These Boots Are Made For Walking

And thats just what they'll do. And one of these days these boots are going
to walk...er...somewhere near a place that has power and a computer!?????!!!

I've not been near a computer in weeks and when I have the e-mail has been
so slow I considered carrier pigeon. Hence it's been such a long time since
I've written, sorry one and all. I hope some of you are still checking this
site, more to follow promise.

"You must be kidding!"

"No way, rubbish, I've never heard that before"

"No, no he might be right"

"Right that's it we are going to buy one tomorrow and see if it works"

Barely twenty-four hours after this conversation I found myself knelt on the
ground drawing a straight line in the sand. Resting at the start of my line
was a beak. The beak was attached to a chicken. And it was hypnotised.

We had arrived at this particular outreach site with not just the usual
suspects. (i.e. me and another poor soul) but also a medical co-ordinator
and a logistician. A huge team by outreach standards.

In honesty, and for reasons so oft repeated it's boring, we had not visited
this clinic (nor the clinic we moved on to) often enough. It wasn't that
they were doing badly but they were (as an NHS manager might put it) 'in
need of input'. More of this later, back to the chicken.

Sitting round a camp fire (containing large amounts of out rubbish that I'd
forgotten to burn the last time!! Whoops!) That night we got into a
discussion about hypnotism and naturally (work with me here) the
conversation moved on to whether it was possible to place animals under
hypnosis. One of our number suggested the method and the following night we
performed a controlled test, of sorts. And it works!!!! For those of you
with access to chicken, and perhaps it's best if you chose a reasonably
docile one, please feel free to conduct a similar experiment along the
following lines.

Take one chicken, lie it on the ground and point it's head to the floor. If
another person slowly draws a line in the sand with their finger in a line
from the beak, about two feet, outwards, the chicken should remain
motionless…indefinitely!!!

Pushing back the knowledge of an outreach team one night, awesome casserole
the next. We had brought the chicken to late to eat that night and were not
overly thrilled with the prospect of the thing squawking for hours. So this
did have a practical purpose too. Not a peep, all night.

Things were going relatively well clinic wise. The contracts were signed
with only one amusing question.

Marcus: So your contracted hours are 40

Staff Member: What …… a day????

Marcus: Err… no…(Completely thrown by this question) a month. …Err. I mean
week. Sorry did you just say a day?

This story would be slightly less worrying had this question not come from
the man in charge of counting the stock!!!

It had been decided to make this town the new county town, what was wrong
with the last one hasn't been properly explained to me. Anyway, the town was
awash with people building and busying themselves. Hundreds of young men
have moved in to work for the various offices of local government, making
the town almost completely young and male. I'm not sure the long-standing
inhabitants quite know what has hit them.

Within a week we had fixed a fence and been able to do some very rudimentary
training with the staff. Often the process involves high amounts of damage
limitation. It's almost about making sure the staff do no harm and then
getting them to do things well. Having said that people like the wound
dresser continue to improve.

Another success was the lady we employ to give the first dose of the
medicine to the children. In many cases (unlike the UK where children are
brought up on a diet of antibiotics) this is the first time the children
will have taken any type of medicine and the mothers are understandably
clueless about the best method of administration.

On previous visits I'd observed out medicine lady using a combination of
face grabbing and overwhelming force. Rather like a patient with aggressive
psychosis the children would be pinned to the ground by an army of mothers
and bystanders. Arms and legs flailing, medicine spat and crying as if limbs
were being pulled off. The whole spectacle resembled a horror film.

This led to some very big questions from my bosses about why it was that our
clinics were using double the number of drugs they should have been. With
the number of children this lady made vomit I'm surprised the number was so
low!

Changing the behaviour has been long and laborious. Starting with, O.K. lets
sit the child up and THEN grab his face to finally, on this visit, lets get
the child to take it off a spoon calmly. I'm sure on occasion the urge to do
things the old way is still strong, and I've no idea what they do when we
are not there. But at least I've tried!

Onto the next clinic. This very calm and tranquil little village had had the
impressive joy of having a borehole and water pump fitted the month before.
This great news had turned very sour as the pump had spluttered water for a
whole day and then produced nothing more impressive than sand and sludge.

A team of engineers were on site when we arrived, swelling our numbers to
seven. Sadly the pump needed a very specific part, and had probably been dug
in the wrong place anyway… so the wait for clean water in this area goes on…

A very very very hot walk in six hours of baking sun back to base. The
temperature was fifty degrees for two hours of the walk. It was also across
open country so shade was limited indeed. All not much fun. Walked into base
with more than a passing resemblance to a raisin.

A quick shower and a beer and then on a flight to the next outreach site.
But more of that in a few days.

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.

Crash, Bang, Wallop!

Before I start I will say that the fact that I'm able to write this means I haven't lost the use of my arms, or hit my head so hard that all my food from now on has to come via a blender. For a brief moment yesterday this outcome was not a certainty.



The day had started regularly enough; I had packed my stuff into my rucksack and was trying to sort out various things in the clinic before flying out for my holiday. This involved sweeping my arms across the desk and depositing all the paperwork I still had to do into a large metal trunk. It can wait until the New Year…probably.



The roar of engines overhead indicated an immediate arrival and departure. The aeroplane thundered across the barren ground billowing sandy dust in its wake. Soon we were bumping along the runway before a roaring departure from terra firma and into the brilliant sun and bright blue sky. After a stop at another project to pick up some passengers we were skimming across the clouds to the missions base.Flying here is so standard it has become a little like a bus or a tube, I have become a bit blasé about the whole enterprise.



