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.

Marcus Wootton – Chicken Farmer

Like busses this blog, nothing for weeks then loads all at once! A very
unexpected thing happened today… I became a chicken farmer. Last night I got
into a conversation with one of the other members of the team about
chickens, I’m not really sure how.

I may have mentioned before that chickens are a regular fixture of the
clinic here. There are a large number of them wandering around chatting away
to themselves and sometimes to us. The first day I was here one came in to
critique my suturing. I’m sure on many occasions they are offering very
sound medical advice, if only we understood. Anyway there has recently been
a bit of a population explosion amongst the chickens and now they need two
huts to keep them all in. They also need someone to oversee their upkeep and
general well being………………me!

Thus here I am in the middle of Africa and for the first time in my life I
have a flock of chickens to look after! Boiled, Fried, Poached and Scrambled
as the chickens are known are now in the custody of a bloke who has lived in
cities for the whole of his adult life, and who’s only contact with
chickens, so far, has come in the form of the Caesar salad variety. If they
only knew.

The plot thickens slightly as not all the chickens in the clinic belong to
us and so I have to round up our feathered friends every night and take then
to their newly refurbished coop. They will soon…hopefully…. get an idea of
where their new home is and do it themselves.

I’ve spent the evening with my chicken farmer colleagues (two medics and a
guard) chasing chickens round the compound. After a breathless chase in
which a one point there were birds and feathers flying in every direction we
cornered them and carried them to the hut. The hut has a newly repaired door
and feed - cornflakes, stale Rivita and eggshells which, apparently, is very
good for them. When it comes to chickens everyone but me is an expert.

On the medical side, I made a game where the nurses in the clinic had to
match the drug with the disease it treated. A work in progress I think.

I also squeezed a bucketful of gunk from a very large abscess on someone’s
neck. They’re coming back for more tomorrow. Yuck!

Tomorrow involves sorting out a large amount of files and holiday days for
the outreach staff. My maths could be strained to the limit!

Out On My Own

“Why is there no milk on your branflakes?” “I’ve never had milk on my
cereal, and besides there isn’t any milk anyway.” ”Hmmmmmmm still think it’s
a bit weird” a rather painful silence then.… “So we’re off tomorrow, it’s
going be ten days of really hard work” she said “who’s off?” I said, between
mouthfuls of cereal “You and me,“ she said. A pause (whilst I cogitated and
chewed) then, trying not to choke on branflakes, “so (trying not to sound
too desperate) I’ll be the only medic” (out here anyone who is a doctor,
nurse or knows how to put a plaster on correctly is referred to as a medic)

“Um…….. (looking a little baffled by my seemingly obvious question)
yes, but you’ll have a doctor on the end of the radio. That is going to
require me to know which bits of the body are which and complicated medical
words to describe the patients’ symptoms, not my forte at all, I thought. A
restless night with, my only medical textbook learning words that would at
least give the impression I knew what I was talking about.

Off to an area that hadn’t been visited by a team for months, and visiting
not one, but two clinics that hadn’t received any input since May, and it’s
the boss, and me could be fun.

Day 1 “Could you come and look at this woman, I think she has died”.

The roar of engines overhead indicated the imminent arrival of a plane, a
plane that most of us thought would arrive in forty-five minutes time. Panic
stations, furrowed brows and people running around in all directions. A
collective chasing of tails.

Cargo to unload and patients to load on, then patients to load off again as
there were too many people on the plane weren’t on the list. Then a loading
of further load of cargo, then the loading, in a chaotic scramble of a few
patients who were being flown home. No concept that a plane overloaded by a
third will find flight impossibility. More unloading of patients. Angry
words. Engines revved. Doors closed. Away.

The plane bumped down to a shuddering stop. The area was more open than any
I had seen before. Vast plains of green grass, and of course mud, in many
directions. It was as flat as a bowling green.

Small hamlets dotted the horizon with small fields of crop next to them.
This area is one of subsistence farming. The small compound and clinic that
we had landed at had had a large program operating. There had been a large
inpatient facility and one of the largest TB treatment centres in the
country. In May this all changed, fighting had lead to an evacuation and,
with the clinic unguarded it had been stripped bare.

