On The Road Again

So another week another clinic, I'm getting some idea of what it is like for
a rock-star to be on tour, minus even the merest whiff of luxury. It seems
like every night I find myself in a different clinic. I exaggerate slightly
but not much. So this week I returned to the first outreach clinic I'd
visited. As any smarmy estate agent (and, though I've never met a non smarmy
estate agent, I presume them too!) will tell you it's all about location,
location and location.

The clinic sits on an artery road between two major towns and provides a
useful stopping point for people walking between the two. The fact that it
has, not only a water pump, but also a fabulous clinic just gives it greater
added value. This means there is an awful lot of traffic that just visits
the clinic for one day, making things like, (heaven forbid!) the review of a
patient the following week, impossible.

The heat on the road up to the clinic was searing. For various reasons we
left late and the sun was already racing upwards into the sky. It's a hard
sun here, the heat and power from it is unremitting. Shade can offer some
comfort but really, there is absolutely no escape. Whilst the walking is
easier in terms of zero water under foot, the heat makes it exhausting.
After a while it feels like your destination is no nearer and you've spent
the last hour on a treadmill. Hamsters stuck in wheels, I can completely
sympathise! Half my rucksacks weight is taken up with drinking water. It's
like being locked in a kiln.

The first night we were there we had a lot of rubbish to burn. I emptied the
various tins and papers into a big pit and dropped in a few matches. The
rubbish hole was just outside the fence (that was still standing following a
struggle to construct it the last time that can best be described as
colossal!), so I left it to burn.

About half an hour later there was an ear splitting bang from the area where
the fire was. Just as I had had time to check all four limbs were still
attached, another explosion, coming again from the direction of the rubbish
fire. This second explosion blew a large crater in the side of the hole and
scattered bits of the fire over a large area, part of a sardines tin landed
at my feet.

People from the clinic and nearby houses came to see what had happened. We
swiftly put the fire out, with copious amounts of water. It hissed and
steamed for hours. Everyone went back to bed none the wiser.

The following day I raked over the remains with a stick. In the bottom of
the hole were two empty bullet casings. Why someone had decided that a
rubbish fire hole was a sensible place to put live bullets baffles me,
thanks to me they weren't live any more!

Other than trying to avoid starting another war the main point of this visit
was to sort out the new 2007 contracts. This job was made much easier by the
fact that everyone got a whopping pay rise. Unfortunately the process
involved taking a few basic details from each member of staff….

Name- well most got that bit right, though sometimes the spelling was
different depending on what form was being written.

Village- again, not exactly straightforward, because here it is pretty
difficult to determine where one village begins and another one ends.

Date of Birth- No one had any idea what their date of birth was. The tax
form demands a date of birth.

So what do you do when you have a crucial form to fill in and a piece of
crucial data unavailable? You make it up. So come with me, dear reader, as I
show you how to both construct an entirely fictitious birthday and thereby
commit multiple fraud.

Marcus: So, do you know what was the date of your birth?

Staff Member: No, Not sure

Marcus: OK what year where you married?

Staff Member: 1986 or 1989, I can't remember (Which reminds me of that joke,
how do you remember your wedding anniversary? Forget it once! Clearly not
the case here)

Marcus: 1986 ok? Right let's say you were twenty then so that makes your
birth year 1966, sounds reasonable?

Staff Member: Yep

Marcus: Any idea what month you were born in?

Staff Member: Nope.

Marcus: No Worries. Pick a number between one and twelve

Staff Member: Erm… Seven?

Marcus: Right, July it is! OK nearly done, any idea what date you were born?

Staff member: No.

Marcus: Not a problem. How many cooking pots do you have at home?

Staff member: Four

Form: Date of Birth

Marcus: 4/7/1966

Voila! Born on the forth of July! This process has been repeated more than
thirty times so far and we aren't even half way. Painful.

Medically, we drained 65mls of fluid off an old blokes knee, (which was very
satisfying indeed.) and the workers in the clinic brought yet another child
with cerebral malaria back from the dead. Rather embarrassingly we turned up
just as the child was turning the corner and so got all the plaudits for it'
s remarkable improvement. Completely undeserved credit is no credit at all.

