It has been an extremely long time since I wrote on the blog. Perhaps this is a sign of ennui with this kind of work and lifestyle, perhaps a sign of the poor internet connectivity I have been subjected to, perhaps because through Facebook everyone who has a vague interest in me already knows what I'm up to or perhaps it is sheer laziness.

After completing a year on a mine in Ghana I agreed to take on another job of a similar nature on a mine in DRC, albeit with a better rotational schedule and a slightly better remuneration. I am on site for 6 weeks and then off-site for 6 weeks, with 2 days each way spent in the air or airports.

I am Senior Medical Advisor at TFM site, working with a team of Intl. SOS expats to care for the workforce and dependents, which in my case means responding to Public Health emergencies like ensuring that the expats have been vaccinated against Hepatitis B, and treating a constant stream of truck drivers with gonorrhea and/or haemorrhoids. My hands have never been washed and disinfected so thoroughly or so frequently!

There have been few but horrific emergencies to deal with including vehicles launching 30 feet off disreputable bridges to the river below, crumbling trains electrified by collapsing electrical wires as they derail for the 4th time in 100km and concertina conveys of trucks carrying cobalt and copper rear-ending in sequence in thick dust on potholed roads. We have very good facilities on site to treat national employees and we have an air-ambulance only a phone call away to evacuate expatriates, which insulates us from the reality that, outside the gates, the infrastructure of this country is crumbling slowly and the population live in the starkest poverty. We have a mandate to stabilise non-employee casualties on-site and transfer them to the public sector hospitals. To transfer a patient with severe injuries to a local hospital, degraded by corruption and civil war to a shell of a building filled with dysfunctional equipment and staff is tantamount to a death sentence.

This is a poor country, recovering from years of civil war, corruption and post-colonial de-development and as much as there is abuse of power and nepotism at the top, there is a real committment by the people on the ground to work towards something better for the people. During our recent school surveillance survey for sub-clinical malaria in school children, the local school inspector happily rearranged the entire schedule of entire schools to accommodate the testing.
Medical staff at the health centres and health posts work without salaries. Volunteers fill brick-pits and dig latrines in the village.

Now, I may, and frequently do, complain about living on a mine site. There is the wrench of leaving home for deepest darkest far flung places, the mining mentality, the dual politics of Intl. SOS and the client company, the lack of internet, the restriction of movement outside the artificial constraints of camp, the limited culinary options, the constant on-call and the separation from friends and family. There is however the.... well, there's the money and the exotic status of being International Doctor of Mystery in interesting places, although I think I had more street-cred when I was fulfilling my passion of NGO work with an empty wallet.

The pay-off for all this has been the fact that after one year in Ghana I had saved a substantial deposit on my very own house and home. No more were my boxes consigned to a moldering corner of Brig and John's shed. The contents of these boxes were liberated into a spacious 2-3 bedroom home where they found niches, nooks and pride of places. I selected a few key pieces that I had picked up on my travels to lead the decor, and have spent a goodly proportion of my off-time painting and decorating around the key tangible proofs of my nomadic wanderings.

Another day in the life....

