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.

Voodoo child

As mentioned before this area sees about as much in the way of healthcare as
Brown and Blair see eye to eye. Not a lot then. The best way to describe the
clinics that operate here is that they are islands of treatment in an ocean
of no treatment. There are no GPs, dentists, and no pharmacies and the only
drugs available are sold in markets. I walked past a shop on Sunday selling
pillowcases, pocket mirrors and IV Gentamycin! The population here can’t get
enough of medicines, injections in particular; if they haven’t had an
injection then they haven’t been treated. We have outreach sites that give
medicine to more than eighty three percent of all the patients they see.
This has massive repercussions in terms of resistance to antibiotics and
costs. It is a problem we are urgently trying to address. However it is also
an issue that cannot be totally solved by us, as outsiders. It is a question
of education, and in a place where only a privileged few go to primary
school and any form of mass media is non-existent it will take years to
solve properly. Besides, it’s not a predicament we have yet solved in
Europe. I lost count of the number of patients I saw as a nurse in London
demanding antibiotics for self-limiting viral infections.

It’s not much of a surprise also that a boom industry here is the
traditional healer. These people range from the mildly hopeless to the
lethal. A particularly barbaric practice is that of cutting. Here, (and in
many parts of the world) it is believed that burns and cuts will alleviate
symptoms. The human body has a fabulous way of healing itself over time, but
often it is the traditional healer who can take credit for the hard work of
the patients own immune system Most commonly we see the patients after the
traditional healer has got his hands on them. In many cases the deep,
infected lacerations present more of a problem than the original illness
does. This is particularly the case with nodal TB. There is a practice here
of attempting to gouge out the offending lymph node with something
resembling a sharp spoon. It is therefore impossible to assess a lymph node
that should be swollen but not painful (if indeed it is nodal TB) because
someone has kindly taken a rusty implement to it and made it very painful
indeed. However in most areas there is nothing else on offer and until a
very large amount investment occurs the traditional healers profits are
safe, even if their practice is anything but.

Cultural Differences

So it’s been a week here of not doing outreach but doing other stuff
instead. I’ve been covering the holidays of other expat staff, which has put
me in charge of an inpatient department. In Europe the first question anyone
would ask is ‘how many beds is it?’ Well here we don’t have beds, a grain
sack on the floor is the nearest thing to it. Furthermore in terms of
admissions if we have more patients than there is space we just put up
another tent. To say we have been putting up more tents this week gives an
indication of how the week has progessed.

The days have been punctuated with many different patients, all with a
unique story and outcome. The first patient I saw was on Saturday. He was
four and weighed the average weight for an 8-month child in Europe (7kg), I
make no exaggeration when I say it was lucky mum and dad decided to come to
the clinic in the morning because by the afternoon there would have been
little point. There were many furrowed brows, tutting and desperate attempts
to get the child going with some fluids. Not an easy task. His skin was
paper-thin and trying to get an IV line was akin to trying to stuff the
machine that dug the Channel Tunnel down a trouser leg!

Eventually 24 attempts, and a lot of huffing and puffing later, we sited an
IV line. Death delayed for a few hours but still very much on the agenda.
Man cannot live by IV fluids alone (though it’s a very good start). The
painstaking process of feeding begun, the parents were magnificent, cajoling
and coercing for hours on end. The child by this stage had reached a point
past hunger and he simply wasn’t interested. This morning, he walked out of
the clinic having reached his target weight in less than a week, leaving a
team of grinning health centre staff with a lovely warm glow inside.

At the other end of the spectrum are those who don’t want to hear what you
are telling them. We have had an eight-year-old boy with us for a nearly two
weeks, he has TB and as a result is malnourished. Culturally here it is very
difficult to convince people their children need IV drips (I still haven’t
got to the bottom of quite why this is!) so this patients parents refused
point blank. Then they refused the special food we gave the child (I think
they may even have been giving it to the sibling and selling it on the
market) Consequently their child got sicker, and so they became angrier. The
final straw occurred two days ago when then accused us of trying to kill
their son.

I walked back to the expat living area with steam gently rising from my
ears, went and threw a Frisbee round the place and played Risk. Felt a
little better after this, and decided that a change of tactics was needed,
bring forth the man with the sticks!!!!!