The walk back was uneventful apart from three very large trucks, the first
cars I've seen in six weeks, thundering down the track. All were laden with
soldiers. The lead truck stopped and the portly commander got out and
introduced himself. My heart was pumping like a train at this point. Trying
to remember what I'd been told to say to highflying generals/army commanders
in my briefing.

It's a bit like talking to the Queen in terms of etiquette. I settled with
just calling everybody 'Sir'. As he approached I looked at the back of
truck, which was stuffed to the gills with soldiers, all young, all armed to
the teeth.

I cursed the fact I hadn't any cigarettes to offer as a bargaining chip.
Being a non-smoker can seriously endanger your life, they should warn us.
Thankfully he was very jovial and offered us a lift. Whilst it would have
turned an hours walk into a few moments drive and was thus very tempting, it
's not quite the done thing and would have got me a flight home much sooner
than anticipated.

Pleasantries exchanged they drove off, the black faces and white teeth of
the soldiers in the back of the truck disappearing into a cloud of dust and
chocking acrid fumes from the badly tuned, gurgling engine.

Tomorrow we are off again, as the outreach travelling circus rolls onto its
next location. So more in a couple of weeks, when we are back in a land of
electricity and e-mails.

Forward and on

With a head still awash with numbers I got up early to try and finish the
statistical report. After a nights sleep it made even less sense and the
notes I had made seemed to be written in a language not of this earth. Never
mind, report dispatched, just have to wait for the feedback on it….gulp!

As is usual for the arrival of the plane, my preparedness was not exactly
that of military precision. Stuffing what clean clothes I had into a small
bag and grabbing a few biros and rushing towards the airstrip I arrived at
the gate and spun on my heal remembering I'd forgotten my stethoscope, I did
this little dance a few times as various other things came to mind that I'd
also left in my hut. The engines were running (A pilots way of telling you
to get yourself into the flippin plane... pronto!!!) by the time I clambered
aboard.

The flight to the outreach site was, if I'm honest, embarrassingly short. It
took just over five minutes to cover a distance that takes as many hours to
walk. The same pilot who flew us last time (and got lost, stop sniggering at
the back there!!) Flew us again and this time there was no mistake, the
airstrip was soon teaming with people who ran to observe this strange lump
of aluminium that had interrupted their morning. This was only the second
plane to land there in two years.

Anyway once landed things were pretty much as we had left them in December.
Everything was running well, various different problems had cropped up. A
few of these later. The BIG difference was the people who I'd got to come on
outreach with me. After a lot of pleading with the boss I'd scored a major
success. We had not only my new outreach buddy but also (da da
daaaaaaaaahhhh!) a Logistician. This I think was because, frankly, when it
comes to organising, things like logistics it's better to get
a ….erm…logistician.

Anyway with the various logistical bucks successfully passed we endeavoured
to try and sort out the medical side of the whole business. Moses (for it
was he again) was doing sterling work. Despite the fact that we hadn't
really worked with him since his arrival, he'd even managed to organise a
half decent off duty rota for the staff (BIG step forward)

The feeding program being offered to the populations' malnourished children
was disaster on every conceivable level. Sadly this wasn't his fault, and
therefore nothing we could easily correct. People seem unwilling or unable
to return for the repeat visits required in order to cure the malnutrition.
With a walk of six hours in temperatures that are in the low forties Celsius
it's not hard to understand why.

Medically the major problem was diarrhoea, no water pump still, it keeps
being promised by another agency…. never happens…out of my hands…tired of
being angry about it… Like so many before me I'm just a bit resigned about
the whole affair now. It's just so depressing,

The water level is lower and scarcer now so the quality has dipped still
further, the dirt is more concerntrated now. I'm not sure how this is
possible, but it is. A thick layer of brown slime sits at the bottom of any
large water container when you empty it. That's all I can say without
screaming!

One morning I was called to see a little girl with a piece of cow bone stuck
in her ear, another unbridled success for our friends in the traditional
healing fraternity. With a pair of tweezers and a lot of tugging I managed
to get it out, but not before causing significant pain and a bit of
bleeding. Hopefully incidents like that will get the message across.