What can best be described as two days of madness saw many years of work
destroyed. The numbers of lives lost as a result of this, in terms of
patients who could not be treated and the damage to the community as a whole
is incalculable. The scars of the looting are still evident. I even found
part of an oxygen resuscitation mask being used as a bracelet by one of the
teenagers in the town (no, I’m not joking). The community has suffered for
the sins of the war and the local staff in the clinic have worked very hard,
against almost impossible odds, to keep some semblance of a medical service
operating. Not for the first time I feel humbled by the people who I have
come to work with.

The plane was soon a spot in the distance as it, carried another group of
patients. They had been kept alive by the ingenuity and dedication of the
local staff for long enough until help arrived another ten people walking
around who otherwise would not have been. The role of the foreign aid worker
is much overrated. In many ways we are a nice optional extra. The local
staff are the people that the bulk of the credit should always go to. But
sadly you don’t see movies about them

With the plane, and thus all contact with the outside world gone, I set
about seeing what patients had remained behind, all were acutely unwell and
the level of treatment available was patchy, however all were showing
encouraging signs of improvement. Various pneumonias, gunshot wounds and a
few children with malnutrition, oddly this is becoming bread and butter
stuff now.

As a rather chaotic ward round was drawing to a close, I got a tap on the
shoulder. “Could you come and look at this woman, I think she has died”. It
was said in such a way as a cashier might say “could you just enter your pin
number”. Bit late for me then isn't it ? I thought as we wandered across the
compound.

An Announcement

I realise that my blog has a mixed audience. It is difficult to write about
cases with enough detail to keep the medics happy but with enough
explanation that the non-medics aren’t totally lost in a world of jargon. So
in order to combat this I’ve bracketed some helpful notes for the non-medics
with the heading NM

When I reached the woman she wasn’t, in fact, dead. But she was making very
great strides towards that end. Her blood pressure wasn’t above 60 systolic
(NM This is not good) she had a temperature of 40 degrees (NM neither is
this) a pulse so fast I lost count, (NM all signs this dear woman is in big
trouble) she had a grossly distended abdomen (NM again not a sign that
things are going well) and she had given birth to a baby boy five days ago
(NM this is nice but not crucial right now), who was, despite everything,
very healthy. As stated before when you try to save a breast-feeding
mothers life you are also trying to save the life of her baby.

Trying to resuscitate someone by yourself in a mud hut in fading light, and
only one cannular (NM IV line) with the whole family watching your every
move could best be described as the fringes of my competence.

Having found the only vein the patient had left I attempted to put an IV
line in. Of course life would be too easy if the cannular managed to get
itself into this woman’s vein correctly. All was going well until it came to
the fiddly bit of advancing to plastic tube into the vessel. At this point
the plastic tube refused to budge. “oh for pities, sake will you just get in
there!” I said to the cannular (although I’m not sure if I used the word
‘pities’). Thankfully the cannular obviously listened and did ‘just get in
there’ and soon the woman was having the proverbial kitchen sink (in terms
of fluids and antibiotics) thrown at her.

We, and again I can claim no credit for this as the national staff did the
vast bulk of the work, kept her going for ten days until a plane arrived. I
went to see her this afternoon. Mum and baby doing fine.

Day 2 Two Twos are seven

A crippling lack of education has meant that most of the population are
basically illiterate and the ones that aren’t have moved away. When it comes
to counting stock and medicines the struggle very badly indeed. Here however
I found that my maths was also a bit dodgy and a pharmacy stock check that
should have taken an hour took a whole day. Most of which was my fault. Went
to bed with brain dribbling out of my ears.

Day 3

Breast cancer is a disease that strikes fear in Europe. It is the subject of
endless soap opera storylines and health promotion campaigns. Not here. What
exactly would you do with the lump if you found one? Today a woman attended
the clinic in the final stages of her disease. The cancer had spread and she
was pretty much riddled.

Trying to convey the hopelessness of her situation to her and her son was
one of the hardest afternoons of my life. Many times they asked why we could
not cut it out. I kept trying to explain the stages of a cancerous growth
and what happens when it spreads. The son said he would take the woman to a
traditional healer. I tried to explain it would just hurt her and make no
difference. But I can see his point, we were offering nothing but
painkillers and sympathy. A traditional healer would promise a cure. This is
what happens when you don’t have an effective health system.

