to a policeman (Kenya ranks at 129 out of 146 for corruption according to transparency international which makes it about as straight laced as Italian football!) I was able to progress to the airport and a very short flight to the airport of Lamu. Arriving at Lamu airport gave some indication of Lamus’ overall character. The airfield was a clearing in a wood; the terminal was a wooden hut. To get to the island itself took a ten minute boat ride. The sense of the pace of life slowing was palpable.

First the history blurb, (thanks Wikipedia!) The town was established in the 14th centuray. It is predominatly Arab, an important port to east africa. Cars are not allowed on the island and so the main method of transport is donkey. The main street in Lamu isn’t quite as wide as the pavement in Oxford Street. The houses are bundled together and rise, haphazardly, upwards, the streets are permanently in shadow.

On every corner is a stall selling all manner of things. Little alleys and cut throughs scurry away off the main roads. To follow every one of these, to their end, would take a life time. The population is around 20,000, though how anyone managed to count them all I don’t know! The place I’m staying is very good, with a sort of decaying charm; my bathroom has no fewer than seven taps. Only two of these actually produce water.

Lamu is known as a place to chill out, which is ideal for me. Certainly no one is ever in much of a hurry here. The first afternoon involved sleep, and little else. The second day was altogether more active. I had talked myself into a boat trip across to another island. On the boat with me were a couple of Germans and a group (mostly Brits) who were at various stages of a stint volunteering on community projects near Mombassa.

They had been sent out by a profit making company to help in various projects such as HIV awareness and teaching. The company they signed up with seemed to be excellent at taking their money and dreadful at supporting them. Many of them, fresh out of school, were put in situations that ranged from disorganised to dangerous. A number were not doing the jobs they had believed they would be doing. A very sad example what happens when charity and profit collide.

Having said all that, they had all triumphed in spite of the company that sent them, if not because of them. All told me how much they had learned about themselves and how they’re horizons had widened significantly. Proof what a profound effect an experience like this can have, no matter what obstacles are placed in your way. However it all seemed a bit of a headache I am glad I don’t have to deal with.

The beach itself was fantastic, miles of white sand and warm water. The dhows and boats bobbing gently in the gleaming water. A million miles from work, which was exactly what was required. The only fly in the ointment is that the pace of building here is frantic. Everywhere the sounds of drills and hammers. If Lamu sounds like your cup of tea then come here soon, before it becomes Mombassa mark two.

A couple of days here for me and then Nairobi for some essential if not very exciting shopping (shoelaces batteries, razors etc etc) and then back into the rough and tumble of outreach. Many thanks to all those who have e-mailed to say you are reading my ramblings. That some of you actually seem to be enjoying the experience is an unexpected bonus. I am finding the whole thing very cathartic. I'm so pleased I am able to share this adventure with you all.

Mombassa

To properly view Kenyas second largest city you have to see it as two separate entities. On the one side there is the Arab old town, rich in history, a rabbit warren of allays and housing built on top of one another. As it is the better half lets deal with this first. In a European context it looks like the type of stuff that The Great Fire of London turned into charcoal in the 1600's.

Geometry defying buildings overhang and seem to cling very precariously to the notion of staying upright. My guide, who had sort of invited himself along for my stroll through town, was a native of Mombassa. He pointed out the newer buildings to replace the ones that had collapsed. Proof that this method of construction will only beat physics for so long. We walked under the overhanging balconies at a pace that can best be described as brisk.

Next on to Fort Jesus, built by the Portuguese to protect themselves from just about everybody. Cannons and turrets face in all directions. Presumably so the Portuguese could shoot at er.... just about everybody. The majority of the building was constructed of coral, which is a terribly impressive, though not very sustainable method of building. Anyway a very reasonable way to spend an afternoon.

Now onto the other side of Mombassa. Even to think about it makes me grimace as if I had just scored a flamboyant own goal in the 89th minute of the cup final. Mombassa has gone in for the, pile it high sell it cheap brand of tourism. When I say cheap I mean, bargain bucket cheap. The coast is littered, and I use that word on purpose, with a plethora of beach resorts. These are about as in keeping with the local landscape as a bouncy castle would be in St Pauls Cathedral.

Spewing from these hotels are hundreds of tourists, most of whom have a waistline that is a danger to light aircraft when they lie down. The beaches along the coast cater for the lowest common denominator of pond life. On many occasions I saw very old western men wandering arm in arm with very young, African girls. And I don't think they were adopted daughters, though the age gap meant they could have been.