The plane slowed as we approached the tarmac of the airfield, the only place we land with tarmac. The flaps wirred into life, the ground rushed to meet us. I really wasn't paying attention. My book ('Rubbish' by Richard Girling) was very diverting and we would soon be on the ground and taxiing, and I would soon be off on holiday. So to summarise I really wasn't prepared for what happened next.



As the plane touched the ground there was a very loud bang. When I say loud, I think some of you in the UK might have heard it and wondered what it was. This was followed by an equally worrying 'wararah wararah wararah' noise. The plane shuddered violently and lurched across the tarmac. Up front, the pilot flicked a few switches and was engaged in a struggle with a plane intent on leaving the tarmac and becoming intimately acquainted with the airfields perimeter fence. As we careered onwards the aircraft adopted a sort of strange diagonal position, a bit like a bad skier trying to parallel turn.



Eventually, after a further loud bang, and more violent shuddering we began to slow down. By this point my skin that had turned the colour of Tip-ex and my eyes were the size of large frying pans. If I had had rosary beads (and, perhaps more importantly, been Catholic!) they would have been a pile of sawdust.



When a tire blows on a big plane like a jumbo jet you don't notice, there are loads of other wheels able to take the strain. Sadly I don't work in place that would accommodate your average 747. In small planes it is a big deal! We had lost one of the three wheels. As we got out of the plane, the damage was clear, a tyre, flat and shredded a landing gear that was sitting at an angle that made the plane look like it had been designed by a drunk four year old. There was also a very nasty new groove in the tarmac of the airfield. Nobody seemed to care about this.



My huge thanks, obviously, to the pilot whose skill prevented a much worse situation, but defiantly something I don't need to repeat.



Anyway, safe and sound, I'm off for a break until the 5th of January. I'm also having a holiday from blog. I'm sure you will all be too busy to read it anyway. Thanks for coming with me in 2006 and hopefully pick up where we left off in early 2007. Happy Christmas and New Year one and all.

---

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Triumph and Disaster

So a week at base camp, and the place that I would call ‘home’ out here.
With no outreach buddy anywhere to be seen I have been kept busy in the
inpatient department. A variety of staff holidays and, what in the business
is called a ‘high patient flow’ (i.e. clinic busting at the seams!) means I
haven’t exactly been idle. The basic figures are as follows. Discharge - 43,
died - 7, admitted - 58. Behind every number is a story, some tragic, some
remarkably uplifting; one of each to follow;

Yesterday we tried to resuscitate a twenty-eight year old man who had
advanced tuberculosis. He had been sick for some time. Sadly there was
‘something else going on’ which is what we term any condition that we cannot
diagnose due to a lack of facilities. Basically we went for hit and hope
treatment. Take an educated guess as to what it is and cross you fingers.
Inevitably we sometimes we get the calculation wrong.

The man was showing signs of acute liver failure and had begun bleeding
heavily internally. I managed to site an IV line and the blood that flowed
was very dark and thin, indicating he was not getting enough oxygen and the
iron level in his blood was dangerously low. A lab test confirmed as much
(Hb of 1.5, yes, I know, 1.5 for the medically minded).

Blood donors only come forward at the last moment and the only
people who donate are members of the immediate family. Sadly none of this
family matched the patients’ blood group. His condition nose-dived in the
mid morning. We struggled to rescue the situation, for every problem we
addressed another two would crop up. In the end the man became very
distressed and agitated, sensing, I think, that time was short. We gave him
a generous dose of diazepam and he gurgled, foamed and convulsed until he
was finally gone. Our national staff were magnificent, considering that the
patient was a personal friend of some of them. I can’t say it was anything
other than horrendous.

Earlier in the week we had seen a child with cerebral malaria.
He was very lethargic and didn’t flinch when we put IV lines into him, which
is never a very good sign. Round the clock observation and high doses of
antimalarials seemed to be getting us nowhere. I decided to have what is
referred to as ‘the chat’ with mum and dad. The chat can basically be
paraphrased, as ‘unless there is some sort of miracle your relative is not
going to survive this’. It is useful in preparing the family for, what is
often, the inevitable demise of a loved one, but it is not exactly easy.

Slowly, very slowly, the little boy began to show signs of
improvement. He began by moving an arm and sighing (as if he found the whole
thing a bit boring). By the next day he had opened his eyes and rolled over
onto his side. Today he was playing with his siblings, and grinning from ear
to ear, my whole year is worth it just for that.

Whilst the individual success stories are, personally, the most
rewarding many more lives are saved by prevention. This week there has been
a much-needed push to improve the care we give to pregnant women. The
newborn fatality rate here is astronomically high. Pregnancy and childbirth
are a leading cause of death in women. It is not difficult to see why. Most
babies are born at home with only a village wise woman (without any training
but lots of experience) in attendance. The babies are delivered onto a muddy
floor, they often aren’t kept warm enough, they may be two days walk from a
health centre should problems develop. The vast majority of mothers have
received no antenatal care whatsoever, and are very anaemic. A consequence
of this is that they bleed heavily and often die.

This situation is compounded by some damaging health beliefs that are
commonly held here. The babies’ umbilical corn is cut with a rusty blade and
the stump is often smeared in cow dung, leading to tetanus and infection.
For the first three days the baby is fed on goats milk, as it is believed
that colostrums is bad for the child. Establishing breast-feeding after this
is very difficult.

We only see deliveries in the clinic when all other avenues have been
attempted. The traditional healer, the old ladies and a multitude of wise
women have had a go at getting baby out and failed.

By this time the mother is often tired, the baby more often than not is dead
and there is precious little we can do about it. Destructive delivery is
often the only feasible option, and I can’t begin to describe what an
unpleasant business that is.