It seems a bit weird that these trips become mundane but it's funny also
what you get used to. A new outreach partner has reminded me how odd this
all is compared to healthcare in the western world. But the numbers (for
this is what really matters I suppose) are better than ever and we seem to
be saving more lives than ever. I cannot describe what an immense
satisfaction that is.

We left a few days later with the majority of the staff for a large party in
the base site. There were speeches under the tree and the staff killed a cow
(and frankly I'm not sure the Iraqi government could have killed anything in
a much more gruesome way!!) and there was signing and dancing long into the
night, I have to admit I was so tired from the walk back that I sloped off
to bed at a conservative 11.45pm. A wonderful evening.

So the plan for this week is a wander off to another outreach site with
large numbers of soldiers and large problems. Will let you all know how that
goes!

Lies, dammed lies and statistics

It is possible to prove anything, they say, with statistics. Who 'they' are
has never been explained to me. Personally, the whole notion of statistics
falls into the 'spirit crushingly dull' tray of my brain. I even find myself
reading the subject bars of e-mails and the mere mention of the word
'statistics' or it's evil twin 'data collection' and it's straight in the
file marked, 'stuff to read when I'm old, unable to move, and barking mad'.

Yes, yes yes I know it's very important to know what is going on,
particularly in clinics where we are not present all of the time, this doesn
't stop it being about as interesting as creosote.

It's the one part of this job I loathe. Every month four members of staff,
one from each clinic, skip merrily through the sand and grit (that until
recently was a swamp!) with books full of numbers to one of the two base
sites. I then have to take the numbers and try and make sense of them. There
are a few problems with this.

Firstly, counting, as has be proved ad-nausem is not a strong point here. I
once made the mistake of trying to explain the concept of percentages.
Frankly I could have been reading a washing machine manual, backwards in
Serbo-Croatian for all the good it did.

Secondly, this is not the sort of environment that lends itself to intricate
and detailed compilation data collection. The fundamental problem is that
the clinics staff are not able to compile large amounts of information in a
monthly report and do the jobs they are supposed to be doing at the same
time. We just about manage the big three, malaria, pneumonia and diarrhoea,
but get into the finer detail and the whole thing comes down like a house of
numerical cards. The raw data provided is erratic. For some months I will
know how many pregnant women pitched up, for other months I won't. This
makes trying to identify patterns hopeless. Conversations with my bosses run
along the lines of;

Marcus: We had a large number of malaria cases in November.

Boss: Really? What about December?

Marcus: Erm…… (Starts to find floor very interesting, makes shape in sand
with shoe, avoids eye contact, or speech. Exits stage right.)

I have been sitting here all afternoon (yes I know, on a SUNDAY!) trying to
do the kind of mathematical gymnastics that would have had Archimedes
wondering if there wasn't some other topic to philosophise about. It's not
much improved after six hours of work. But at least the Excel columns are
now in different colours!!!! The guys who cracked the Enigma code are the
only beings on earth who can truly understand my pain!!!!!

Thankfully in just over twenty-four hours we are flying to an outreach site
to do some fun stuff. My brain may have stopped dribbling out of my ears by
then!

BREAKING NEWS. Just got an e-mail from my medical boss. There is a
nutritionist coming next month to assess our feeding program in the
outreach. Despite much effort our feeding program is an unmitigated disaster
on every conceivable level. I'm in so much trouble!!!!!!!

In the bleak mid winter.

It is winter here. I'm not exactly reaching for the bobble hat, gloves and
Bovril. Not much of a winter season by all accounts, it is still hitting the
mid thirties every lunchtime, but the early mornings and evenings are more
chilly, I'm sitting here in a long-sleeved top!! And it hasn't rained at all
since I arrived back. I know that's nothing to those of you looking out on a
snowy blizzard, but it's a big deal here in the desert.

No outreach this week, I've tried to operate them by remote control and
failed miserably. I've dispatched various letters with various questions and
received letters with various answers, which would be fine, except they aren
't answers to the questions to the ones I've asked!!!