It is like Bangkok with a beach. Offers of drugs are never far away and some of Kenyas finest tourist tat can also be seen along vast swathes of the beach If you ignore this aspect of it Mombassa is lovely. I did and I enjoyed it.

All Aboard!

As the taxi weaved its way through the crowds heading down a tarmaced road the sign on the building at the end of the road came into view… Nairobi train station. I’m sure at times of the day it’s a lovely place to sit and people watch. At six o’clock on a Wednesday night it resembles a cross between a mass bar brawl and a rugby scrum.

Thankfully there were large numbers commuter trains, to match the large numbers of commuters. I watched as they carried the thousands of people off into the suburbs. The station itself is clearly a throwback to a colonial past. It looks like it’s just fallen out of a Hornby box and has a wonderful smell of smoke and diesel. I sort of expected there to be a fat controller, but there wasn’t. In fact nobody seemed to be in charge of anything at all.

Soon we were aboard the night train to Mombassa. I was becoming slightly concerned that the only people using this service were Europeans. Did the Kenyans know something we didn’t? The straightforward answer to this was yes! A departure time of seven got pushed back and back, the hours tickled by, with the only movement being shunts of less than a foot in both directions.

Finally, with various loud clunks and a whistle we were off into the Nairobi night. Three and a half hours later than planned. The others in my compartment were three people from Cambridge. They were assessing the chances of starting up some sort of holiday business for tourists. When I told them what I did, they told me I shouldn’t go back. Perhaps unwisely I’ve no plans to take up their advice.

A fairly uninterrupted sleep found us cutting through the African countryside as the sun rose. The whole vast flat landscape of scrubby desert and red sand streached out in all directions. We passed through villages made of just a few huts, at a leisurely pace. In fact whilst the website describes the train as ‘The iron snake of Africa’ I think ‘iron snail’ would perhaps be more appropriate. As we got into the outskirts of Kenyans’ second largest town the buildings began to huddle closer together. This wall of housing was only broken by a five minute tour of Mombassa municipal land fill site. There was a hurried closing of windows and audible cries of revulsion as our driver decided to take this part of the journey at a particularly slow pace. Only a few hours behind schedule the train arrived.

I caught a cab ‘somewhere near the sea please, not too expensive’. I soon found myself sat in a hotel that is not too expensive and near the sea. After dumping all my stuff I walked along a path to the beach. I recoiled in horror at what I saw on the beach. Lying there were hundreds of whales that had been involved in some horrendous mass suicide pact. I glanced around looking for the onrushing teams of willing volunteers with buckets and those large orange inflatable things. Then I looked back at the beach. Closer inspection revealed these were not beached whales but tourists engaged in a ‘who can eat themselves to death the quickest competition.’ No need for a home based feeding program here I think. A few days here and I flight to Lamu. It’s great to catch up on some sleep.

Nairobi

An exhausting couple of days to get here only to find Nairobi is a truly exhausting city. The traffic reminds me of downtown Saigon. Cars rush round tight bends in all directions like caught in some giant pinball game. Pedestrians march out into the road seemingly oblivious to the tons of metal hurtling past, inches from them.

Needless to say, the hustle and bustle of one of the largest cities in Africa is a very sharp contrast to the last two months of the rural pace of life. I'd had problems trying to find accommodation; luckily a friend of my dads was able to offer a roof over my head for the night. A more genial host I could not have wished for. A pilot, who had taken time off from flying to pursue other interests, mainly in banking.

We went out with a friend of his to an Italian restaurant. Any food that hasn't spent some time in a tin tastes good right now, but this was particularly good grub! Nairobi itself has, by all accounts improved as a place dramatically. Not so long ago car-jacking was a very real problem and the city rapidly acquired the tag Nairobbery.

Things now are much better, though walking out after dark is still advised against. I was so tired that there was no chance of being able to do anything, let alone walk after about seven pm! A day of shopping for the essentials - shoelaces, new books etc and then the night train to Mombassa.

Up, Up And Away

I woke up early, to the roar of engines overhead. Momentarily forgetting that the plane would be making three trips to us that day I stumbled out of my tent and frantically grabbed my half-damp clothing from the washing line. It wasn't until I'd stuffed one bag full of damp clothes that I remembered. Cue sniggering from the rest of the team.