As an attempt to stem this lethal tide we have been constructing and
improving home delivery kits. These are kits given to pregnant mothers for
use in delivering their child. They consist of string to tie off the
umbilical cord, a razor for cutting the umbilical cord, soap for mum and
baby, cloth and blanket to wrap the baby in, gloves for whoever is helping
in the procedure and a large plastic sheet in preference to a muddy floor.
Simple but, all the research indicates, very effective

Their construction rivals Wembley stadium in terms of length and problems! A
committee of a few of us (being the only children’s nurse got me mired in
this particular adventure!) have met to discuss various aspects of the kit.
What do we include, what not to include, how to train mothers and so on. The
‘do we need a plastic bag for the placenta’ argument dragged on for weeks.
Finally resolved we began to give out the kits this week.

Obviously first on our hit list was the clinics staff. I held a large
teaching session for all the staff that wanted to come. I proceeded to open
up a kit, mime having a shave with the razor, I blew up one of gloves like a
balloon bouncing it up and down and took a bite out of the soap (which was
stupid).

My point being that if we don’t teach mothers how to use the kit we may as
well not give them out. It at least got a laugh and hopefully made the
point. I finished by telling them that as there were twenty of them there if
they each told five pregnant women to come and collect a kit that would help
to save the lives of one hundred babies and one hundred women. Back to
numbers again

So health interventions in there mega and nano versions this week, what will
happen next? Your guess is as good as mine.

All change please, all change

To grossly misquote Wilde 'to lose one outreach partner could be seen as a
misfortune, to lose another smacks of carelessness'. Of carelessness I am
clearly guilty. The revolving door that is the outreach nursing team has
sprung suddenly into life again! Francis has decided outreach really isn't
where he wants to be. This coupled with a very attractive masters degree
offer has led to him beat a hasty retreat. From resignation to departing
took less then ten hours.

It's obviously very disappointing but this isn't the sort of work you can do
if you aren't fully committed. In honesty he wasn't happy about the set up
here from the moment he stepped off the plane. And towards the end of our
time together it began to show. It has been a bit difficult, but everyone
has been really supportive and reassured me that it isn't my fault I was
beginning to wonder!

I've been keeping myself busy by helping out in the base clinic which is
starting to resemble an Accident and Emergency waiting room with patients
almost sitting on each others laps! The edited highlights of my week to
follow in the next few days.

A, now much needed, holiday is fast approaching. I actually escape next
Friday for a few weeks, though plans are a little fluid at present.

Are You Chicken?

I want to honour a food that I’ve grown to loath. It’s the perfect fodder
for aid workers toiling in war torn areas, such as this one. Arriving in its
own bulletproof vest, know commonly as a tin. It has tried to make its mark
on the culinary landscape of many a project.

In fact there is only one thing holding this great food back from global
domination, at least when it comes to feeding those who have little option.
It is practically inedible. I refer to chicken luncheon meat.

Even the name is misleading. Luncheon is the term that, the queen and
well-to-do pearl encrusted Daily Mail readers use to describe the meal in
the middle of the day.

This food would not exactly be on the menu at Buckingham palace. It would
struggle to get a look in at the workhouse in Oliver Twist. Certainly if it
was, Dickens great masterpiece would have taken a very different direction.
Young Oliver, carted off, lethargic, green and vomiting, to hospital after
managing to finish a portion of the offending item. ‘Please sir, can I have
a stomach pump?’

Created by Regal of Mauritius it is 260g of pure bile. It arrives in a
cylindrical tin an inch tall and two inches in diameter. If I had my way it
would go straight from factory to landfill without ever being offered for
human consumption.

The picture on the front of the tin displays what appears to be a large,
pinky-orange, sliced sausage surrounded by, rather tired, looking lettuce
and tomatoes. It even has the audacity to site this as a ‘serving suggestion
’. What exactly are the manufactures suggesting? Remove from tin, cut into
bits and put with fresh food in an effort to make it look appealing, not
exactly Jamie-flippin’-Oliver is it?

The ingredients listed, thankfully, include chicken meat, which I must say
came as a bit of a shock. Red rice and phosphate E451 are present which I
would feel happier about, if I knew what they were. Finally, in this
concoction, is the sinister sounding MSG E21, which sounds like the sort of
thing used to kill off dissident Russians.

I made the mistake of bringing a tin to outreach with me. By the end of the
week we were running a little short of grub and I decided to try an
incorporate it into a lunch (eon). I felt this was particularly important,
as I had just had a bit of a go at the clinics pharmacist for letting a few
boxes of drugs expire and the luncheon meat was a month of expiry.

I broke the tin open with a rusty opener and dug in with a spoon in the way
a normal person might eat yoghurt. I could just about see the rings of the
base of the tin when I began to feel very sick. Even as a student I was
never driven to try cat food, however chicken luncheon meat is as near as I
ever want to get. I fed the rest of the tin to an emaciated passing dog, who
didn’t finish it.

The fact that a poor animal has had to sacrifice its life in the creation of
this product makes even this carnivorous bloke come over all Linda
McCartney. I’m sitting with a tin in front of me as I type this; (funnily
enough we have stacks of the stuff in the store!) and I’ve just noticed one
slightly redeeming feature. The product claims to be Halaal, meaning that a
huge portion of the world’s population is able to see exactly what I’m
talking about for themselves, multi faith excrement indeed.

So here's to you Regal, creators of a food that even people who are really
hungry would rather chew on broken glass than eat. Chicken luncheon meat I
salute you!

Ten Things I’ve learnt Since Being Here.

I’m nearly at the halfway mark and I’m in retrospective mood. So I thought I
’d write down a few truths that have become apparent since my arrival. In no
particular order here we go……..