No dear reader, I didn’t pay a man with sticks to attack the couple in
question, though for a few moments I considered it. The man with sticks was
a TB patient who had presented months ago unable to move and feed himself,
and now after a bucket full of TB drugs and equally important food he was
able to walk ala cross country skier with two sticks. He lived in the TB
camp

This is a large area of more than seventy patients who are all at various
stages of TB treatment. Treatment for TB can take six months or longer and
so they live in a little community of tents and huts whilst they complete
the arduous course of medication. Caretakers and Improving patients care for
the sicker patients. The mood is always buoyant; there is always a game of
something going on. It is a place of laughter (followed by bouts heavy
coughing!) and millions of children running in all directions. I wish I
could spend more time there.

I took the parents to see the place we intended to bring their child once he
was improving and we sat in a small circle whilst the old man with sticks
recounted his TB experience and how the process had been long, painful but
ultimately successful. Things then took a bit of an unexpected turn, as the
topic of our discussion became public knowledge in the camp. Soon there was
no stopping them! A large crowd of people gathered all with stories about
their own TB crisis and the importance of nutrition and taking the medicine
as prescribed. Our poor translator nearly had a stroke trying to translate
the quick fire conversation that followed, In the end he just gave up and
gave us the topics been discussed. The plan could not have worked better, I’
ve just seen the child in question now and things are picking up. No more
arguments about the treatment, my life is less stressful and their child is
better. Everyone’s a winner!

Of course there are those who arrive too late. I won’t pretend that good
news outweighs bad. Four people passed away last week including an eight
year old boy and a mother who left a thirteen year old girl and four year
old boy to fend for themselves (the father died last year). Tragedy is a
constant companion, however I have never felt that I have made such a
difference as I do here.

I’ve passed my first two months, in many ways it has flown by, but then
again London seems an awfully long time ago. And two months means a break,
so I fly out on Monday for a few days R&R. The sea is calling I think.
Though I think I’ll have a bath first.

A story of rain, maize and influential chickens

Well… it couldn’t last; the rain had held off for a few weeks and now is
back by the lorry full. Thunder and sky splitting lightening are now a daily
occurance. On a personal level this is of no particular concern to me as I’m
not going anywhere for the next few weeks. For everyone else it is a real
headache. With the airstrip now having a deep end and a shallow end (and a
definite vacancy for a lifeguard) the chances of a plane for the next week
is remote.

Luckily (as my protracted arrival proves) it has rained here before and we
have enough supplies to keep us going for weeks, hopefully there will be a
break in the weather soon. In the meantime the clinic is deserted. In fact
it's so empty the tumbleweed has moved on somewhere more interesting. The
rising water has made travel from anywhere but the nearest towns impossible.
We expect to see more patients in a worse state when the weather improves.

The crop this year is causing concern also, and this batch of rain may have
come to late to solve that problem. Enough water but in short bursts, rather
than drizzle is the main problem. This is the only rain they will get before
a very long, arid dry season. We are seeing malnutrition increase already. I
hope things are not as bad as predicted once we get to February.

In a land so utterly different from my own it is nice sometimes when things
happen that seem a little too familiar. A child presented today with a piece
of maize stuck in her ear. It is refreshing to know that even thousands of
miles away from home children still put silly things in every facial orifice
imaginable! Needless to say we didn’t have anything like the right equipment
to get it out and our efforts (I say ‘our’ as two of us were involved in
this venture) resembled a cross between bomb disposal and that thing the
space shuttle does when it’s trying to grab an errant satellite with the
robotic arm. Left a bit, right, up a touch…missed. Anyway the child will
come back for round two when it stops raining. Any bright ideas please feel
free to e-mail.

The chickens are well, and getting used to their new home,
though they seem a bit too attached to the old one. This means there is a
nightly scramble round the clinic rounding them up and taking them back to
the new coop. We still have to find (and no this is not a joke) an
‘influential’ chicken, convince that flock that the new home is preferable
and the rest will, apparently follow. Hmmmm. I will keep you posted.

Otherwise all is well, I did a teaching session on antibiotic resistance,
which involved drawing with a marker pen on one of the nurses hands. And
then when trying to do it again seeing how he moved his hand away. I little
like antibiotics, not so effective if you try them too often. Things here
are a little basic, but the eagerness to learn puts us in Europe to shame.

Not sure what tomorrow brings (which is still the most exciting thing about
being here!) if it’s worth writing down I’ll let you know.