I headed straight to the clinic. As I entered the treatment room the bench on which our child with malaria had been set now lay empty. My hearty sunk into my shoes. What had happened? Had the nurses not been checking his breathing during the night? Why didn't anyone say he'd died? As I left the treatment room in search of answers a small child gingerly walking with the help of his mother confronted me. For a while I didn't appreciate who this was... then it dawned on me. From critically ill to walking and talking in three days. "God is great," said the childs mother, and I couldn't agree more, adding, "as are anti-malarials!"

The noise of the plane was in the morning air again. Soon it was away and back and then it was my turn. As I climbed into the small twin prop plane only one seat remained. That of the co-pilot! "I don't mind sitting there as long as you don't want me to do anything!" I said. "Ah no worries mate" came the thick Kiwi drawl from the pilot "this baby flies herself."

As we climbed through the air It became very unnerving flying when you can view the direction of travel. We skimmed through fluffy white water and around giant columns of formulating thunderstomrs. "That's an anvil formation," said the pilot pointing to a large cloudbank ahead of us. It did indeed look a bit like an anvil, but it looked more like another lump of cloud. Clearly I have some reading on clouds to do. "It would snap the wings off this aircraft in two seconds" he informed me as it rushed forward to meet us. I was therefore more than a little pleased when he decided it was best avoided and produced a 'top-gun' style turn to the right that made my head feel like it was going to pop.

A night of pizza, beers and cards then a very tedious flight from there to Nairobi, Kenya. Which is were I'm sat right now. Tonight I'm getting the night train to Mombassa. So I'll let you know how that goes. Though all I can say about things at the moment is that the brutal switch from impoverished surroundings to a cosmopolitan city has jarred a little. More later, I've got a train to catch!

"Mama"

Well, after the rather sobering last entry I thought I’d start with some
positive news. I woke up early this morning. It being Sunday this itself was
miraculous. I had a very large cup of tea, (and of course branflakes - minus
milk!) and headed over to the clinic. Not only had my malaria ridden child
not died during the night (as I was half expecting) but he was showing signs
of improvement. He had stopped convulsing, had spat out his airway and was
breathing well. He was, delightfully, much more responsive. He was shifting
around the treatment bench, where he was laying in the manner of a teenager
in need of an extra five minutes sleep before school. As I was looking at
him his groaning became more formulated sounds, and as his eyes peaked open,
a word…“mama”. A lump the size of a grapefruit formed in my throat.

The childs parents had, convinced he was certain to die, taken home the
mosquito net, and the food we had given them. I told them to go back home
and bring everything back. The child had already ‘died’ once and I was not
about to let it happen again. This is not a time or place for negative
thinking. They are still understandably downbeat, but there is cause here
for very cautious optimism. Certainly those who have seen this sort of thing
before are very happy with progress. We shall see.

I wrote yesterday that the healthcare problems of Africa were encapsulated
on a micro level in the treatment room of two nights ago. I can only add
that, one ingredient was present during that dark night has become more
evident as the day has progressed. Amongst the sorrow and the loss, one
precious commodity is still in evidence. Hope.

A hope for something better, a hope for more good days and fewer bad ones
and a hope that one day the preventable and the treatable will be both
prevented and treated as in other areas of the world.

Who ever claims this aid-work malarkey is glamorous clearly hasn’t been an
outreach nurse. I am up to my eyeballs in human resources and paper work. I
have received the data from the various sites today. One site has seen a
near doubling of its caseload in a month and another is running at half
capacity. “Why is this?” I hear you cry. The simple answer is, I don’t know,
and without actually going there I’m unlikely to find out.

So, in order to fill in numerous reports, I have to make wild stabs in the
dark, which is, incidentally what some of the outreach sites are treating in
huge numbers! Furthermore a whole load of staff are leaving to join the
police, who apparently pay better. And the monthly data analysis needs to be
sorted, though clearly I’m not doing that either because I’m sitting writing
this. Though I’m at least part way there. Excel is, at least, open on my
toolbar.

I’ve found the best way to deal with stuff like this is to ignore it and
hope it goes away. So after an hour of number crunching I went out to the
airstrip and threw a Frisbee round with nearly forty children. A proper way
to spend a Sunday.

Tomorrow stage two of my plan comes into action as I fly out for a holiday
for a few days. Hopefully after this, the paperwork and the human resources
nightmare will have (delete as applicable) evaporated/been forgotten about/
been lost/ been solved by somebody else.

I’ll be on the Hotmail e-mail account as of today.

Mortality And Morbidity

Well it’s getting towards the end of a tragic forty-eight hours here. The
following paragraphs outline, in detail the story of two children, who I’ve
had the privilege to look after in the last two days. I have not spared the
more upsetting elements of the story, as I believe they are important.
Furthermore I want to provide a human face to the endless statistics of
mortality and morbidity that bombard us in the west. But it’s not exactly a
laugh a minute.