1) The notion of ‘sterile’ is a relative concept.

2) Any medical device, including IV lines, Naso-gastric tubes,
catheters etc can be made to attach any other medical device if you push the
two ends together with enough vigour!

3) Any food in a tin (cheese, mackerel, peaches etc) can become
strangely addictive.

4) Chicken farming is much more complicated than it would first appear.

5) People will work through the most extraordinarily difficult
circumstances with, almost nothing, to keep a clinic open. And save hundreds
of lives in the process.

6) How the western/‘developed’ world deals with the African ‘problem’
leaves an awful lot to be desired.

7) Having said that foreign aid CAN make a difference if (and it’s an
oft forgotten ‘if’) it is directed in the right way. When this does not
happen it often does more harm than positive good.

8) The IPOD solar charger is beyond criticism.

9) Sometimes even the simplest improvement in practice can yield
fantastically impressive results.

10) The world isn’t fair. I think I knew this already, but the last few
months have confirmed it.

Cometh The Hour, Cometh The Man.

Moses (of bible fame) was a very interesting bloke. His ability to cast
asunder large bodies of water would be particularly useful to many an
outreach expedition. Whilst his namesake, as far as I’m aware, is unable to
do this he did manage to save both the clinic and my frayed nerves!

One of the staff, David, had mentioned that there was a health worker who
lived not far from the clinic. He hadn’t worked for a few years and had been
doing other things (attending theological college for one) but he was
currently not working. David hadn’t finished his sentence by the time I had
written the letter to this man inviting him for an informal chat.

Moses, the health worker (Not the bible bloke, otherwise I really would have
something to write about!) strode through the early morning mist. He greeted
me with a bone-crushing handshake. He was a tall man, with a short beard and
voice ten octaves below baritone. It wasn’t so much as voice as a low
rumble. The sort of tone that could really put fire and brimstone into any
sermon.

As we spoke the sun broke through the clouds and cast the clinic in a
brilliant white light. A heavenly sign? I hoped so. A few moments later all
was well, the clinic had a new supervisor and I had stopped at least some of
my hair turning charcoal grey. We had been eight hours from closure. I never
want to be that close again.

Moses started the next day and whilst there were a few bits that had lodged
somewhere near the back of his brain they seemed to jump easily enough into
his working memory. I am sure he will be fine.

Very pleased with ourselves we half walked half skipped back to base, where
I am now, chilling. The next few weeks’ movements are a little up in the
air, but a holiday is defiantly on the agenda.

Spot The Healthworker

Regular readers of my musings on this blog will be aware that about a month
ago I had an outreach visit that involved a human resources nightmare. I had
hoped that the whole thing had rather blown over and I wouldn’t need to
discuss it again. It didn’t so much blow over and blow up!

Our outreach clinics are overseen by a supervisor who has been given nine
months training in all things medical and sent out to run the clinic and
treat whatever falls though the door. The rest of the staff effectively
operate in support of him, doing malaria tests, giving out medicines,
fetching water etc etc. Anyway, to say this member is crucial to the clinics
survival is to say money is reasonably important to Donald Trump. Without
this health worker the clinic does not open. Full stop.

A short version (the long version might put me in therapy) is that the
supervisor of this particular clinic managed the following during the last
visit;

He picked an argument with us for absolutely no reason at all. Then, when
informed in the most reasonable voice I could muster, that this was
unacceptable and that he should consider his behaviour in future he walked
out in an overly dramatic, eye-rolling strop. Walked out, I might add
straight into the arms of another NGO and a near tripling of his salary.
Just be glad there weren’t any large or sharp objects in the immediate
vicinity. I was a tad peeved.

So this left two outreach nurses playing an increasingly frantic game of
spot the health worker. Initially we solved the problem by dragging a
substitute on from another clinic. The problems really started when he also
(for valid enough reasons) had to leave very quickly too.

We found ourselves hot footing it back from one outreach site and straight
onto a plane to rescue another. Things didn’t go quite according to plan
from the outset when the pilot keyed the wrong coordinates into his GPS and
flew us in totally the wrong direction. Thankfully Francis was much more
awake than I was and pointed this out. 12,000 feet is not the sort of
environment that facilitates easily stopping to ask for directions. After
scrambling around with maps we resorted to flying to somewhere near it
(which we had the coordinates for) and circling until we spotted the
village. This accomplished the plane was onto the dusty savannah in a matter
of minutes.

The first thing to do was to hold a staff meeting. We informed all the staff
that we would be seeing the patients ourselves for the week and sorting out
the health worker vacancy at the same time. In truth it had all gone (to use
the south London vernacular) pear shaped. We hadn’t a clue where we were
going to find someone. The situation was looking bleak. Clinic closure and
redundancy loomed large. I don’t think either of us slept very well.

Some very sick patients compounded this state of affairs. The worst was a
two-week-old baby who attended the clinic and had been seen by both of us.
He looked very well, he was feeding well and mother had few concerns. She
had actually attended with her other child, for her to be seen. The next day
the mother came back, this time with just the baby in a basket. As I took
the covering off the basket it was obvious that things were very serious. A
confirmatory listen with the stethoscope was the evidence. The babies’ heart
rate was extremely slow and the breathing was shallow and gasping. Fifteen
minutes of frantic efforts were not enough and, sadly, the baby passed away
as I held him.

There was no temperature and the child seemed well nourished and cared for,
I have absolutely no idea why the baby died. Infant mortality statistics
look a whole load different when you see them in flesh and blood. The
parents took the child home in the same basket that they brought him in.
Another Tuesday morning in Africa.