Marcus Wootton – Chicken Farmer

Like busses this blog, nothing for weeks then loads all at once! A very
unexpected thing happened today… I became a chicken farmer. Last night I got
into a conversation with one of the other members of the team about
chickens, I’m not really sure how.

I may have mentioned before that chickens are a regular fixture of the
clinic here. There are a large number of them wandering around chatting away
to themselves and sometimes to us. The first day I was here one came in to
critique my suturing. I’m sure on many occasions they are offering very
sound medical advice, if only we understood. Anyway there has recently been
a bit of a population explosion amongst the chickens and now they need two
huts to keep them all in. They also need someone to oversee their upkeep and
general well being………………me!

Thus here I am in the middle of Africa and for the first time in my life I
have a flock of chickens to look after! Boiled, Fried, Poached and Scrambled
as the chickens are known are now in the custody of a bloke who has lived in
cities for the whole of his adult life, and who’s only contact with
chickens, so far, has come in the form of the Caesar salad variety. If they
only knew.

The plot thickens slightly as not all the chickens in the clinic belong to
us and so I have to round up our feathered friends every night and take then
to their newly refurbished coop. They will soon…hopefully…. get an idea of
where their new home is and do it themselves.

I’ve spent the evening with my chicken farmer colleagues (two medics and a
guard) chasing chickens round the compound. After a breathless chase in
which a one point there were birds and feathers flying in every direction we
cornered them and carried them to the hut. The hut has a newly repaired door
and feed - cornflakes, stale Rivita and eggshells which, apparently, is very
good for them. When it comes to chickens everyone but me is an expert.

On the medical side, I made a game where the nurses in the clinic had to
match the drug with the disease it treated. A work in progress I think.

I also squeezed a bucketful of gunk from a very large abscess on someone’s
neck. They’re coming back for more tomorrow. Yuck!

Tomorrow involves sorting out a large amount of files and holiday days for
the outreach staff. My maths could be strained to the limit!

Out On My Own

“Why is there no milk on your branflakes?” “I’ve never had milk on my
cereal, and besides there isn’t any milk anyway.” ”Hmmmmmmm still think it’s
a bit weird” a rather painful silence then.… “So we’re off tomorrow, it’s
going be ten days of really hard work” she said “who’s off?” I said, between
mouthfuls of cereal “You and me,“ she said. A pause (whilst I cogitated and
chewed) then, trying not to choke on branflakes, “so (trying not to sound
too desperate) I’ll be the only medic” (out here anyone who is a doctor,
nurse or knows how to put a plaster on correctly is referred to as a medic)

“Um…….. (looking a little baffled by my seemingly obvious question)
yes, but you’ll have a doctor on the end of the radio. That is going to
require me to know which bits of the body are which and complicated medical
words to describe the patients’ symptoms, not my forte at all, I thought. A
restless night with, my only medical textbook learning words that would at
least give the impression I knew what I was talking about.

Off to an area that hadn’t been visited by a team for months, and visiting
not one, but two clinics that hadn’t received any input since May, and it’s
the boss, and me could be fun.

Day 1 “Could you come and look at this woman, I think she has died”.

The roar of engines overhead indicated the imminent arrival of a plane, a
plane that most of us thought would arrive in forty-five minutes time. Panic
stations, furrowed brows and people running around in all directions. A
collective chasing of tails.

Cargo to unload and patients to load on, then patients to load off again as
there were too many people on the plane weren’t on the list. Then a loading
of further load of cargo, then the loading, in a chaotic scramble of a few
patients who were being flown home. No concept that a plane overloaded by a
third will find flight impossibility. More unloading of patients. Angry
words. Engines revved. Doors closed. Away.

The plane bumped down to a shuddering stop. The area was more open than any
I had seen before. Vast plains of green grass, and of course mud, in many
directions. It was as flat as a bowling green.

Small hamlets dotted the horizon with small fields of crop next to them.
This area is one of subsistence farming. The small compound and clinic that
we had landed at had had a large program operating. There had been a large
inpatient facility and one of the largest TB treatment centres in the
country. In May this all changed, fighting had lead to an evacuation and,
with the clinic unguarded it had been stripped bare.