When I was working in Azerbaijan I encountered many challenges. Not least of these was the day a Pakistani man brought his son to see me. The problem, he explained candidly, was that his son had been circumcised in Pakistan some weeks before and there was a plastic ring around his penis which the surgeon had informed him would fall off naturally after a couple of weeks. The ring had not fallen off and the father hoped that I would be able to resolve the issue. This young lad of 3 years of age lay on the examination bed very calmly as I examined, and stood back to contemplate the issue. Sure enough, tightly constricting this little boys little appendage was a thick plastic ring which by now was causing swelling and some obvious discomfort. I was somewhat dumbfounded, which as those who know me, is not a very common situation.
In the meantime, I was trying by phone to resolve the issue of another Pakistani lady who had collapsed when confronted by a dog, who by all accounts was perfectly friendly and was wanting to make her acquaintance, but she, suffering a morbid fear of dogs, felt it fitting to fall faint to the floor suffering some injury which necessitated an MRI scan to fully reassure the patient of the unlikeliness of her imminent death. While at the hospital she became quite hysterical and the nurse with her had rung me to say that she was now unconscious and unresponsive and they were rushing her back to the clinic for me to resuscitate her. It crossed my mind that as she was already at a hospital, perhaps resuscitation would be better undertaken there rather than bringing her back through tortuous, congested one-way streets to me.
The father of the little boy with his ring where a ring should not be, at least not at that tender age, was insistent that I should speak to the surgeon in Pakistan who had done the procedure. Cheerily the surgeon informed me by phone, in a lilting, melodic Pakistani accent, that I should just cut it off ... the ring that is, although given that the appendage to which it was firmly stuck was little bigger than a baked bean and the ring was of hard thick plastic I had visions of disaster. Not being one to shirk from my responsibilities, I took the smallest scissors and clamps I could find, carefully positioning clamps between the ring and the shaft while the young boy lay there still as a statue with tears running down his face. I was mid-way though cutting through the ring, swearing soundly to myself through gritted teeth, when my hysterical unconscious patient was brought with great drama back into the emergency room with staff yelling, puffing and sweating and the lady twitching melodramatically. As she was wheeled past me in a flurry I was able to note that she was breathing which was enough sign of life for me to try to concentrate back on the delicate task at hand. "Oh dear me, that is my neighbour" said the father of the boy as he leaned back over to watch what I was doing. I managed to cut through the ring, remove it without Bobbitting the boy and step across to the other bed as my other patient roused from her swoon and starting crying loudly about the fearfulness of dogs.
Just another day in the life of the International Doctor of Mystery. Life in Ghana has been less dramatic. Of the 2 snake-bites we have treated, neither has sustained more than a superficial scratch. The victims of occupational injury have suffered cut fingers. The acute collapses have fainted or have been suffering a severe case of hangover, apart from the one poor gentleman who had suffered a stroke. I examine feverish children, dispense bottles of paracetemol syrup and write prescriptions for malaria prophylaxis or lab requests for malaria tests.

It's now the beginning of Harmattan, the time of year that microscopic particles of the Sahara make their way across to the coast and create a thick pall through which the sun barely penetrates. The joys of West Africa.

Crossing to the quiet life

Things are fairly quiet here in Ghana. As one of the few countries in Africa with a stable political system and economy it is not fraught with war or militant factionalism. The gold-mine operates under the motto "The Right Way, The Safe Way, Every Day" and judging by the few cases of work related trauma that we see in the clinic, this motto is adhered to fairly well. I live a quiet life in the residential village. In fact, I am sheltered almost completely from "Ghana" being restricted to moving from work to the village.

The only time I really feel as though I am in Africa is when I drop one of our staff up into the neighbouring village at the end of the day when she can't get local transport. Kenyasi is a small but bustling village, in the typical African fashion, with all the shop fronts and daily life right on the street. On a Friday night it has more bustle than usual, buses dropping staff in the town navigate the perilously narrow streets and all manor of lifestock and family life are being herded home. Last night I had to come to a halt in the middle of the main street, mid-wave to a group of gorgeous little children in oversized t-shirts with gleaming white teeth in a cheeky smile, as a very small goat leapt out in front of me. Stopped, I couldn't see where it was over the bonnet of my large 4WD; fortunately a bystander smiled broadly, gave the universal "wait" signal of hand held up like an Indian "How" and reached under the front wheels and dragged the goat out by its tail.

The drive too and from work through the luxuriant jungle and past the tailings mounds still gives me pleasure, which can rapidly vapourise arriving at the entrance to the mine camp where lines of cars wait to be searched and slowly passed through the electronic boom gate. Impatiently, I sit for up to 10 minutes in the morning waiting my turn to swipe my cards and trundle slowly into the compound, slushing through muddy potholes and crowds of workers swarming towards their departments.

Still, all things must be put into perspective and compared with crossing Erez (from Israel to Gaza) the boom gate is a small and painless thing.

Erez resembles an airport from the Israeli side, constructed of steel and glass with vast linoleum terminals, countless security cameras and personnel and passport booths. The procedure to enter Gaza is relatively straightforward; assuming you have the "coordination" (permission from the Israeli side to enter Gaza which is only given to NGOs, journalists and few Palestinians) you arrive to the gate, hand over your passport and wait in the full sun or driving rain for anywhere from 15 minutes to 2 hours for the authorities inside the building to issue the "coordination papers". Clutching this paper and passport, you proceed through a gate and into the terminal building and go to Passport Control. A short interrogation later you are permitted to pass and cross the terminal, through electronically controlled turnstiles until reaching the wall which separates Israel from Gaza. Usually, as you approach the wall the gate will slide open allowing you to cross onto the Gaza side but sometimes it will not open, and you must wait, trapped between an 8-metre high wall and impenetratable gate and a security fence until the gate opens. After the wall the "tunnel" winds through security fences until discharging you from between bombed concrete walls and perilously flapping sheets of roofing iron onto a rutted, pot-holed (bomb-holed) dirt road flanked by skeletons of buildings crumbling into ruin since being destroyed by Israeli tanks and bombs. Another 500m of wasteland, like a modern-day apocalypse, must be crossed to reach the nearest point that vehicles can reach. A short car ride past donkey-carts hauling scrap from the ruins and around craters in the road takes you to the Hamas checkpoint to register foreign persons entering Gaza and then you are on the road towards Gaza City. A distance of approximately 100km from Jerusalem to Gaza and it takes a minimum of 2.5 hours, despite 75km of this being on first-world standard roads.

