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.