It was getting to around six o’clock in the evening of Friday. The sun was
beginning to turn the wonderful colours it does here as it sets. The wispy
lines of clouds were beginning to adopt new shades as the light diminished,
the whole world had a sandy orange glow.

All over the clinic burned small fires. The patients and their caretakers
were beginning to cook the evening meal. The day itself had been one of my
more uneventful here. An old woman, who had been admitted the day before
with a vicious chest infection, had gently deteriorated. By old, I mean late
fifties; you don’t see many seventy year olds here. She was not expected to
see out the week. A dose of morphine had settled her down for the night.

The only other patients I was worried about were two boys around the same
age. One was the TB boy who has been mentioned previously. Despite his
parents meeting the other TB patients he had not been given his full evening
meal the previous night. During the early hours of the morning his blood
sugar had dropped to a level that made him comatose. A big dose of glucose
had corrected this but he remained weak. The morning was spent with the
parents, and again, the issue of feeding was addressed. Though I’m not sure
they believed us. During the day he had begun to vomit and it was clear that
his overall condition was deteriorating further.

The second child had been diagnosed with malaria earlier in the day. He had
been on the drowsy side, though had sat on his mothers lap during the
evening. He had managed some food and we had put him on a drip and given
anti-malarial medication. He was settling down with his parents in the
clinic for the night.

As I approached the clinic, I could hear a piercing cry coming from outside
the treatment room. This was the mother of our TB patient, who was lying
prone on the floor, beating the ground with her fists. As I entered the
treatment room I found the patient in a dreadful state. Events had overtaken
us and his situation was dire. We attempted to gain IV access, but this was
difficult. Eventually fluids were being administered and I had managed to
get him into a position where his breathing was easier. He was lucid and
talking but clearly, to use a phrase popular in UK nursing, ‘going off’. The
father, after a bit of persuasion, had donated blood and the child was given
antibiotics. We managed to, if not stabilise him fully at least halt his
decline after three hours of very hard work.

As we began to relax a little, one of the nurses tapped me on the shoulder.
“There is another sick patient next door”. ‘This had better be a VERY sick
patient’ I thought as I left the TB infected child to go and investigate.
Leaving the clinic doctor, Teshome, in the treatment room.

I entered the hut and was directed to the child with malaria, still with
drip in situ, who was lying under a mosquito net. His heart had just stopped
beating. With the help of one of the nurses, we attempted to drag the child
from the hut. As would happen at a time like this the drip became ensnared
in the mosquito net, and we endured a good thirty seconds of trying to
untangle ourselves whilst attempting CPR.

Once free we carried the child out into the open. We were met by Teshome
coming from the treatment room with a bag and mask, and a syringe of
adrenaline, which had actually been prepared for the other child. A frantic
resuscitation effort ensued. I managed to continue CPR whilst the Teshome
gave adrenaline, in the almost pitch black I saw, what looked like a flicker
of life in the childs face. A couple of rotations of CPR later and he was
breathing by himself, heart restarted. The phrase ‘nick of time’ doesn’t
really cover it.

We carried him into the treatment room next to the other patient, who had
begun to deteriorate in our absence. For another hour or so both children
lay there, as we made every effort possible to keep them alive.

Finally, at around eleven in the evening the child with TB began to start
breathing in a shallow and irregular way. Not long after this he gurgled,
coughed and passed away. A piercing howl went up from the relatives gathered
around. The atmosphere became one of unimaginable grief, the sense of loss
palpable.

And there, in a small treatment room in the middle of Africa a continents
healthcare problems were personified. A child lying dead of preventable
malnutrition and treatable tuberculosis. Another child critically ill from
Malaria, a disease that is both preventable and treatable. Both children lay
in a filthy, ill equipped, treatment room woefully unable to treat either
case to any level of proficiency.

The mother sunk to floor, the sense of sorrow was unbearable. They carried
the child from the room and into the night for a swift burial, as is the
custom here. There wasn’t anything I could say that could make this
situation any easier, so I didn’t bother. We quietly continued to care for
the other child, whilst the howling continued into the blackness of outside.

Throughout the night we rotated in shifts. Attempting to correct the
problems created. Our remaining child fitted on numerous occasions and we
trod a tightrope between giving enough medication to control the fitting
whilst not suppressing his breathing.