Day 3 Bees and Broken shoes

Early in the morning, VERY early in the morning (no time for Branflakes) we
roused our troops and headed on foot to the next outreach site. The convoy
consisted of drugs, a radio and various other bits and pieces. The water ran
to chest height in places but I’ve written before about the roads and once
you’ve waded through water for a few hours once, the experience is pretty
similar the next time! This trip was marked by two key events. Firstly my
rather snazzy shoes, which up until this point had performed impeccably
spontaneously combusted. The strap broke in such a way as to make them
unwearable. I performed a variety of suturing techniques to hold them
together but they were, essentially, screwed.

The hours rolled by and the flat countryside splayed out
before us. It was time to stop for a break, and put another few stitches in
my shoe. “There’s a very odd fly in my hair” said the boss as we rested
under the shade of a tree “Looks a bit like a bee” I mused looking for a
spot to sit down on. Then glanced at the tree to see one side completely
covered in bees. The bees were clearly not great fans of ours and began to
swarm…

….It had been a quite day for Mrs Elizabeth and her children, she had set a
large fire going in the corner of her hut and was just getting her five
children settled for lunch. At this point their day was rudely interrupted
by a screaming noise and the sound of lots of people running, this was
followed by the sight of two white faced Europeans busting into her hut
screaming like thirteen year olds at a boy band gig, closely followed by a
large group of very angry bees. Luckily bees fall asleep with smoke and the
group were soon much calmer and the male European, who had been shouting the
loudest, was soon blowing bubbles with the children. They thanked Mrs
Elizabeth very much for the use of her hut and hoped they hadn’t disturbed
her day. A family anecdote for years to come.

After the attack of the bees progress was much slower, the
running had snapped another strap off the shoe. The next event was the
crossing of a large river. At this point I suffered my second equipment
failure of the day. My dry bag suffered a nasty tear, singularly making it
neither dry, nor an actual bag and thus making it a … er…

Days 4 & 5 Across the line

We crossed a former frontline in the fighting, and it showed. Thousands of
people without the most basics of life, but a health clinic that,
miraculously, had stayed open. Again there were patients we couldn’t treat.
There was a child with an abscess that had collapsed one lung and was making
strong inroads into the second and a woman with mental health issues. But
also many who were receiving care and getting better. The evening saw the
worse storm I have seen since being here. The omens looked very bad for the
walk back.

Day 6

Walk back can be summed up in three words Long. Hard. Slog.

Days 7 & 8 Shifting priorities

The wasteful nature of foreign aid witnessed today. A plane landed and pushy
American doctor got out. She went straight to the child she had come to
assess to see if the little girl had the disease she thought she did. She
didn’t, so she got back on the plane and flew away again. Had the doctor
glanced to her left she would have seen a large group of totally
un-immunised children and behind them a group of expectant mothers without
the basics of maternity care. All could have been paid for by the cost of
her plane visit to see one child with a non fatal disease that she didn’t
have.

Day 9

Spent the day in the clinic surrounded by patients many of them displaying
symptoms that I’d only ever seen in books. The learning curve here is
vertical and I’m sure I’m missing things. But you can only do your best.
Flew back to the main base the next morning.

So that was my week. Highs and lows as ever, thanks again for the messages.
Glad to know there are a few of you still reading! Today I’ve spent the
morning doing paperwork (booo) and the afternoon playing football (Hurray!)

I’m going to be a bit more settled for the next few weeks as I’m covering
various holidays and stuff so hopefully I’ll be able to update the blog a
bit more often. And get round to replying to a few e-mails. But I think that
is enough to be getting on with for now, ten days of hard work it was.
Tired. Off to bed.