The people here accept child death as a norm, of course losing a child is
unimaginably painful, and I know they feel grief just as acutely as anyone,
but
children dying here is also greeted with a sad resignation, rather than
surprise.

A deeply depressing few days indeed, to depress myself further I looked
through the clinic records and found that many of the patients lived hours
walk away from the clinic and that its closure would cut a swathe of them
off from any healthcare at all. Furthermore the clinic was seeing patients
who were critically ill. I estimated that closure could cost 150 lives a
month.

The land where 'yes' is 'no' and 'no' is ......um...

“Yes” he said, “no, lets just get this clear, you are saying the pump is
fixed and working well,” I said “yes, yes” he said, “new pump, put in by
UNICEF. very good”. These words were still ringing in my ears as Francis and
I stood by what was a very new but (as might have been guessed) very broken
water pump.

The meeting with the tribal chief had been a useful one in that none of what
he had told us about the outreach clinic accurate. In fact in almost every
case the reverse was true. The people weren’t getting sick from drinking
dirty water (they were), the clinic fence had been repaired (it hadn’t) and
there were no military forces in the area (again, a bare faced lie!!).

The walk to the outreach site was uneventful, gone is the mud, replaced by
rutted tracks and smooth sandy paths. The sun is burning the vegetation away
from around us, with all the delicacy of a blowtorch. Not much has remained
unaffected and everywhere is yellow and dying.

As we walked along we passed though a village where the population seemed
very pleased to see us. Laughing could be heard in various houses and from
behind trees and bushes. In the distance men danced around and fell over. It
became obvious; as we got closer that everyone in the entire village, over
the age of four, was drunk.

The harvest season has just finished and the people here are able to make a
sort of wine homebrew. Clearly this village had enjoyed a bumper crop. Even
more impressive that they had managed to reach this level of alcoholic
stupor by nine thirty in the morning. It was like Liverpool on a Saturday
night. In some ways it might have been fun to stay and see what happened
when the party really got going! Another time.

The outreach clinic was running very well despite numerous problems. The
most comical was a difficulty experienced with weighing the children. In
order to do this we use a pair of dungaree shorts hung from what looks like
a butchers scales, suspended from the branch of a tree. Unfortunately the
bloke
doing this had a nasty habit of hanging the scales upside down. This led to
some babies weighing in at a stonking 25 kilos. A marker pen and a ‘this way
up ‘arrow soon solved the problem.

Statistics will, if you believe them, tell you anything and in this case I
can tell you exactly what date the pump broke (Wednesday November 3rd just
in case you’re interested). Why can I tell you this? Because three days
later we had an 67% upsurge in cases of gastroenteritis, we saw 33% more
wounds that week, caused by having to walk through a swamp to get to the
deeper drinking water, and a whooping 56% increase in eye infections, from
washing with, yes, you guessed it…filthy water.

The patients were drinking their medicine in the clinic with water that
looked like the sort of stuff found at the bottom of the sink after washing
up (for those of you who’ve lived with me, yes I am aware of what washing up
water looks like!). Putrid is the only way I can describe it. What is
particularly ironic is that we are giving them medicine to treat, amongst
other things, diarrhoea. And then we get them to knock it back with water
that you wouldn’t wash your car with in the west. I’m beginning to bore
myself about the water so I’ll stop now. Point, exhaustively, made.

The saddest case we saw involved a little girl who had been shot in the hand
during fighting four days earlier. The bullet had taken away a chunk of skin
at the base of her thumb and blown one of her fingers clean off. She wore an
expression of confused bewilderment, too young to understand the nature of
what had happened to her. As I lay awake that night listening to the
sinister rattle of machine gunfire I wondered what would turn up at the
clinic the next morning. Nothing did arrive, the optimist in me would like
to think that’s because no one got hurt. The realist thinks it’s probably
because they were beyond our help.

The staff themselves were all doing various jobs with an impressive degree
of efficiency, which considering we hadn’t visited in months, leads me to
think that actually it would be better if we just stayed at home and stopped
interfering. We were even able to promote a few which was fantastic for
them, and, I hope the clinic.

The high moral was shattered with dreadful Mozart cover version - the ring
tone on the satellite phone, which I can’t manage to change.“Hi Marcus, it’s
me (the boss). Listen there’s a bit of a problem, we’ve had to close one of
the clinics, the supervisor has resigned” “Resigned? You’re kidding.” “No”
she said. And, she meant it.

H2 oh!

I am going to have a Geldorf moment, it is my first for a few months. I
think it's really in important, and I don't mean 'I think it's really
important' in a David Cameron 'I'll say anything is really important, just
as long as you vote for me' kind of a way. By all means ignore my rant and
come back in a few weeks when I've done some more outreach.

The chances are, as you read this, you are sitting fairly near a tap. And if
you were to get up and get a glass of water it would not cross your mind
that the water you are drinking could kill you.

Envisage for a moment that the water company decided one day to stop
supplying water to your house. (For those of you who pay vast sums of money
to Thames water every year for truly appalling service this won't require a
giant leap of imagination!)

Now picture a scene where, not only do you not get water to your home, but
not to the street where you live or even the distance between you and your
place of work.

And now imagine your nearest source of clean water is three hours walk away.
And you can't drive because there isn't a road. And even if there was, you
haven't got a car anyway. Part of the route involves crossing a swamp.

If you think this situation is bad, we haven't really started yet.

So the water pump is three hours away, and obviously it's not just you in
this predicament. So, you spend vast parts of your day either walking to the
pump or queuing to use it. You also need to carry the water you've collected
back, in a cracked, plastic container that splashes your precious clean
water across the countryside. Full, it could weigh up to twenty kilograms.
Oh, and did I mention that it's forty degrees in the midday sun?

