West Africa so far....

I have worked in West Africa before. In late 2005 I took a locum in Nigeria, based in the filthy and violent city of Port Harcourt. My first week there was, what I think they call, trial by fire…. Indoctrination of hell…. Something like that.

On my fourth night in PHC, while recovering from the Christmas party the night before, I got a rather terse phone call from the Business Manager telling me that I had to go the clinic NOW. Not being one to argue, I dutifully headed along the streets, past the uniformly apricot residential buildings to the clinic and entered upon scenes from a horror movie. True to the nature of African airline safety records, a local airliner had fallen from the skies, onto the runway of PHC airport, around a couple of cows and had skidded into a fiery ball. There were 103 dead on impact, mostly children returning home for the Christmas holidays. There were 7 survivors and our clinic received 2; both Nigerian women in their 30s with 70-80% of their body burnt and with concomitant traumatic wounds. There is a formula in medicine that says “age of patient + %age body burn >100 = death”. So we were up against it, and the odds won. Despite all efforts over night both the patients died. We barely had time to gather ourselves when the call came in that there had been a bus crash up country, involving foreign missionaries. The ambulances and vehicles went out on the dark, bandit infested roads and returned just after midnight with 5 seriously injured young ladies on whom we worked throughout the night. The following morning I was given a large red emergency medical bag and was instructed to go to the golf course. At this stage I was still quite new to the camp and the first thought to cross my mind was “cool, there’s a golf course!” before I realised that I wasn’t there to tee off but to jump aboard a helicopter to retrieve the last survivor of the bus crash who had been in Enugu local hospital overnight. We were pacing Enugu airport as dusk approached more quickly than the ambulance bringing us the patient and by the time she arrived to us I didn’t have to time to stabilise any of her significant injuries before we had to take off and fly back to PHC in the hazy twilight of a hundred burning gas flares. We spent all that night back in the clinic working on this girl to try to keep her alive and it was late the next night before we were able to get her onto an air ambulance from S Africa for further care. This was now the 4th consecutive night of high drama and trauma but we were in for one further test of our endurance and resilience when a riot broke out at a neighbouring camp and the inciter of the riot was brought to us having been shot in the leg by an AK47. He was still passionate about whatever cause had caused him to incite the riot and pretty annoyed about being shot and it was only after he had lost about half of his blood volume that his aggressive behaviour petered out and we were able to treat him.

This visit to West Africa has, so far, been significantly less dramatic. My visit to Equatorial Guinea was not what I expected; the female expatriates that I was originally seconded to consult with had left EG so my time was spend having an orientation to the ISOS operations in EG, visiting the local hospitals and Hess (Oil company) community development activities and giving a malaria presentation to the local staff of one of the subcontractors.

I found a clinic stocked to the gunwales with top of the line equipment sitting idly, between operational checks, waiting for the emergency that would justify the existence of the clinic while the medical staff spent their days doling out ibuprofen and anti-malarials. The Hess staff are looked after to the point of pandering with virtually free-flowing alcohol, extensive recreational facilities and a 28 day on/28 day off rotational schedule that undoubtedly throws their home life in contrast to the luxury they are afforded as expatriates.

After 12 days in the camp I returned to Malabo, the EG capital, located on an island in the Gulf of Guinea while the EG mainland steamed one-hour flight away. I was scheduled to leave with Aeroocontractors, a local air company, to take a short tour of West Africa including Libreville, Gabon and Lagos, Nigeria on my way to Accra. As is to be expected in such places, plans do not necessarily translate into reality and I arrived to the airport to find that my flight had left earlier that morning without me and I was left standing in the shabby airport foyer with the Spanish speaking driver trying to communicate that I needed to return to the office to organise my next move. Fortunately ISOS are reactive and I was soon booked on Air France to proceed via Europe to Ghana later that night. So it was that I spent the day on the porch of the Hess staffhouse, watching the local staff paint the walls of the compound while I savoured the last pages of my book and was delivered by the drivers at 6pm for dinner at a coastal hotel before my flight. Sitting on a vast terrace with only the drone of helicopters reaching out to the offshore oil boats and the oscillation of the air accompanying the roosting of hundreds of white cranes on one singular tree on a rocky outcrop I sat and quietly ate my meal, sipped my beer and contemplated the many places I have sat and eaten on my own, not quite sure what is supposed to be happening next.

PS: What happens next…. Check in 3 hours before flight to Paris and find there is no duty-free, no restaurant, no facilities at all and sitting on a hard bench for 2.5 hours waiting to board the plane is not very funny….

Nepal stories

There are some things which make you believe in human resilience and determination. There are some things which make you cringe at the excesses of "developed" societies and a wish to beat into them a realisation of how lucky they are.

I worked for MSF in Nepal in 2006. The reason for the mission was to provide medical services to a population affected by conflict, deep in the heartland of Maoist controlled mid-west Nepal. In reality, these subsistence populations were not so much disadvantaged by conflict as by location, living on precipitous and remote mountains, reachable only on foot and subsisting only on what they can grow or barter.

MSF provided a clinic, built from rocks hewn from the ground, plastered in buffalo dung and mud and equipped with basic drugs which were portered up from the nearest airstrip 10 hours walk away. We had no oxygen, unreliable electricity and were located at the very top of a hill on top of a mountain an hour walk from the nearest village. Our catchment area extended to cover 15 or so villages, located up to 5 days walk from the clinic. Patients came to us on foot or in a doko (basket adapted to accommodate a fully-grown adult and carried by a head-strap by a porter).

One day I was asked by one of the health workers to assess a 1-year old boy suffering a chest infection and severe malnutrition. Twig-like arms and legs shuddered with every breath as he lay in the arms of his 7-year old sister who had carried him from a village 5 hours away. Given his frail state and high chance of mortality we advised that he be admitted to our in-patient room at least overnight, however his sister tearfully refused, explaining that her parents would be too worried about her if she did not return directly to the village and that she could not leave the infant with us as her parents would be angry. Que garni? as they say in Nepali, what to do? We prescribed and dispensed vitamin A, antibiotics, worming tablets, supplementary nutrition, oral rehydration sachets, paracetamol and iron tablets, taking care to explain the regime to the illiterate girl, stressing the importance of completing the treatment and beseaching her to bring the child back if he deteriorated and to come back in a week for reassessment if he was improving.

Watching the small figures diminishing down the rutted goat track to their village we felt little hope that we would see him again.

One week later, the girl presented to the clinic, in her arms squirmed a babbling smiling child. She showed us the empty packets of tablets, explained how she had given them all on the prescribed schedule, crushing the tablets, mixing them with dhal, painstakingly spooning the mixture into her brother, sitting with him at night to watch him. That little girl saved his life. I hugged her, thanked her, praised her and sent her off again on a 5-hour walk back to her village.