Take A Walk On The Wild Side

Well, it's been a very interested fortnight. In many ways it seems like a very long time ago since I wrote anything, so thank you all those of you who have kept faith and are still reading!
I'm going to try and write about the last week in a semi chronological order but I might, as is my whim, wander off on a tangent or two!
Day 1- Take me to the river
If Al Green had been here in rainy season he would have no need to be taken to a river,here, the river comes to you! We left the base earlier in the morning in a convoy of people carrying supplies and all the things we would need for two weeks at the outreach sites. Despite leaving early in the morning the temperature was still well into the twenties and would hit forty-five by the end of the day. As previously stated we are currently in rainy season. For those of you who are reading this for the first time - scroll down and start from the beginning and this will all make much more sense!
We wandered into the countryside, a land of green grass and tanned acacia trees, not the sandy scrub I was expecting, apparently this happens in rainy season. At a small opening in the fairly thick undergrowth our path hit the first crossroad. I enquired as to which direction we would be taking. "That one there" said someone. I replied rather meekly that it was a long time since I sat in a geography lesson, but to me, (and I'm no expert), the route indicated resembled a moderately large stream. This large stream turned out to have a path hidden underneath it.
As we waded first toe, then knee, then thigh and finally waist deep into the water, I made an interesting new scientific discovery. I discovered a new compound. The mud here is such a consistency as to be ice rink slippery but sandal grippingly sludgy AT THE SAME TIME. Surely you would think something is either slippery or sticky, however, this mud manages both with apparent ease. This makes walking an unbridled joy.
I had wondered, before I left the UK if I would be fit enough to cope with the physical rigours of outreach nursing. At about half an hour into my first walk I had glorious confirmation that I was not. The water continued all the way, short areas of dry paths, offered painful false hope, before we were plunged back into the murky water again. A three-hour walk took six and a half, and we arrived at the outreach site, exhausted, tired, soaked and smelling like we'd been for a swim in a sewer pit.
Deciding that the best thing to do was to collapse for the rest of the day and cope with the clinics the following day.
Day 2 - One shandy too many
The sun broke the surface of the horizon at around six and soon my tent was bathed in a warm orange light, the sort of morning that happens a few times a year back home, but is almost an every day occurrence here. I had emerged from the walk with relatively few blisters (unlike my colleague) and we were soon sipping tea (very civilised this aid work thing!) and wandering round the corner to the clinic. This clinic is normally run by national staff and our role is mainly supervision, training and seeing patients. Whilst Susa when off and dealt with the senior staff I walked over to see the bloke whose job it is to initially assess the patients and write down their details on a card. A sort of triage nurse/ receptionist. He spun round on his chair to greet me and tried to fix his eyes on me, but seemed unable to, he then staggered to his feet and half jumped half fell over towards me. It took a while to work out what I was witnessing. The first member of staff I saw was absolutely plastered. This gentleman was politely informed his services were no longer required. Not a very auspicious start as a supervisor, to sack the first worker you meet for being drunk.
Day 3 White face is here!
Word had clearly got round the small village, and the many that surrounded it which housed the clinic that we were in that the white faces were back in town. Thus by the afternoon of the second day people had come from far and wide with their medical ailments. It is perhaps an indication of how bereft this country is of medical care that people are prepared to walk five hours just to see a reasonably inexperienced nurse like me, a very responsible reputation to live up to. Their faith that we will make them better is indeed humbling. However it is difficult to know how to treat 'ten year history of back pain when the only half appropriate medicines in your armoury are ibuprofen and paracetamol. Worse still were the ones who arrived with a common cold or some virus or other. I politely told them they had a self-limiting virus that would improve and could they now walk the four hours home with no medicine what so ever.
Day 4 Poverty, poverty all is poverty.
The poverty here is different to what is shown on TV. There are not vast numbers of people in some god forsaken refugee camp. I don't wake up every morning to see a 'biblical famine' to quote a famous phrase. But every child I see has no shoes and rarely clothes that are not torn, ripped or falling off them. Every older person has a face wizen and worn by a lifetime of struggle and hardship. These are people who are on the tipping point, a bad harvest or lack of rain, or war and insecurity and they could become those faces we see in a refugee camp on the news. This is a place run along Dawins survival of the fittest principle and no other.
Day 5 Pneumonia African style
A child arrived today, who was struggling for every breath. Attempting to treat a severe pneumonia without the basics like oxygen is becoming a specialty. The people here are resilient but the lack of available infrastructure is devastating. It makes you appreciate the number of options available to patients and healthcare workers in the west. NHS all is forgiven!