However there is an alternative. Just near your house is a moderately sized
swamp. Obviously, the water isn't clean (in fact it's the swamp you use as a
toilet) but it's much easier to get to and you can get much water everyday.
So you decide to use this water instead. Dirty water is obviously not ideal,
and lo and behold your children become sick, and so do you. So your walk to
fetch water is punctuated by regular bouts of infective diarrhoea and
vomiting. Furthermore because you didn't get any type of formal education
you are completely unaware that it is the dirty water that is causing all
this.

In order to solve this problem you hear that the advice from the health
service (which consists of a single clinic two hours walk away) is to err.
drink more water.

If you live on planet earth you have a one in three chance of drinking water
from an unsafe source. That a situation like this should be the case in the
early twenty-first centaury should shame us all.

I'm away again tomorrow so no blog for a few weeks. Sorry that was all a bit
heavy. Go and have a glass of water.

A Bugs Life - The Story of Atomic Geckos.

I was actually going to write about something else this evening, but my mum
e-mailed this afternoon and said she wanted to know about the wildlife. I
realised I hadn’t scribbled much on the various creatures that inhabit this
area, a glaring omission indeed. So here in short is the low down on the
various aspects of wildlife here. (Chickens and cows excluded)

I think the real reason I haven’t mentioned anything about the animals here
is that it’s a bit like asking me about modern art. I haven’t got a clue
what I’m supposed to looking for or at! There are birds here of various
shapes and sizes but I haven’t the slightest inkling what they are called.
During the last walk we did I commented on the goats in the clearing next to
us. I was informed they were, actually, sheep. In short you’ve asked the
wrong bloke. But anyway, here goes!

As well can be imagined this is not the sort of place that people come on
safari. I don’t spend large parts of my outreach walks standing on the side
of the road watching open topped Landrover Discoveries with kaki clad
tourists, speed past.

The water situation prohibits and of the big five - Elephants, giraffes (I
can’t remember the other three…. is one of them skunks?) from being here.
The land simply isn’t stable enough to support large numbers of lumbering
animals (Apart from me!). It fails to support human life adequately.

We do a good line in snakes, of the toxic and non-toxic variety and the
clinics sees a fair few bites from both types. Before this the only bite
from an animal on a human I’d ever seen had been a woman who had been bitten
by a squirrel. Curiously we also see a high number of people who have had
snakes spit in their eyes, which I’m told feels like someone has just thrown
boiling water in your face.

However where this area really excels is in the realm of insects. At primary
school this group were referred to as mini beasts. Less of the mini here
sadly. You only need to leave a torch on for a few moments to see swarms of
various different creepy-crawlies congregated round it. As I’m sitting here,
a lamp on the table near me has hundreds of creatures buzzing around it as
if at a rave.

By far the most feared of these are, of course mosquito. Responsible for
more deaths than all wars in history combined the mosquito wreaks havoc
daily. The particular variety here seems to have the ability to treat
repellent as a mild inconvenience and punch through two layers of clothing.
In fact nothing, proves any deterrent at all and you get the feeling they
could probably bite you if you were dressed in a suit of Kevlar.

To say this area has a fly problem is to say George Bush is a slightly
incompetent president. I’ve just about got used to them crawling everywhere
except my face. Maybe in a few months I won’t care about that either. The
local people here seem able to ignore them completely. They adorn the
childrens faces like bizarre jewellery. Occasionally on a walk I’ll swallow
one by accident, which I supposed provides me with some much-needed
sustenance, but isn’t to be recommended if you can avoid it.

The other much feared bug here is the scorpion. Able to punch so far above
their weight it’s laughable, they are a real problem. No bites for me yet
but I’m told when it happens you know about it. Thankfully actual fatalities
are rare, though it does paralyse the limb affected for a while, which can’t
be a pleasant way to spend an afternoon.

The way Iâve found to deal with them is to encourage them to the floor and
place my foot on top of them and then scrape backwards in the manner of an
irritated donkey, they tend not to recover from this method.

Speaking of our sad grey friends, donkeys are also abound in number, though
it’s difficult to work out exactly what they do all day apart from wander
around the place looking melancholy.

And finally the humble gecko, possibly my favourite animal of all time, for
two reasons.

Firstly they eat flies and so in many ways we don’t have a fly problem but a
gecko shortage. Secondly their use of Van-Der Waals theory of atomic
attraction to climb walls and ceilings. Yes, I’d never really thought about
it either.

For those of you unfamiliar (as I was until it was explained to me last
night) it goes as follows. All atoms exert a small amount of attraction on
every other atom. Geckos have microscopically fine hairs on their feet and
an excellent weight for surface ratio meaning they literally stick
themselves to the wall at an atomic level. So that’s one for the pub
tonight.

On that note, the various arachnids that were finding the lamp attractive
are now beginning to congeal around the light from this laptop so it’s time
to leave you to type gecko into Google and see if I’m right.

Causing a fence

Bad, bad pun, not a good way to start, oh well never mind. I suppose really
this is a tale of two clinics (a better title).

The week started well, (after the slight hiccup over English speakers). The
walk to outreach site number one, which had been so torturous before (See
‘Take a walk on the wild side’) was now much dryer and the travel time had
halved.

The first site is stuck in a rather unfortunate geographical position.
Firstly it sits on an artery route to a major city. (Not that there is
tarmac or anything, it’s a path, that could just about accommodate a quad
bike) and secondly it has the only hand water pump for three hours walk in
any direction.