Coming back out of Gaza is the reverse procedure with extra bells and whistles. Arriving at the Palestinian terminal (a shipping container amongst the desolation with a tea stand propped at one end) you give your passport, the details of which are radioed through to the Israeli terminal to confirm you have permission to cross. After a variable amount of time you are returned your passport and set off across the wastelands towards the terminal. On a good day, the gate in the wall will slide open as you approach, on a bad day the gate stays determinatedly closed and you wait. Once inside the gate, you must open your bags and show them to a camera stationed on the ceiling, otherwise face the wrath of the faceless voice that yells from the intercom to follow instructions and show your bag. Then you're at the mercy of the electronic gates and turnstiles - green light = go, red light = wait. Two turnstiles later you arrive at the baggage check, where all electronic items including laptop, phone, power cables, USB flash-drives, camera etc must be separated out and sent through the x-ray machine and the remainder of your bag will follow. Once your belongings have gone through you are directed to the "body-machine" - a glass doored booth which opens eerily as you approach. You are directed to place your feet on the marks on the floor, put your hands above your head as the doors click shut and the scanner whizzes 180 degrees around and back. If this is satisfactory, the doors will open and you step into electronically controlled booths while the images of your scan are analysed. If this is satisfactory you may proceed to the conveyor belt, where if you are lucky your personal belongings have arrived. If said personal items are not there, you have to go out through yet another electronically controlled turnstile to find your belongings being thoroughly searched by security before being returned to you. Then, passport control, another interrogation, this one usually considerably longer than the entrance interrogation, out of the terminal building, across the carpark, through another turnstile and you're free!

Boom gate at Camp A is a breeze really!

Zambia and Botswana

I have always loved the African continent. I first visited in 1996; landing at Hwange Airstrip in Zimbabwe I felt an instantaneous connection and comfort that few strange places can give. I attributed my instantaneous reaction on the rarefied light; the shining-white, genuine smiles of the people; the glorious sunsets and the reverberations on the air of the roar of the lions. Whatever it is about Africa, it has endless appeal.

I met my parents in Johannesburg on the day of the South African Presidential inauguration; the hotel lobby was bustling with traditional African dress and sculpted hair. The hotel complex, called Emperor’s Palace, includes faux colonnades, the spinning and clacking of countless roulette wheels and slot machines and an artificial sky of spring-blue dotted with clouds and stars. This was an ostentatious and artificial environment from which to spring-board to going bush, getting feral and leaving behind all the trappings of life.

The morning awoke clear and bright and opened with a luscious breakfast buffet spread and moved rapidly along to the airport to check into a flight to Lusaka. The flight was as uneventful as a 2-hour flight across deepest darkest Africa can be. We transferred, with assistance from ground staff, through immigration and watched with some trepidation as a dishevelled expatriate pilot shuffled out towards the shiny gold plane waiting on the tarmac.

We flew over lurking clouds and landed at Mfuwe International Airport, which is a small hunched terminal building on the edge of the jungle. We were met by Robbie, our guide, and transferred to Flat Dogs Camp, on the edge of the river, with comfortable chalets, a camping area for the over-land travellers, and an extensive bar/restaurant area. The rules of the camp were that we were not permitted onto the river bank due to the risk of “Flat Dogs’ (crocodiles), and after dark we were to be escorted to and fro our chalet in case of wild-life in the camp. No sooner had we dropped out bags, than we set out on our first night drive.

The thing with safaris is that you get into a routine of getting up before the sun, taking a small breakfast and wrapping up in layers and layers of clothes to insulate against the crispness of the Southern African pre-dawn. Loading up with camera and binoculars you board the open safari vehicle to drive out into raw, unadulterated landscapes to observe the rhythms of nature that are only seen in condensed form on wildlife programs. Every animal is different and on different days, even if you see the same animal, there is a different social or environmental interaction going on which is a privilege to watch.

