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.