Naturally the clinic attracts a significant amount of its patients from
those who were just passing through on other business and fancied having a
health check. This issue was one of the hardest things to understand
medically since arriving. Having done a load of courses and reading (OK,
well a bit of reading!) I expected everyone who walks for hours to get to
the clinic to be at deaths door. It has taken me months to appreciate that
(long pause, for the sake of drama) some of the people who come to clinic
aren’t really very sick at all. As in the UK a good number of people turn up
with colds and minor ailments. The first few patients I saw like this got
every test I could come up with, on the assumption that they can’t have come
all this way with a snotty nose. But people, apparently, do.

Because so many patients live far from the clinic, or are just passing
through, there is no chance of bringing them back for a review and
complaints that require a repeat visit, The notes on dressings, meningitis
treatment, and therapeutic feeding are littered with people who turn up for
the first visit and never return, what happens to them, we are unable to
determine, but its not good news.

To further make things difficult, recently, the clinic fence was dismantled,
for reasons too laborious to go into. The staff now spend a large percentage
of their time herding cattle, dogs, and sheep from the clinic compound,
rather than actually doing what they are supposed to be doing. The odds are
therefore very much stacked against this place operating with any great
success at all. In fact it is the best of all four sites by some distance.

The cattle were causing untold damage to the clinics buildings. Priority
number one….build fence. I’m not sure I went to the ‘how to build organise
the building of a fence’ lecture at university. Must have been on a Monday
morning.

So not a problem I’ve faced before, my dad is an engineer though, so I hoped
the genes might help... they didn't. We convened a meeting with various
village
officialsand others, including a large cow, who wandered though the clinic,
over the reamains of said fence to hear the discussion. Through them,
(except
presumably the cow) the village was alerted to the fact that we wanted
construction materials, primarily sticks with which to build.

It was about six thirty the following morning when I heard the loud crunch
of a pile of sticks fall from their position atop a ladies head onto the
ground. I stirred, rolled over and went back to sleep. By the time I
actually got up it was eight thirty and the clinic compound was filled with
hundreds of bundles of sticks. The task of ascertaining who brought which
bundle and haggling a price began in earnest. After an exhaustive two days
we had enough materials to begin construction. It’s funny, seven months ago
if someone had said I would be spending my days organising a fence in
deepest Africa I don’t think I would have quite believed them.

We left the clinic four days later with a whole load of construction
projects well under way and having treated some very sick people into the
bargain. It will be very interesting to go back and see how they’ve got on.

Walking away into the early morning sun, the staff waving us off I had a
great feeling of a job well done… unfortunately the walk led us straight
into a human resources hurricane.

Before all that, the walk to the clinic was fascinating. An anthropologist
might have exploded with excitement. We passed through tiny settlements of a
few mud huts and, invariably somewhere cleared for cattle. Hushed whispers
of ‘white-face’ (obviously in the local dialect!) could be heard as we
passed. The children greeted us with curiosity and mild terror, so strange a
creature were we. This was a place that had not changed significantly for a
thousand years, was totally self-sufficient and won’t see either running
water or electricity for a generation at least. At one point we had to cross
a large, deep river. I regretted accepting small‘runners’ to carry our
equipment
and drugs. A few of them almost had to start swimming!

The clinic was surrounded on all sides by green, flat, grassy savannah. It
looked like a becalmed emerald sea; in fact, apart from the odd acacia tree
and mud hut it could have been rural Holland. A group of vultures spiralled
overhead as if on some invisible helter skelter. You would think a place
like this would feel peaceful actually the only word I can use to describe
it was desolate.

From a stress point of view, this was far and away the most difficult
outreach visit I have done, and not because of any of the patients, in fact
I barely clapped eyes on one for the first two days.

I don’t want to go into the whys and wherefores because frankly it’s not
worth any of your time, or anymore of mine, discussing it. Suffice to say
that I’m not sure a bloke has had to deal with so many problems, all at the
same time, since Steve McQueen got stuck at the top of the Towering Inferno.

The clinic was seeing a great number of patients from surrounding
settlements, though the length of time people travel to come is
unbelievable. Seven or eight hours is not uncommon. After one particularly
hard day I came back and began idly fiddling with the communication radio we
have. As I channel hopped further up the channels a loud, clear voice
brought the machine to life. “This is the BBC, here is the news” And so a
brief contact from the outside world. The top news item? The removal of
Donald Rumsfeld, the day had improved immeasurably, only the rest of them to
go!

At least, now, most of the issues have reached a conclusion and we can look
forward to going back in the future and actually doing something patient
related, ever the optimist me.

Finally seem to be getting into the swing of outreach, and, despite the
aforementioned stresses finding it a fantastic challenge. I didn’t want an
easy assignment, and I’m pleased I haven’t got one.

A few days chilling in the base (though I rather stupidly volunteered to be
on call tonight! Duh!) Then off for some more.

Back in Business 2

The airstrip was full of people; boxes unloaded then put back on again, a
goat or two, children running in all directions. There is a word for this
type of manoeuvre. The word is chaos. Luckily most of our outreach stuff was
unloaded without due incident. Even more fortunate was the fact that the
only box that was accidentally left on the plane was full of all our
paperwork. So I don’t have to worry about that for a couple of weeks. We'll
catch up with it at the other base.

Its great to be back here, and working after the stagnation of last week. We
are all packed and ready for an outreach exertion tomorrow. The boxes we are
taking litter the floor around me. Again chaos is a predominant theme(Maybe
it's me?). Hopefully we will get to two outreach sites, which means I’ve
been to every site at least once. Considering I’m a quarter of the way
through my time here I’m not sure that is anything to be particularly
pleased about. A lot of it has been unavoidable, but it still isn't very
good.