First task of the week - brief my new outreach buddy, another UK nurse who
is as new to this game as I was not so long ago. She bounced in from the
other base, with a whole load of other new people. The number of expats has,
instantly, swelled hugely. The majority of them are from the UK. This has
had the unexpected bonus of meaning the office computer's spell check has
now been permanently switched to English (U.K.). Proof of a change in the
balance of power if ever there was one.

The reason for the coming of the proverbial cavalry has been the massive
increase in workload and having them here has (rather typically) coincided
with a significant downturn in the number of patients, leading to our new
arrivals all wondering what all the fuss was about. I was trying to explain
that before Christmas, vast areas of the clinic grounds were covered by
people sleeping on the floor, now they are as God intended. Empty. I think
they tried really hard to believe me. They will see when it all picks up
again!!! I'm staring to sound like one of those awful people who rattle on
about how it wasn't like this in their day!!!! Must make efforts to
stop......quickly!

Anyway my new outreach colleague seems very keen and eager so that is a big
improvement on the last two. We hope to head to our first clinic as early as
next week.

I've found myself doing briefings rather than listening to them, which is
VERY peculiar. It seems only yesterday I was asking the sort of questions I'
m now answering. I'm fielding enquiries about everything from security to
the rates of malaria in expectant mothers without batting an eyelid!

Every day here provides me with a new challenge, and I can't say that about
any job I've had before. This week included the usual mix of triumph and
tragedy. The child with convulsions (mentioned in the last entry) recovered,
against all the odds, and is now running around with his siblings. I'm still
none the wiser as to what it was, but something we did, clearly, worked.

The usual collision between the traditional and the western method of
healing has continued unabated. We lost a month old baby who, inexplicably,
had been fed cows milk since birth and had a very serious infection of the
gut. As things became terminal I gave some morphine and encouraged the
mother to breast-feed for the first time. The child fed beautifully. I left
the hut, wishing the mother had just done that in the first place and not
listened to the ramblings of some village wise woman, all very frustrating.

On an up (because I don't like to end on a down note) I did a refresher
lesson with the staff on pneumonia and not only had they remembered what I
taught them but they had also gone away and read MORE. Some of the detailed
questions at the end rather threw me!!!! Off now to brush up on a few things
about digestion before I get caught out again tomorrow.

To the place I was before.

After a fantastic, and by all accounts, much needed break I'm back. But no
outreach just yet as having returned from a holiday I'm now covering others
time off. This at least allows me a couple of weeks to get slowly readjusted
back to life here. How quickly and easy it is to forget what a harsh and
unforgiving environment this is.

The flight back in was, thankfully, much less eventful than the flight out.
>From the air it is possible to see the transformation in the landscape.
Sandy yellow is the new green. The change is little short of remarkable.
This area gets more rainfall than south east England, it just happens to get
it in just under three months (July, August, and September.) The rest of the
year is arid and dry. I was looking at photographs of what things looked
like in August and it is like a different county. Our airstrip, that only a
few months ago was ankle deep in water, is now a long, thin sand pit.

The wind whips around the mud huts and the buildings. It carries sand and
dust in every corner and crevice imaginable. Every surface is covered in a
fine film of it. The air itself is warm and a little like having a softly
blowing hair dryer six inches from you… permanently. And this, my friends is
only the beginning. Soon it's going to get REALLY hot.

By the afternoon of my arrival it was back to work with a bump. Various
patients, various problems, all in need of sorting out. Tonight I've just
returned from dealing with a child who was having a nasty convulsion. The
fitting we have managed to stop, but as might be expected he remains deeply
unconscious. He has no fever and the malaria test is negative so I'm not
really sure why he is convulsing, there is a list as long of my arm of
possible causes. We have given everything and covered all the bases
possible, I've just had a bit of a chat with the mum and dad and they seem
quite clued up. The situation is, needless to say, dire. we will see how the
night goes, but it is not up to me anymore.

So a few weeks here and then, hopefully some outreach, with a new outreach
buddy who is currently in the other base, doing a similar job to me. There
is also a staff party to organise, so I won't be sitting around.

I hope you are all struggling back to work ok, for those who have e-mailed;
apologies for my hopelessness I will sit down and reply soon.