What can best be described as two days of madness saw many years of work
destroyed. The numbers of lives lost as a result of this, in terms of
patients who could not be treated and the damage to the community as a whole
is incalculable. The scars of the looting are still evident. I even found
part of an oxygen resuscitation mask being used as a bracelet by one of the
teenagers in the town (no, I’m not joking). The community has suffered for
the sins of the war and the local staff in the clinic have worked very hard,
against almost impossible odds, to keep some semblance of a medical service
operating. Not for the first time I feel humbled by the people who I have
come to work with.

The plane was soon a spot in the distance as it, carried another group of
patients. They had been kept alive by the ingenuity and dedication of the
local staff for long enough until help arrived another ten people walking
around who otherwise would not have been. The role of the foreign aid worker
is much overrated. In many ways we are a nice optional extra. The local
staff are the people that the bulk of the credit should always go to. But
sadly you don’t see movies about them

With the plane, and thus all contact with the outside world gone, I set
about seeing what patients had remained behind, all were acutely unwell and
the level of treatment available was patchy, however all were showing
encouraging signs of improvement. Various pneumonias, gunshot wounds and a
few children with malnutrition, oddly this is becoming bread and butter
stuff now.

As a rather chaotic ward round was drawing to a close, I got a tap on the
shoulder. “Could you come and look at this woman, I think she has died”. It
was said in such a way as a cashier might say “could you just enter your pin
number”. Bit late for me then isn't it ? I thought as we wandered across the
compound.

An Announcement

I realise that my blog has a mixed audience. It is difficult to write about
cases with enough detail to keep the medics happy but with enough
explanation that the non-medics aren’t totally lost in a world of jargon. So
in order to combat this I’ve bracketed some helpful notes for the non-medics
with the heading NM

When I reached the woman she wasn’t, in fact, dead. But she was making very
great strides towards that end. Her blood pressure wasn’t above 60 systolic
(NM This is not good) she had a temperature of 40 degrees (NM neither is
this) a pulse so fast I lost count, (NM all signs this dear woman is in big
trouble) she had a grossly distended abdomen (NM again not a sign that
things are going well) and she had given birth to a baby boy five days ago
(NM this is nice but not crucial right now), who was, despite everything,
very healthy. As stated before when you try to save a breast-feeding
mothers life you are also trying to save the life of her baby.

Trying to resuscitate someone by yourself in a mud hut in fading light, and
only one cannular (NM IV line) with the whole family watching your every
move could best be described as the fringes of my competence.

Having found the only vein the patient had left I attempted to put an IV
line in. Of course life would be too easy if the cannular managed to get
itself into this woman’s vein correctly. All was going well until it came to
the fiddly bit of advancing to plastic tube into the vessel. At this point
the plastic tube refused to budge. “oh for pities, sake will you just get in
there!” I said to the cannular (although I’m not sure if I used the word
‘pities’). Thankfully the cannular obviously listened and did ‘just get in
there’ and soon the woman was having the proverbial kitchen sink (in terms
of fluids and antibiotics) thrown at her.

We, and again I can claim no credit for this as the national staff did the
vast bulk of the work, kept her going for ten days until a plane arrived. I
went to see her this afternoon. Mum and baby doing fine.

Day 2 Two Twos are seven

A crippling lack of education has meant that most of the population are
basically illiterate and the ones that aren’t have moved away. When it comes
to counting stock and medicines the struggle very badly indeed. Here however
I found that my maths was also a bit dodgy and a pharmacy stock check that
should have taken an hour took a whole day. Most of which was my fault. Went
to bed with brain dribbling out of my ears.

Day 3

Breast cancer is a disease that strikes fear in Europe. It is the subject of
endless soap opera storylines and health promotion campaigns. Not here. What
exactly would you do with the lump if you found one? Today a woman attended
the clinic in the final stages of her disease. The cancer had spread and she
was pretty much riddled.

Trying to convey the hopelessness of her situation to her and her son was
one of the hardest afternoons of my life. Many times they asked why we could
not cut it out. I kept trying to explain the stages of a cancerous growth
and what happens when it spreads. The son said he would take the woman to a
traditional healer. I tried to explain it would just hurt her and make no
difference. But I can see his point, we were offering nothing but
painkillers and sympathy. A traditional healer would promise a cure. This is
what happens when you don’t have an effective health system.