Whilst all this went on, quietly, alone, and with no fuss, the old woman
with a chest infection, died. I found her huddled in a blanket, cold.

It’s now Saturday night and I’ve just been to check on our critically ill
child. Not much change, he remains deeply unconscious. But all that can be
done is being done, and I just don’t know if this part of the story will
have a happy ending, I dearly hope so.

Voodoo child

As mentioned before this area sees about as much in the way of healthcare as
Brown and Blair see eye to eye. Not a lot then. The best way to describe the
clinics that operate here is that they are islands of treatment in an ocean
of no treatment. There are no GPs, dentists, and no pharmacies and the only
drugs available are sold in markets. I walked past a shop on Sunday selling
pillowcases, pocket mirrors and IV Gentamycin! The population here can’t get
enough of medicines, injections in particular; if they haven’t had an
injection then they haven’t been treated. We have outreach sites that give
medicine to more than eighty three percent of all the patients they see.
This has massive repercussions in terms of resistance to antibiotics and
costs. It is a problem we are urgently trying to address. However it is also
an issue that cannot be totally solved by us, as outsiders. It is a question
of education, and in a place where only a privileged few go to primary
school and any form of mass media is non-existent it will take years to
solve properly. Besides, it’s not a predicament we have yet solved in
Europe. I lost count of the number of patients I saw as a nurse in London
demanding antibiotics for self-limiting viral infections.

It’s not much of a surprise also that a boom industry here is the
traditional healer. These people range from the mildly hopeless to the
lethal. A particularly barbaric practice is that of cutting. Here, (and in
many parts of the world) it is believed that burns and cuts will alleviate
symptoms. The human body has a fabulous way of healing itself over time, but
often it is the traditional healer who can take credit for the hard work of
the patients own immune system Most commonly we see the patients after the
traditional healer has got his hands on them. In many cases the deep,
infected lacerations present more of a problem than the original illness
does. This is particularly the case with nodal TB. There is a practice here
of attempting to gouge out the offending lymph node with something
resembling a sharp spoon. It is therefore impossible to assess a lymph node
that should be swollen but not painful (if indeed it is nodal TB) because
someone has kindly taken a rusty implement to it and made it very painful
indeed. However in most areas there is nothing else on offer and until a
very large amount investment occurs the traditional healers profits are
safe, even if their practice is anything but.

Cultural Differences

So it’s been a week here of not doing outreach but doing other stuff
instead. I’ve been covering the holidays of other expat staff, which has put
me in charge of an inpatient department. In Europe the first question anyone
would ask is ‘how many beds is it?’ Well here we don’t have beds, a grain
sack on the floor is the nearest thing to it. Furthermore in terms of
admissions if we have more patients than there is space we just put up
another tent. To say we have been putting up more tents this week gives an
indication of how the week has progessed.

The days have been punctuated with many different patients, all with a
unique story and outcome. The first patient I saw was on Saturday. He was
four and weighed the average weight for an 8-month child in Europe (7kg), I
make no exaggeration when I say it was lucky mum and dad decided to come to
the clinic in the morning because by the afternoon there would have been
little point. There were many furrowed brows, tutting and desperate attempts
to get the child going with some fluids. Not an easy task. His skin was
paper-thin and trying to get an IV line was akin to trying to stuff the
machine that dug the Channel Tunnel down a trouser leg!

Eventually 24 attempts, and a lot of huffing and puffing later, we sited an
IV line. Death delayed for a few hours but still very much on the agenda.
Man cannot live by IV fluids alone (though it’s a very good start). The
painstaking process of feeding begun, the parents were magnificent, cajoling
and coercing for hours on end. The child by this stage had reached a point
past hunger and he simply wasn’t interested. This morning, he walked out of
the clinic having reached his target weight in less than a week, leaving a
team of grinning health centre staff with a lovely warm glow inside.

At the other end of the spectrum are those who don’t want to hear what you
are telling them. We have had an eight-year-old boy with us for a nearly two
weeks, he has TB and as a result is malnourished. Culturally here it is very
difficult to convince people their children need IV drips (I still haven’t
got to the bottom of quite why this is!) so this patients parents refused
point blank. Then they refused the special food we gave the child (I think
they may even have been giving it to the sibling and selling it on the
market) Consequently their child got sicker, and so they became angrier. The
final straw occurred two days ago when then accused us of trying to kill
their son.

I walked back to the expat living area with steam gently rising from my
ears, went and threw a Frisbee round the place and played Risk. Felt a
little better after this, and decided that a change of tactics was needed,
bring forth the man with the sticks!!!!!

