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".

Photo album

In no particular order:


The road home from the mine site (Camp A); driving through the jungle on the rain scoured dirt roads.

The local villagers are often on the road, by foot or by bicycle

One of the mounds of topsoil generated from the mining process... almost picturesque but not quite

The road leading away from the mine site with the mountains of waste rock

Entering the residential village, cleared land with some 70+ modern houses for expats and senior staff.

Signage on the road home, just before the Haul Road crossing


The residential village on a cloudy Sunday morning

My kiwiana shelves, with my Palestinian embroideries

The drum and dance group at the Independence Day celebrations

My bedroom, complete with Floyd the teddy and Tickle Toes the baby-chuckle bear

My lounge, now resplendent with ethnic knick-knacks picked up on my travels

My Gaza coffee mug on the table is just the right size for my morning caffeine jolt

Ghanaian ladies playing board games at the Ghana Independence Day celebrations

Haul truck crossing the Haul Rd.... this is why it's prudent to stop at the stop sign... the wheels on this beast are taller than I am.

Ghanaian ladies enjoying the Ghana Independence Day celebrations

Ghanain lady getting her groove on and this lady sure could move it!

Local village shops

The mine.... the buildings are the maintenance areas with the pile of waste rock just behind them... this is the view from the ISOS clinic

The beginning of the jungle just opposite the main gate to the mine site

School girls on their way to school in Ntotroso village

Plantain for sale

Pineapple for sale... you have to love tropical countries sometimes. Sure, there's the unremitting heat, the mosquitos, the rainy seasons and the snakes, but there is fresh, sweet fruit everyday

My house in the residential village - a 3-bedroom palace

Looking over the roofs of the residential village towards yet another mountain of waste rock

In Hwidiem village

Ghana

Here I am in Ghana. It's deepest darkest Africa, with red-dirt roads cutting through sparse jungle, heavy pre-rainy season clouds hanging like fluffy chandeliers, villages of dusty wooden/cement block buildings, women balancing loads of wood on their heads with young children swaddled onto their backs and bunches of plantains for sale on the road side.



My work environment (see above) is a utilitarian series of structures around one edge of the 2 massive holes in the ground that are the mines, with the processing mills and refineries providing the backdrop to the clinic.



The temperature stays a reasonably steady 26-33 degrees Celsius and the humidity hovers around 90%. This necessitates drinking your body weight in water daily.



I work 5.5 days a week from 7am to 5pm seeing a few patients, doing a few referrals, sorting out a few administrative issues, doing a bit of continuing medical education, nothing at all out of the ordinary; it's the reassuring thing about medicine, you can be anywhere in the world and the general principles remain the same.

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.

The oldies but the goodies

Apparently, there are some stories from my travels that I tell often, due to the peculiarity of events that unfolded, the bizarreness of the situation I found myself in and the insights into the strength and resilience or alternatively the generosity and kindness of people I have met.

I will try to write some of these stories down for posterity.

In no particular order these might include:

1. The major animal stories of Africa in 1999 featuring zebras, breakfast-stealing baboons, elephants and macaques
   
2. Leaving a trail of disaster in my wake while traveling in 1999
3. The little girl who carried her malnourished baby brother up a hill for 5 hours to reach the clinic in Nepal and then brought him back 1 week later for review
4. My final walk out from Rukumkot, covered in marigolds and tikka powder, accompanying a seriously ill patient in a thunder storm, hobbling on 2 sticks
   
5. My first week in Nigeria contending with a plane crash, a bus crash and a shooting, including many sleepless nights and a helicopter retrieval
   
6. Culinary experiences in Vietnam, including silk worms, scorpions, mini-fish on a boat off Phu Quoc, chicken feet and chicken tongues
7. Humiliations at Erez crossing into Gaza
8. Carpet buying and a ring in Jerusalem
9. Burns, hormones, stones and dying in Nepal
10. Goat head soup
11. MoPol clearing the road in Nigeria by waving a bazooka
12. Buying petrol in Gaza
13. Checkpoints, suicides and trauma in Sri Lanka

There are more and I may well just copy/paste bits of old emails into this forum just because I have already written them....