Day 3 Bees and Broken shoes

Early in the morning, VERY early in the morning (no time for Branflakes) we
roused our troops and headed on foot to the next outreach site. The convoy
consisted of drugs, a radio and various other bits and pieces. The water ran
to chest height in places but I’ve written before about the roads and once
you’ve waded through water for a few hours once, the experience is pretty
similar the next time! This trip was marked by two key events. Firstly my
rather snazzy shoes, which up until this point had performed impeccably
spontaneously combusted. The strap broke in such a way as to make them
unwearable. I performed a variety of suturing techniques to hold them
together but they were, essentially, screwed.

The hours rolled by and the flat countryside splayed out
before us. It was time to stop for a break, and put another few stitches in
my shoe. “There’s a very odd fly in my hair” said the boss as we rested
under the shade of a tree “Looks a bit like a bee” I mused looking for a
spot to sit down on. Then glanced at the tree to see one side completely
covered in bees. The bees were clearly not great fans of ours and began to
swarm…

….It had been a quite day for Mrs Elizabeth and her children, she had set a
large fire going in the corner of her hut and was just getting her five
children settled for lunch. At this point their day was rudely interrupted
by a screaming noise and the sound of lots of people running, this was
followed by the sight of two white faced Europeans busting into her hut
screaming like thirteen year olds at a boy band gig, closely followed by a
large group of very angry bees. Luckily bees fall asleep with smoke and the
group were soon much calmer and the male European, who had been shouting the
loudest, was soon blowing bubbles with the children. They thanked Mrs
Elizabeth very much for the use of her hut and hoped they hadn’t disturbed
her day. A family anecdote for years to come.

After the attack of the bees progress was much slower, the
running had snapped another strap off the shoe. The next event was the
crossing of a large river. At this point I suffered my second equipment
failure of the day. My dry bag suffered a nasty tear, singularly making it
neither dry, nor an actual bag and thus making it a … er…

Days 4 & 5 Across the line

We crossed a former frontline in the fighting, and it showed. Thousands of
people without the most basics of life, but a health clinic that,
miraculously, had stayed open. Again there were patients we couldn’t treat.
There was a child with an abscess that had collapsed one lung and was making
strong inroads into the second and a woman with mental health issues. But
also many who were receiving care and getting better. The evening saw the
worse storm I have seen since being here. The omens looked very bad for the
walk back.

Day 6

Walk back can be summed up in three words Long. Hard. Slog.

Days 7 & 8 Shifting priorities

The wasteful nature of foreign aid witnessed today. A plane landed and pushy
American doctor got out. She went straight to the child she had come to
assess to see if the little girl had the disease she thought she did. She
didn’t, so she got back on the plane and flew away again. Had the doctor
glanced to her left she would have seen a large group of totally
un-immunised children and behind them a group of expectant mothers without
the basics of maternity care. All could have been paid for by the cost of
her plane visit to see one child with a non fatal disease that she didn’t
have.

Day 9

Spent the day in the clinic surrounded by patients many of them displaying
symptoms that I’d only ever seen in books. The learning curve here is
vertical and I’m sure I’m missing things. But you can only do your best.
Flew back to the main base the next morning.

So that was my week. Highs and lows as ever, thanks again for the messages.
Glad to know there are a few of you still reading! Today I’ve spent the
morning doing paperwork (booo) and the afternoon playing football (Hurray!)

I’m going to be a bit more settled for the next few weeks as I’m covering
various holidays and stuff so hopefully I’ll be able to update the blog a
bit more often. And get round to replying to a few e-mails. But I think that
is enough to be getting on with for now, ten days of hard work it was.
Tired. Off to bed.

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.

A target no longer.

So after fifteen days trapped by an uncompromising weather situation I had
almost resigned myself to the fact that I was going to spend another week
doing the square root of not very much. Teshome, one of the doctors also
stuck in the rain soaked base and I enquired about the chances of flying on
Wednesday. 'Non-existent' was the reply. Fine. Not flying tomorrow, nice to
know where we stand, lets go and play pool.

After endless games of pool, a few beers and a VERY late night home crashed
to bed in the wee small hours safe in the knowledge that tomorrow guaranteed
a lie in of biblical proportions. At 8.03 am precisely there was a crisp rap
on knuckles on my door. "Marcus, get up, the landing strip has dried up, and
we are flying in an hour". Not since Dunkirk have so many people had to pack
up so much stuff in such a short space of time. Panic and chaos reigned. We
were tripping over each other and running in all directions, like some long
dormant volcano was imminently about to erupt.