Once the sun has lifted away from the horizon, the deep amber and cerise colours have faded into the uniformly blue sky and the sunshine glows on the branches and stalks of the vegetation, there is a coffee break in an area assessed to be free of dangerous animals, with particular emphasis on checking behind a suitable bush for the use of the ladies, and a steaming mug of coffee is sipped on riverside/beside a waterhole/on an open savannah. Layers of clothes can be peeled off as the day warms. The drive continues in the full expanse of the day as the diurnal animals are going about their business and a slow drive back towards the lodge or camp reveals antelope sparring, baboons frolicking, elephants browsing and birds flitting like flying jewels.

Siesta at camp allows an opportunity to take a bucket shower (or real shower depending on the accommodation), at least one more meal and interact with whatever wildlife happens past the camp. High tea in the afternoon precedes the evening drive; sunshine gives way to deepening colours of sunset as a suitable spot is chosen to have gin and tonic and nibbles and see the changing of shift as the diurnal animals settle in for the night and the sloping, prowling nocturnal animals slink out of shadow. Reaching camp in the dark, the twinkling lights of the paraffin lamps welcome you to a hot meal, a glass of wine and sighs of deep satisfaction.

This was the routine of our 3-week safari, repeated at Flat Dogs Camp and Kapamba Lodge in Zambia, a 10-day mobile camping safari through Chobe and Moremi National Parks, and lodges in the Okavango and Nxai Pan regions of Botswana.

Unfailingly, the scenery was beautiful and unspoilt and for the majority of the trip we were an exclusive group of 3 with a guide to experience close hand magnificent animals. We were better informed about the habits and peculiarities of flora and fauna and learned to recognise paw-prints in the sand, differentiate birds on the wing and social hierarchies of herds/journies/pods/dazzles of animals.

On our first night in Flat Dogs we surprised a hippo, which was grazing between 2 of the chalets, as we were escorted back from dinner. The following night a pair of hippos came up from the river and grazed outside the chalet, the sound of tearing grass, grinding teeth and snorting rousing us from our beds to go and watch them from the balcony. Wherever there were hippos there was the deep rumbling chuckle as they called; it sounded like a Chinese whispers joke that was passed down the river from individual to individual and pod to pod as they chortled to each other.

We were lucky enough to have 5 separate sightings of leopard; on one occasion we happened upon one on the side of the road. As we approached, it disappeared into the bush, only to reappear moments later and walk around the vehicle so close that Mum could have reached out to touch it. Being a responsible tourist she did not do this but was so overcome that her photographic evidence of the encounter is a blurred shot of the back end, with characteristic markings, as it nonchalantly walked past her.

We saw so many lions that, although it is impossible to tire of lions, we were complacent about having fully grown males with bristling manes lying metres from us in the grass with tails and paws twitching in sleep or lumbering powerfully down bush air-strips past our vehicle close enough to hear their breathing. We watched courtships (mating is initiated by the female and the male lies at attention waiting for the signal until she is ready; it is amusing to watch the King of the Jungle looking downcast and beseechingly at the female while she sleeps), prides of lions stealthily and patiently following a herd of buffalo for tens of kilometres and 24 hours in hope of a kill and were roared at by a male, a mere 20m from us before he joined another male and walked up the hill towards our camp. We radioed up to tell the camp staff that 2 males were heading their way and drove up to intercept them; we found Sunday, one of the camp hands, hiding behind the tent taking photos with his mobile phone.

At Meno a Kwena camp, a luxurious and beautifully appointed permanent-tented camp near Nxai Pans we dozed fitfully, woken every 20 minutes throughout the night by the roaring of a male lion, probably 1km away, but the sound carries into every cell of the body.

One of the camp sites near Moremi Park (voted Africa’s most beautiful National Park for good reason) was in a cluster of Camel Thorn Acacia trees, a tree favoured by elephants for their large fibrous seeds pods which they harvest by purposefully pressing their trunks and heads against the tree trunk and pushing, causing the towering trees to shake from their roots and a shower of pods to fall to the ground. Our camp being in the middle of a grove of these trees was no deterrent to the elephants who shook trees, tore down branches and gathered seed pods around the tents.

Driving along bush roads we were constantly surprised when massive elephants stepped out onto the road and disappeared instantly amongst the scrub on the other side of the road; there is an expectation that elephants should be fairly easy to spot but they are incredibly deceptive in their ability to be hidden completely from view while standing only a few metres away.

