Strange days....

Yesterday was a funny day. I received a payslip from the Accra office that bears absolutely no resemblance to the pay that I am supposed to receive according to my contract or what is paid into my bank account. I also received a big envelope which contained a zip-lock bag with 2 squeezy jars of marmite and a post-it note that had my name, title and address in Ahafo on it but no information on who it was from. Still, never look a gift horse in the mouth or question some free marmite!

I got home, immediately changed and headed to the gym; mid-workout the skies blackened, the power went out and all hell broke loose from the sky. By the time I had finished my 40 minutes of aerobic exercise, sheets of water were cascading downwards and sideways and I walked through it, arriving home rain-drenched, wind-battered and cold! There was no power or water so I briskly toweled off in the dark and sat in my pyjamas waiting for the power to come on so I could make dinner. As I waited I noticed that my phone wasn't working due to penetrating water injury from the walk home and changing to my other phone I managed to cancel the morning alarm function.

So, the marmite rose to the occasion on a couple of water crackers as a make-shift breakfast in my consulting box this morning as I had woken at 6.25 am wondering why it was already light and "oh S***" as I realised the time, dove into my clothes and bolted out the door to be at work at 7am!

My morning was pretty quiet and I achieved a complete overhaul of the Pharmacy Standard Operating Procedures before lunch.

Arriving back from lunch I was met by "Lawn Mower Man" for his wound and fracture review. Wounds looked good, patient is well and the temporary cast was successfully replaced with a full below knee cast which resulted in my trousers attaining the speckled hue of someone who sits under a flock of seagulls, from all the plaster splots. As I was finishing up I was informed that there had been a car accident and the casualties were on their way in to us. As we put Lawn Mower Man under a hair dryer to set his cast and wiped the plaster from the emergency table the 2 casualties arrived. The passenger had 3 facial lacerations including 2 around his eye which required me to utilise all my cross-stitching and crafting finesse in order to place sutures in the eyelid crease and above his eye. The driver had minor lacerations; patching him up took less time than it did to fill in all the incident reports and documentation. By this stage the Health Safety and Los Prevention people were informing me that one of the pedestrians that had been hit by the Newmont vehicle was admitted to the local hospital and they wanted one of our national doctors to review her condition.

I sent off Dr Darko to see the patient and he reported back that she was 28 weeks pregnant, her abdomen was distended and they had aspirated blood from the abdomen; she was stable but obviously seriously injured. We decided to transfer her to a neighbouring hospital for better care however by the time that the paramedic and ambulance arrived to the local hospital her condition had significantly deteriorated and she was not fit to be moved. Despite Hwidiem hospital being a tiny, under-resourced facility the doctors there elected to take her directly to theatre (which apparently hosts at least one over-size cockroach) and the ISOS team went into theatre to assist. Thank God! On opening the abdomen they found the uterus distended with no source of bleeding outside the uterus; they opened the uterus and found haemorrhage compromising the baby and delivered it immediately. The baby came out flat, not breathing and blue; fortunately the paramedic and ISOS doctor were there and resuscitated it. Then followed another 2 hours of phone calls back and forth to decide on the best course of action. Kudos to Newmont, they agreed to do everything possible for the woman and baby, so at 8pm the ambulance, paramedic, ISOS doctor, Hwidiem nurse, family member and a security officer set off for the 2 hour trip to Kumasi to get the baby into the neonatal care unit there. Hopefully mother can join them tomorrow.

In the middle of all the phone calls I also managed to do my weekly shop and see a patient with a burn to his hand who just happened to drop by the house to see if I could see him there rather than going all the way back into the clinic. Thank goodness for the emergency cupboard of medical supplies at the house - I put on a burnshield dressing and a bandage, prescribed paracetemol for pain all with my phone tucked into my shoulder coordinating medical care/food for the team/accommodation in Kumasi and updating the Newmont Rapid Response team.

Now I've rested, eaten, made sure my alarm clock is set for tomorrow and will see what the rest of the week brings!

What a difference a day makes....

Sunrise on the way to work - much like any other morning

Thursday started much like any Thursday. I awoke at 5.30am to a pitch black, 30+ degree morning and conducted my routine coffee and BBC news before clambering into the Toyota Landcruiser and backing out onto the road. I stopped at the compound gate momentarily to have the guard check that I wasn't stealing any electrical items or gym equipment (not sure what else they would be searching the cars for) and headed out onto the jungle roads, with my amber light flashing on the roof of the car and negotiated the potholes, rain ruts and locals to reach Camp A. I queued with all the other arriving Toyota Landcruisers to enter the camp - stop, swipe ID card and car ID card and wait for the boom gate to rise - and then pulled up outside the clinic. The entrance gate to Camp A

Pausing in my consultation box to put down my bag and turn on the light, air-conditioner and computer I went into the main clinic for morning prayers and staff meeting before taking a large mug of nescafe back out to my box and starting to go through e-mails and administrative files with my iPod on and a high hope of sorting out a large part of the pending problems.

My consultation box and my LandCruiser

At 10am the paramedic called and said that a patient had been brought to the Emergency Room with a cut foot, it didn't look too bad but I should probably take a look. My first sight when I entered the ER was a blood splattered floor and a thin, stoic patient on the gurney gushing blood out of his right foot and his left ankle swollen as though someone was smuggling tennis balls in there. Admittedly the paramedic is from S Africa and what looks bad to a S African paramedic and what looks bad to most people are probably quite different; these things are relative.