Finally with moments to spare we piled onto the single engine prop plane
(The smallest plane I have ever SEEN, let alone flown in, the other aircraft
would have eaten this one as a light snack!). As I gazed at the two
gentlemen walking across the tarmac to in white shirts I thought, 'ahhhh isn
't that great, the pilot has brought his son along for the flight. This
person turned out to be our planes co-pilot and I can't say he did a bad
job. For a twelve year old!

The country stretched out before us, unsurprisingly for wet season, it was a
vision of green, pockmarked with trees and small huts. It resembled a giant
reptiles skin, with its small ridges and divots. A more serene and peaceful
land it is impossible to picture. Ironic considering how war torn this place
was, and is. Hours of flying through a storm, all occupants of out tiny
plane convinced the landing strip would be a long straight pond. And we
would do a graceful circle before heading back to base again.

The pilot broke the plane through the thick cloud and swooped low to assess
the quality of what he was about to attempt to land his plane on. A large
heard of cattle were grazing in the centre of the landing strip and, at the
sight of the plane, people could be seen desperately pushing them off to the
side of the runway. A deep turn to the right, a sharp ear popping turn to
the left, a rapid decent and WALLOP! A vertebrae jangling landing. And then
that was it. Hundreds of people unpacked the plane, and the pilot, clearly
in no mood to hand around, was off again. No more waiting, no more briefing,
just a minutes walk and there I was.

The compound is a collection of huts with straw roofs mud and stick walls.
The power is solar only. The toilet is a glorified (though there isn't much
glory to it) hole in the ground, and the shower is outdoors and consists of
a large tank with a tap. This will be my base for the next year, though were
I'm actually working will be many different sites dotted around this base
and another which is currently being opened. The base team consists of two
nurses, (From Kenya and Holland) a doctor (Ethiopia) A lab technician
(Kenya) and logistician and a boss (UK). This is complimented by a plethora
of national staff. All, it appears, called James, which is helpful.

Then there is the outreach team, of which I comprise fifty percent. The
other half is Suza a German nurse who has been doing this kind of thing for
years. For this I am eternally grateful, as it is great to have an
experienced person around to answer my many stupid questions.

I lay awake last night listening to the all encompassing sounds, trying to
work out what animal produced them. Today I'm none the wiser.

My first full day in the base, which is drawing to a close under a blood red
sky, has been frantic. We plan to leave tomorrow to go to our first out
reach position. All the food must come in tins and we have to take all the
supplies with us. Trying to pack what you think you will need personally for
two weeks into a bag that constitutes hand luggage on most airlines has been
tough. Again, thank you God for Ipods!

With most of the planning down by the German, and therefore ruthlessly
efficient Suza I had the afternoon off to go and see some actual patients.
The first patient I saw needed a few stitches in her head. Previously the
only thing I've put stitches into was an orange. Anyway with no one else to
do it I put in three (reasonably neat) sutures. This was made more
stressful, because halfway though a chicken wandered into the hut where I
was working and took great interest in what I was doing! I think it may have
been trying to give a few helpful suggestions!

Anyway, tomorrow the real work begins in earnest. A seven-hour walk through
a swamp to our first outreach post and then the fun begins! No blog for two
weeks but LOTS to tell after that I'm sure. It is GREAT to finally be here.

A rain check and a word on e-mails

             Well, it's been a very positive afternoon. predominantly this is because it hasn't rained. I've also learnt my first swahili. "Habari" which is "greetings friend". The problem with this is that the locals, particularly the kids, think then that i'm fluent and launch into a full ten minute monologue on something or other, to which I meekly reply "greetings friend". You don't need to speak the same language to know what "is this man a complete muppet?" looks like when demonstrated as a facial expression. If I was writing a school report on my Swahili I think it would include the line, 'must do better'!

 

            Anyhow, whilst I'm stuck out of my project i've got access to the internet and therefore my hotmail account. All those of you who've sent e-mails to my project e-mail don't worry, they're not lost, I just can't access them yet. Basically as soon as I finally get the project I won't have access to the internet and will rely solely on the project's e-mail. Which you all have, (if you haven't then ask your friends!) I hope this makes the situation a bit clearer and hopefully, not properly confused things!

 

            In the meantime life revolves around writing this and doing paperwork, none of which I really understand fully! Those who have had the misfortune of seeing me in professional capacity will testify to just how appalling my paperwork can be! 