We were watching a mother elephant with 2 adolescents on the other side of the river in the Okavango one morning. All was at peace until we started moving off and with a bellow like a room full of 5-years olds learning to play the trumpet with amplifiers, the adult female charged across the river, pushing spumes of water over her flailing trunk and outstretched ears. She proceeded to chase us, continuing to bellow, for 400m as we drove as fast as the sandy/under-water river bank road would allow us; for the first 200m she was gaining on us and it was only when we reached firmer ground that we were able to get some speed and out run her. She turned back, thrashing her head and shrieking in anger all the way back across the river to her calves and we caught our breath, burst out laughing with relief and had a cup of coffee.

At the campsite in Moremi, Mum and Dad were woken in the night by a scuffling sound at the back of their tent, where the pit-latrine/bucket shower en suite was situated (this area was enclosed by a simple canvas but was separated from the tent by sturdy canvas and zips). At about 4.30am I heard a massive crash; I assumed that the camp hands had dropped something in the kitchen as this was the time they were up preparing hot water and breakfast and snuggled down under my blankets. Footsteps went past my tent and I looked out through the mesh as the silhouette of a hyena passed directly outside my window in the dark. Half an hour later, Power came to give us our wake-up call and bring hot water for freshening up; from Mum and Dad’s tent I could hear them saying to him “….. toilet seat…. in the bush…. toilet…. it’s gone….” or something similar. Once I’d dressed I went over to their tent and the story emerged that the something that had been scuffling outside their tent was the hyena who had put his head under the canvas, pushed the toilet base right across the en suite and had stolen their heavy wooden lidded toilet seat, dragging it some 10-15m into the bush out the back of their tent. Power thought they were joking, Mum had to dash out into the bush to retrieve the toilet seat and Power was somewhat embarrassed later when he realised it was a true event; as he said “it’s a very strange story”.

The same hyena came back to our camp for the next 2 nights, at one stage he was sighted right inside the camp as we were at the campfire; he was peering over the table with the coffee accoutrement on it with only his heavy muzzle and fluffy ears visible.

Wild dog are endangered and we were lucky enough to have 3 sightings of packs of dog playing, sniffing and scratching much like a group of domestic dogs.

We saw a sitatunga, a very elusive aquatic antelope which is rarely seen, in the papyrus reeds from a boat. We were immensely lucky in our wildlife sightings.


Giraffes loped behind bush as we approached and then stopped and watched us with big eyes set in their comical heads sticking up from behind cover. Zebras dazzled in herds, their stripes dizzying the eyes and concealing them in shadow. Troops of baboons foraged and frolicked, under the watchful guard of one member of the troop sitting up high on a tree or a termite mound to look for danger. Impala leapt, grazed and males locked horns in combat. Jackals skulked on the periphery of waterholes and herds of antelope. Vervet monkeys capered in the trees, grooming each other, leaping with trapeze-artist graze from spindly branch to spindly branch and lunging at us from overhanging branches when they deemed us too close. Warthog trotted, warts proudly displayed and tails erect like tiny flags. Wildebeest wandered shaggily across the open plains. Large birds waded or expanded wings to full extent as they beat the air to launch into flight and small birds lifted and twisted in flocks or perched with iridescent colours glinting in the sun.

Our staunch safari vehicles traversed deeply rutted tracks where elephants had churned the mud, flooded tracks with water rising up the sides of the vehicle and sandy roads shifting and squeaking under our tyres. Endless supplies of good food and drink were dispensed from the stashes in the vehicles and from the kitchens, with fresh bread, cakes, tender meat and well-seasoned vegetables appearing from the camp ovens cooked over open coals. Our accommodation was comfortable, with all amenities overlooking the wild – watching elephants from the shower is an incomparable experience and having to rescue 2 large tree frogs from the bath tub after they jetted out of the tap when I turned it on requires patience.

Our guides were incredible sources of information and skills – from knowing the mating habits of the smallest, seemingly most insignificant animals to rewiring spotlights in the middle of a night drive. We had a San guide in Nxai Pans who demonstrated bush skills and a complex language comprised of a set of clicks impossible for the untrained tongue to emulate.


We spent 2 days in Livingstone to see the Victoria Falls. Due to an exceptional amount of water falling on the Angolan Heights some months before, the Zambezi was flowing faster and harder than usual and the thunderous power of the Falls threw up drenching spray at the viewing platforms with sparkling rainbows arching into the lush rain forest and a mist of water visible from the plane as we landed at the airport. We also took a sunset cruise on the upper Zambezi, enjoying free flowing G&T as the river flowed, the sun sank like a maraschino cherry in a cocktail and the roar of the Falls thrummed in the night air.

It was a magical holiday and we’re already planning the next African safari itinerary…..

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