The scene of the Lawn Mower incident

The patient had been grass cutting at the residential village when one of his colleagues lost control of his lawn mower which ran into our patients ankle and then ran over his right foot. Thank goodness for steel capped safety boots is all I can say; things could have been considerably worse. After an intense effort to clean and suture wounds and splint the ankle in order to transfer him to the local hospital for an x-ray, most of the remaining morning had passed me by and 4 expatriate patients were patiently waiting to see me.

Camp A in the distance

This took me to lunch and beyond at which point my afternoon meeting schedule started and I ran from office to office all over camp in 35+ degree temperatures trying to keep my thermoregulatory and mental cool while the phone interrupted any semi-mature thought I may have generated and the hours ticked over. I finally managed to get back to my friend the Lawn Mower man at the very tail end of the day and attempted to put on a Plaster of Paris cast out of raw materials that were distinctly lacking plaster and had less support than a Parisian baguette. We persevered until a semi-solid cast was achieved and the patient was tucked up in bed with a plate of chicken and pounded yam and I scrambled out to freedom.

Misty morning drive to work

This morning, after my morning routine, I stepped out to the car and couldn't see it. Neither could I see the house on the opposite side of the road, or the road, or in fact my own house when I turned back towards the front door. Everything was blanketed in the most impressively thick fog; this made for a fraught drive to work as I couldn't see the end of the bonnet on the winding roads. Five hours later, as I left at the end of my Saturday-half-day-effort the sun had burnt the mist to a crisp and the distant hills cut the horizon and every leaf of the jungle foliage glistened and sparkled. What a difference a day makes.

Clear skied sunny Saturday afternoon

African animal stories

Here I am in deepest darkest Africa. So far my wildlife experience is limited to dodging around some guinea fowl on the road to work in the morning, and watching small skinks and lizards flit around the container that is my consulting room. I was somewhat startled by a very large gecko in my kitchen one evening, but he was quite welcome due to the fact that I also have trails of ants wandering around the kitchen and I was quite hoping that the gecko would gorge himself continuously and not chirrup too loudly in the middle of the night. However, he only made one appearance and has since taken himself back outside, presumably to feast on larger and more nutritious fare.

I have been lucky enough to travel through other parts of Africa where wildlife has been more forthcoming. Half-way up Mount Kenya our Land Rover, the Nimble Fairy, got thoroughly bogged in squelching ruts of mud and we were forced to pitch up for the night. The next morning I rolled out of the back of the Nimble Fairy and went to take my morning ... um ... ablutions in the thick grass on the side of the road. As I was ...um ... abluting I glanced to my left and saw a very large pile of elephant dung not 2m from me. Steaming, fresh, recently deposited elephant dung; the perpertrator must have passed our bogged Land Rover not minutes before without making a sound.

As we continued on our way south through East Africa we traversed sun blistered savannahs dotted with flat-top acacia trees, with the sun burnishing the sky in ochre hues and Mt Kilamanjaro, snow-capped and cloud wreathed, in the distance. Cruising as fast as the Fairy would take us, a zebra ran across our path. That's what is called a zebra crossing in Africa.

In Victoria Falls town, I had heard rumours, there was an elephant that visited the camping ground. Various persons tried to dissuade me from believing this tale, but I had hope it would be true. Over a BBQ, with a glass of wine and a plate of salad I heard a "craaaaaaack" noise and looked over my shoulder to see a huge bull elephant stepping OVER the 7-foot security fence. He meandered over to where we sat, waving his trunk in the direction of my salad, then wandered off to knock over a couple of rubbish bins and terrorise the bar.

The next morning I was sitting out with a cup of coffee as the people in the tent next to ours got up. The man headed off to the ablution block, the woman went back into their tent to bring out the breakfast. She came out with plates and cutlery, went back into the tent, came back out with bread and jam, went back into the tent, came out with a box of cereal and milk and went back into the tent. At that moment, the 3 baboons sitting on the fence gave the predetermined signal, dropped to the ground, moved over the table at lightening speed grabbing all the breakfast and sat up on the opposite fence, grinning, tearing the bread between them and passing round the box of cereal. I couldn't stop myself from laughing out loud and as the woman emerged from her tent with the orange juice to find a bare table she glared at me as though I had stolen her breakfast. It was as much as I could do to hold my sides and point at the feasting baboons.

Arriving in Lusaka, Zambia, after a 12 hour drive, the last vestiges of energy were spent putting up the tent and I then gathered my toilet bag and towel and headed off for a shower. At the door to the women's bathroom I found myself obstructed. Bleary eyed and tired I paused, tried to find a way around the obstruction and then decided to be more proactive so I stepped up and smacked the zebra on the butt and told it to get out of my way.

In Namibia we stayed in Etosha National Park in a self-contained cabin, complete with BBQ. We found meat, potatoes and salad and got the embers going. As the meat charred the jackals approached the BBQ, and one of us had to be on guard at all times to protect our dinner. Gives a more literal meaning to "keeping the jackals at bay".