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.