No dear reader, I didn’t pay a man with sticks to attack the couple in
question, though for a few moments I considered it. The man with sticks was
a TB patient who had presented months ago unable to move and feed himself,
and now after a bucket full of TB drugs and equally important food he was
able to walk ala cross country skier with two sticks. He lived in the TB
camp

This is a large area of more than seventy patients who are all at various
stages of TB treatment. Treatment for TB can take six months or longer and
so they live in a little community of tents and huts whilst they complete
the arduous course of medication. Caretakers and Improving patients care for
the sicker patients. The mood is always buoyant; there is always a game of
something going on. It is a place of laughter (followed by bouts heavy
coughing!) and millions of children running in all directions. I wish I
could spend more time there.

I took the parents to see the place we intended to bring their child once he
was improving and we sat in a small circle whilst the old man with sticks
recounted his TB experience and how the process had been long, painful but
ultimately successful. Things then took a bit of an unexpected turn, as the
topic of our discussion became public knowledge in the camp. Soon there was
no stopping them! A large crowd of people gathered all with stories about
their own TB crisis and the importance of nutrition and taking the medicine
as prescribed. Our poor translator nearly had a stroke trying to translate
the quick fire conversation that followed, In the end he just gave up and
gave us the topics been discussed. The plan could not have worked better, I’
ve just seen the child in question now and things are picking up. No more
arguments about the treatment, my life is less stressful and their child is
better. Everyone’s a winner!

Of course there are those who arrive too late. I won’t pretend that good
news outweighs bad. Four people passed away last week including an eight
year old boy and a mother who left a thirteen year old girl and four year
old boy to fend for themselves (the father died last year). Tragedy is a
constant companion, however I have never felt that I have made such a
difference as I do here.

I’ve passed my first two months, in many ways it has flown by, but then
again London seems an awfully long time ago. And two months means a break,
so I fly out on Monday for a few days R&R. The sea is calling I think.
Though I think I’ll have a bath first.

A story of rain, maize and influential chickens

Well… it couldn’t last; the rain had held off for a few weeks and now is
back by the lorry full. Thunder and sky splitting lightening are now a daily
occurance. On a personal level this is of no particular concern to me as I’m
not going anywhere for the next few weeks. For everyone else it is a real
headache. With the airstrip now having a deep end and a shallow end (and a
definite vacancy for a lifeguard) the chances of a plane for the next week
is remote.

Luckily (as my protracted arrival proves) it has rained here before and we
have enough supplies to keep us going for weeks, hopefully there will be a
break in the weather soon. In the meantime the clinic is deserted. In fact
it's so empty the tumbleweed has moved on somewhere more interesting. The
rising water has made travel from anywhere but the nearest towns impossible.
We expect to see more patients in a worse state when the weather improves.

The crop this year is causing concern also, and this batch of rain may have
come to late to solve that problem. Enough water but in short bursts, rather
than drizzle is the main problem. This is the only rain they will get before
a very long, arid dry season. We are seeing malnutrition increase already. I
hope things are not as bad as predicted once we get to February.

In a land so utterly different from my own it is nice sometimes when things
happen that seem a little too familiar. A child presented today with a piece
of maize stuck in her ear. It is refreshing to know that even thousands of
miles away from home children still put silly things in every facial orifice
imaginable! Needless to say we didn’t have anything like the right equipment
to get it out and our efforts (I say ‘our’ as two of us were involved in
this venture) resembled a cross between bomb disposal and that thing the
space shuttle does when it’s trying to grab an errant satellite with the
robotic arm. Left a bit, right, up a touch…missed. Anyway the child will
come back for round two when it stops raining. Any bright ideas please feel
free to e-mail.

The chickens are well, and getting used to their new home,
though they seem a bit too attached to the old one. This means there is a
nightly scramble round the clinic rounding them up and taking them back to
the new coop. We still have to find (and no this is not a joke) an
‘influential’ chicken, convince that flock that the new home is preferable
and the rest will, apparently follow. Hmmmm. I will keep you posted.

Otherwise all is well, I did a teaching session on antibiotic resistance,
which involved drawing with a marker pen on one of the nurses hands. And
then when trying to do it again seeing how he moved his hand away. I little
like antibiotics, not so effective if you try them too often. Things here
are a little basic, but the eagerness to learn puts us in Europe to shame.

Not sure what tomorrow brings (which is still the most exciting thing about
being here!) if it’s worth writing down I’ll let you know.