Anyway I’m sure they’ll be lots to write about on my return. I hear the
water may be waist deep for a few hours. (So much for dry season!)
Thankfully I’m absolutely recovered from the fun and games of last week so
here's hoping I only make an appearance in the monthly medical statistics
once! No e-mail so no blog for a week or two.

Contact!

I realised that there was no method of Rhonda (or anyone else for that matter) who doesn't have my e-mail address contacting me. This may have inhibited the responses to my plea slightly. In view of this I have set up an e-mail address just for you.

So if you are reading this and fancy dropping me a line please feel free! I won't be able to check it very often (internet cafes are limited in the middle of the sand pit I call home) but whenever the chance arrives I'll do my best and who knows, I might even reply to a few of them!

You can contact me at email year_africa@yahoo.co.uk

The best laid plans of mice and men….

I’ve discovered a few truths since being here. The most important so far is as follows; How an outreach jaunt goes doesn’t depend so much on the plans made, or the place you’re visiting, but on factors totally out of your control. In fact you could spend days and days in planning meetings trying to organise everything to the finest degree and still find something like the weather, or water waiting with an enormous spanner to throw gleefully in the works at the last moment. Anyway, I’m getting ahead of myself.

The week had started with a nasty jolt. The team opening the base clinic had been working very hard to get things moving again, with great success. After the initial rush of opening, things were starting to settle a little, though the pace of work was still frenetic. As I was kicking my heals a little I offered to cover the night shift. This didn’t mean very much except that if any of the patients deteriorated overnight I would be summoned by one of the national staff. I had just drifted off to sleep when I was woken up.

The three month old little girl was lying under a mosquito net on the examination table. She had been admitted for malnourishment and a slight chest infection but had begun to feed. She lay motionless as I approached the table. I lifted up the mosquito net and was confronted by a still warm, but sadly departed, baby. With only a head torch as light I conducted a fairly rudimentary examination. No chest movement. No response to pain. A few murmurings from the heart but nothing that could be called a 'heartbeat'. In Europe this would mean action stations with state of the art intensive care facilities and assorted paraphernalia and, if I’m honest, probably the same result, just a bit delayed.

Here anything like that isn’t an option, so I removed the feeding tube, the IV line and closed the baby’s eyes. I then took a deep breath, emerged from the mosquito net and sat on the floor with the mother and the health worker. I began, what has become a now oft repeated paragraph, starting with my condolences, the sickness of the child she had lost and it being Gods will (which is how things are viewed here). Oft repeated but it doesn’t get any easier.

The next day we assembled the runners who would help us carry the things we needed to our outreach location. It’s only recently that I’ve discovered that the word ‘runners’, when translated, actually translates as 'woman of ill repute', which goes some way to explaining the quizzical looks I got when I asked someone to organise eight of them to turn up at the compound at six thirty in the morning.

This theme of the seedy continued when we arrived. The front door of mud hut we were staying in had the words “Welcome Brothel” scribbled in felt tip pen on it. Closer examination revealed the ‘L’ of brothel to be a poorly written ‘R’. A huge relief all round as I’m not sure that the former is the kind of image that any aid agency would want to portray.

The walk to the clinic had been uneventful except for a very large river that required wading through with my worldly possessions held above my head. To everyone’s huge amusement I was savaged by a leach as I emerged. The only method of dealing with this effectively was to stamp on my own foot where the annelid was making very successful efforts at veinapuncture. This, in a single effort, scattering the unfortunate leach in three different directions.

The fact there was a clinic to visit at all was remarkable, the fact it was actually thriving was humbling. It was another that had been looted and damaged by fighting and hadn’t had a visit since May. In fact no-one I knew had ever been there. Many of the staff had ‘run away’ (a term used rather, in the same way as Chile's 'Disappeared') and it was operating with half the number of workers that it should have been. One member of staff was doing three jobs all at once (My friends still working in the NHS are entitled at this point to exclaim “... and ?”) staff were running from one hut to the next and then back again in a giddy whirl.

First job; Employ more staff which was easy until we came to the job that required the person to count the drug tablets into bags for the patients. We weren’t able to find anyone who was able to count above fifteen in the village, who wasn’t already working for us. A work in progress that one. We'll try again next time.

The week was spent rebuilding the clinic fence, seeing a variety of patients and having meetings with various chiefs, headmen, and village elders (and yes there is a BIG difference between them!). I’ve become more attuned to the body language they will adopt if they like what I’m saying and when they don’t. Generally, spitting on the floor is good news, clicking with the back of the throat is excellent, and falling asleep means their bored. I’m not surprised if some of them fall asleep as they always insist on having the meetings outside, in the middle of the day and they always go on for hours.

However at the end of it all we’ve normally agreed something and we normally get something for the clinic out of it. Generally, the longer meeting, the more things the clinic aquires. The marathon meeting of Wednesday, which lasted nearly three hours yielded help with a fence and airstrip clearance. But at times I found myself trying to avoid joining some of the junior headmen in blissful slumber.

The week took a bit of a downturn next. The water quality in this area is abysmal, leading to many of the diseases we treat at the clinic. Despite the fact that the water we drink is filtered, boiled, chlorinated and blessed (OK, I lied about the last bit!) occasionally some little nasty can slip through.

Unfortunately it did on this occasion and I became another health statistic. Hence the week was cut a day short and I find myself back in the missions’ headquarters on a few antibiotics and replacing what the week has taken out. Did the man who invented oral re-hydration salts get a noble prize for science? If he didn’t, it’s a fallacy!

I’m much better now looking to get back into the thick of things early next week. It is all a bit frustrating. But I guess you can’t work somewhere with so many diseases wafting around the place and not expect to pick up one or two along the way! Still no contact from Rhonda.