 

            I've packed my bag, i'm ready to go, and I'm leaving on a jet plane. Well no... we shouldn't get too excited about this because i've done this pretty much every day for the two weeks! So i'm no nearer knowing when I'll be off, but if the weather holds, possibly tomorrow.I will find out more when the project staff call in tonight with the latest developments. Hopefully no-more fish!

IL PLEUT!

Glad I wasn't holding my breath, I would be a tinge of dark blue by now! It actually didn't rain last night (which is good) but it wasn't hot enough to dry up all water either.... So possibly tomorrow, but who knows.

This is certainly not a problem that would even have entered my thinking before I came out here, and is an excellent example of how difficult working in such remote areas can be. Frustratingly, I’m discovering the places that really need help, don't always have the African equivalent of Gatwick airport down the road. And at least they are getting rain, which will hopefully lead to a good crop and fewer cases of malnourishment, but we shall have to see.

A few people have e-mailed to ask for more detailed info on the fish on the runway. Firstly, no, I don't think the air traffic control became confused between a Boeing and herring, and I don't have any information on whether it was a flying fish! Have a good Monday morning one and all.

Fish On A Sunday

Since yesterday.....

1. It hasn't rained.
2. Someone found a fish on the landing strip as it dried up! Proof if proof were needed that it has been VERY wet.

Still not sure if tomorrow is going to be the day, but even the most pessimistic seem to think it might be. I've also met up with my immediate boss in the project who flew in for a holiday. She seems lovely and very much on the ball, which is what you want from someone in charge of your overall security! The work, she outlined, that needs to be done is extensive and I lay awake last night thinking of what is being attempted, the task seemed daunting indeed.

In many of these places we are not the alternative to shabby run down local health care service the we ARE the healthcare service. Certainly a sentence that grabbed my attention!

Anyway we will see how it all pans out. I'll try to write as often as possible, but there may be long periods when I can't write anything as many of the sites I'm visiting don't have access to clean water, let alone e-mail or satellite communications, please keep checking for updates as the whole reason for writing this is to provide a small insight into the current situation, as I see it, rather than a sanatised media version which, in terms of Africa is all many of us have been privy to. Once I get out for a holiday, at some point in October, I'll post some pictures.

Hopefully some form of flying movement tomorrow, but after so many false dawns I'm not sure I'll quite believe it until the planes wheels have touched the landing strip..............minus fish!

Ou Est Le Soleil ?

After my last posting I received numerous e-mails questioning my sanity. I think it was the Billy Ocean tirade that swung so many people into action. One very good friend questioned how it was possible, in such overcast conditions to succumb to sunstroke. It isn't, I wasn't, thank you all for your concern.

Anyway BIG news of the last few days, I awoke this morning to find not only had I been eaten alive by various creatures of the insect variety but also (and of greatest importance) the sun had finally split the, horizon filling, cloud. And you all know what a drop in the rainfall and glorious sunshine means. Yes that's right.......... I can charge my Ipod on its solar charger!

As an aside it also means I might in the next week get to where I'm supposed to be going! This all depends on the if, and it's a gloriously sized IF, it stops raining.

There is even talk of a flight on Monday, but I've been down this road a few too many times in the past week to get too hopeful at the moment. I’ve not exactly rivaled Nostradamus in terms of predictions so I think I’ll just keep stum! Lap of the Gods and all that. This week has demonstrated the fundamental problem with working in inaccessible area.... It’s inaccessible!

In the mean time I've been trying to keep myself entertained, trying to fatten myself up for the inevitable weight plunge that will happen once I finally get to my project. I will write with more news as soon as there is some.

Going Nowhere Fast

My understanding of the blog is that you should write something when an event worth documenting has occurred. Most peoples I saw before coming here seemed to be about something exciting, the birth of a first born, discovering a cure for cancer that afternoon, captaining a world cup winning side etc etc. May I say at the outset that nothing has happened today at all. Well actually that’s a lie.... It’s rained by the bucket.

In fact today has proved King Lear’s assertion - Nothing has come of nothing. It's rained some more, the ground is a saturated quagmire and to fly now would be to ask the pilot to come and share in the misery of those stuck in the project as he would be unable to extract his plane from the gloop he had just landed on.

Apparently it is not so much the landing as the taking off that is the problem. I sense this has been learnt, bitterly, after many years of people having to dig planes out of chocolate pudding like mud. Anyhow instead of continually moaning about a situation that cannot be sorted short of a parachute jump, or as someone suggested, strapping us to a food drop crate and hoping to land butter side up! Take it as read that I’m stuck where I don't want to be unless otherwise stated!