Day 6 Simple additions
The afternoon involved helping the storekeeper do the monthly stock check. There are only two people in the clinic that can count. (I'm not including myself and Susa in this) neither of these happens to be the store keeper, whose job it is to keep a tally on what is going in and out of the store. A long time was spent explaining that twelve plus thirty did not equal forty. So there I found myself sitting in a mud hut with a man who can't count, attempting to do a stock check, with stock that isn't labelled and no clue as to when it expires. What should have taken an afternoon took two days. I found myself doing a passable impression of the face in Edward Munch's ''The Scream' on more than one occasion
Day 7 Day of rest
Day off. Read a great book about the arms industry (As used on the famous Nelson Mandela by Marc Thomas) and slept.lots.
Day 8 The Currency of Cows
A lesson today in currency here. It's not something you'll see on Bloomberg or the smarmy bloke on the BBC business news. Cows. Here the main currency is Cows and goats; God only knows their wallets look like! Of course there is money, but really if you want to purchase something like a wife you do it with cows. Yes that wasn't a mistake I did say wife. Wives are purchased (with consent) here for cows in the same way as we buy used cars. A top of the range woman (a Ferrari if you will) will set you back forty cows, a middle of the range woman (Mondeo) will cost twenty to thirty cows and a bottom of the range woman (Skoda) would be more in the fifteen cow bracket. I've no idea what optional extras you can with you wife. electric windows, five year warranty etc etc but what I do know is that, here, nothing says 'Í love you' like a large herd of cattle. (Cow prices correct as of 12:35pm 28/8/08. The value of your bovine investment may fall as well as rise)
Day 9 Neonatal unit.anyone?
A mother arrived today with a basket on her head. I had seen her last week when she was pregnant, now she looked exhausted. As she moved closer it became clear that she was no longer pregnant and that contained within the basket was her (and I'm estimating here) born at 28-weeks son. Obviously babies born on time have considerably unfavourable odds for surviving childhood. Those odds lengthen to the horizon when they are born prematurely. The babies' heart rate was around 90 (for the non-medics that' s very slow) his feeding was poor and he was wrapped in filthy, infection riddled blankets. This is the first situation I came across where I was able to do nothing at all, despite the clear medical emergency. A gripping sense of powerlessness descended. I spent a while with mum and baby but, not wanting the child to contract anything from the other children, sent them home. I'm sure the baby has since passed away. Child mortality figures take on a whole new meaning when you see them personified before you.
Day 10 A success
Following a rather depressing day came the news that a woman who had arrived looking gravely ill a few days previously was making marked improvement. She had arrived on a bamboo stretcher (christened a Bamulance) at the clinic a few days previously. She was painfully thin and as I pulled back the blanket to assess her, nestling with her, was a fortnight old baby. The woman was obviously malnourished and anaemic (the only anaemia test being to look at the lower eye lid, which was white as driven snow, look in the mirror tonight, and you'll see what colour they should be). I was sure the woman would die, and as a breast-feeding mother, the chances for her child also looked bleak. On top of all this she had a chest infection and diarrhoea. To complicate matters further there was a limit to what drugs we could give this breast feeding mother, though it had be said her breast feeding was very poor to non existant.
However, having thrown the veritable kitchen sink at her in terms of care, nutritional support iron, paracetamol and antibiotics she slowly started to improve. In the end we were able to refer her to a larger health unit for further care and support, a journey that would have killed her had she gone straight from home. Proof that whilst tragedy can be found in abundance there is always hope for something better. Proof also that I'm not wasting my time rearranging deckchairs on the Titanic and that the money given to charity can, and does make a real difference here (now if I write any more I 'm going to start sounding like Bob flipping' Geldof and nobody wants that!)
Day 11. The walk home
The ground had soaked the water up like a sponge and the walk back was a different proposition. Four hours, a few steams but not a problem, perhaps I 'm becoming better at it too. Much easier but (and I'll say this quietly) not as much fun!
Future plans are a bit up in the air at the moment (Almost literally) but possibly off to some more outreach on Tuesday, who knows. I'll do my best to keep you posted. Thanks for all the e-mails, as ever, a continued source of encouragement. For those who've offered to send things, I have all I need here, and more, please spend the money on a charity.
One other notice which is to remind one and all that this blog is my own individual opinion and does not reflect the opinions of any organisation. Further more in the interests of keeping me safe in terms of security please don't forward this to any (small or large) media moguls, newspapers, heads of state, or anyone else for that matter. This blog is very much for private consumption. Thank you all for your understanding.