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.