So for the rest of my blog today I’m going to remark on an African musical obsession.……….Billy Ocean.
Wikipedia (Up there with Google Earth in its ability to waist large portions of the day) defines him as..
'A UK based popular music performer, who had a string of rhythm and blues tinged international pop hits in the 1970s and 1980s.'
If you don’t know who he is, watch a mid eighties film and somewhere you’ll hear a Billy Ocean track. Or if you’re really bored with loads of time on your hands, see www.billyocean.co.uk/.

Actually, on that last point seeing as you all have proper jobs that don’t require you to wait around in the dust until it stops raining I think I’m the only one, bored, with loads of time on my hands!

Regardless, this cheesy disco crooner (that's my definition, not wikipedias') who I presumed to have gone the same way as t-shirts that changed color with heat or ninja turtles is enjoying a resurgence in Africa. And he's not even African! The man, apparently, now lives in Milton Keynes! You cannot go anywhere without hearing the strains of some of his, rather poor, mid eighties syth-pop. I've only been here a week and I'm beginning to think that being banished to Milton Keynes is some sort of karma!

That a continent with such wonderful musical heritage is even giving this man airtime is baffling! I just hope this is some 'in' joke I’m missing. Mind you, it could be worse (for worse please see Germanys ongoing obsession with David Hasslehoff, the only man to be out-acted by a talking car!)

I, possibly, could have too much time on my hands. I haven't gone near anyone sick in a few weeks, perhaps I’m heading that way myself as some form of compensation. A sunny few days would be welcome.

Stuck!

Apparently my first word, and also my current predicament. The landing strip is too wet and there's standing water everywhere. In fact the rain is so bad I'm sure there is a latter day African Noah rubbing his hands and gathering his animals in pairs in the belief that his moment has come! Certainly far away in Ethiopia there is widespread flooding that has killed hundreds, the rain, a continental problem.

Hopes were raised by a sustained period of sun all of yesterday afternoon and then last night it rained incessantly, depressingly for hours! You couldn't land a plane in the car park of the compound (which is concrete) let alone a mud strip. Stuck indeed.

The prognosis is also poor, some doom laden predictions (alarmingly, from people who have been here the longest) put our possible delay at two weeks. Rather like King Canute on the beach I'm powerless to stop the water.

Other than being bored beyond all possible comprehension. I'm actually all right. I went for a walk into town yesterday. Apparently the standard of living, by African standards is actually quite good. However there are areas of deprivation here, on a scale not seen in the UK for hundreds of years.

I was the only white person on display that afternoon, and recived a lot of attention from the kids who would come up behind me, touch my arm and run away giggling. Amazing that, in this ever shrinking globe, places like this still exist within easy reach of the rest of the world.

Off the main street, a large area of people existing in huts constructed from mud and plastic sheeting, no clean water or sanitation to speak of, the largest collection of woefully inadequate 'housing' I've ever seen, again, Apparently the standard of living, by African standards is actually quite good. Poverty clearly isn't history just yet.

At the side of the road sat a small trestle table, and, (rather like the women's institute would sell lemon drizzle cake in a church hall at home) a traditional healer selling medicines. Glaxo-Smithcline this was not. One bottle of potion contained a liquid that was a guaranteed cure for cancer, depression, malaria, TB and diseases of the toe (whatever they are!) Pretty powerful stuff no doubt. An indication, also, of the standard of healthcare available to vast numbers of this continents populous.

Returned for a night reading my book (the Wah-Wah Diaries by Richard E Grant) under the stars. A view denied by the orange glow of endless street lighting in London.

Russian dolls for planes

So I'm here... well, no... actually i'm not. I've been in three planes so far (and not reached my destination!) the weather has been unpredictable. I'm stuck a tantalizing hours flight from my final destination. The weather means I cannot progress any further until things improve.

It's impressively frustrating. A month of build up and now sitting around waiting, an Ipod and a good book for company. However it could be much worse.

The planes I've been on have got smaller with every flight. The last one was particularly impressive. A twin prop plane that skimmed above the clouds for an hour or two and then broke the clouds cover to reveal an all-encompassing view of sand and scrub. Fulham this is not. Hopefully something a little more, interesting in the next blog. (Like actually doing some work!)