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....

Kiwi Christmas....

Oh it's so nice to be home.
The pohutakawa are in full flower. The sun sparkles on the waters of the Bay of Islands.

The fish nibble, tug and tease on the end of fishing lines. And dolphins frolick around the boat.














The fishing on Friday started a bit slow with some gust-propelled drifting across the bay with winds so strong that even the strongest snapper couldn't keep up with the bait, but culminated nicely with a drift between rocky outcrops, oyster-encrusted and pohutakawa fringed bays past a pod of frisky dolphins and we brought home enough fresh fish to feed a family a few times over.

The barbeque has spluttered and smoked as the sausages and steak charred to a slightly-less-than-carcinogenic-still-authentic-BBQ flavour.

Bottles of wine jostle in the fridge.

Menu-plans have been generated necessitating multiple trips to the local New World, butchers and weekend Farmer's Market for fresh raspberries, prawns, turkey, ham, cream and salad.

My pregnant baby-sister, her husband and her bump are expected home on Christmas Eve. Given that I haven't seen my baby-sister since her wedding 3 years ago, this makes for a full family Christmas.

Technology has gone mad - my parents have stepped up to the challenge with a Flash Drive (small steps for Gen-X, giant steps for parent-kind), a new lap-top, a wireless modem so I can email and blog from the comfort of the lounge (I don't think it was just for my benefit although I did do a bit of propaganda and enthusiastic extolling of benefits), a Wii and this has all required a fair amount of installation, explanation, testing and fiddling.








And throughout, cats do what cats do best.... be exactly where they want to be, which is not necessarily where you want them to be (inside clothes drawers, on the computer and kneading sunburnt knees with their razor-sharp claws).


Ah, it's good to be home.....

Going home...

I have been here in glorious Melbourne for almost 4 weeks and I have succeeded on a few objectives.



Firstly I have caught up with significant friends and enjoyed evenings on the couch with a bottle of good NZ white wine, or on the deck with a few beers as the sun dapples through the eucalyptus trees or watching the moon from the backyard of suburban Ballarat.



I have had evenings out; Kiwi Fish and Chips in the park or jugs of Singapore Slings on rooftops and consistently I have had high-quality, wonderful, generous, interesting and inspiring company.






I have reestablished a relationship with all the children that I know and love; baby cuddles and giggles are still the best therapy for any kind of ill and kids say the funniest things.




The boxes containing those worldly possessions which don't fit in my backpack and have been moldering in the corner of the shed for 5 years have been opened and thoroughly appreciated for the fact that everything has survived without damage and the eclectic nature of the contents.




Simultaneously a selection of items has been taken aside for relocation to deepest, darkest Africa; after 5 years surviving on 20kg of "stuff" I figure it's about time to take advantage of the relocation package and take along some kitchen utensils and a little black dress... well you never know when jungle fever will hit and I'll need to sashay around in a cocktail frock with a wooden spoon! Along with the wooden spoon a large number of food items ranging from miso soup paste to balsamic vinegar are being taken along for the ride and will hopefully augment the local ingredients available.


I have had a full medical check and can happily report that I am in certified good health, and I have had my hair done so I am now blonded up for summer!






And now I am getting ready to go home... good ol' NZ for a month of suxty-sux fush and chups, and all the good things that NZ does so well..... like 42 Below Vodka, Living Nature products, Olivado oils, Monteiths Beer, Marlborough Sauvignon Blanc, lamb, dairy, IceBreakers, hokey-pokey icecream..... And of course to have a wonderful Christmas with the family :-)

Coming down

I've been out of Palestine for 2.5 weeks now, and I realise something that I should have learnt before. Every single time I get back from a mission I go through the same process and every single time I get stressed about it. I think that the stress is part of the process and needs to be endured like the other stages of "coming down" but it does become tedious.

The first stage of "coming down" is the flight home; many long days of travel, recycled underwear, sleeping in an upright position with my tray table folded and arriving jet-lagged and tired, but determined not to be affected by these
nuisance value physical complaints.

The second phase is the "catch up with everyone in the shortest possible amount of time while simultaneously stressing about the amount of mail that needs to sorted out, the boxes in the shed and finding a pair of trousers that hasn't been on a 1:3 rotation for the last 6 months". This phase may also be accompanied by worrying about or sorting out my next contract and starting to let my mind wander out to the airport, onto a plane and across the world to my new destination.

The next phase, which is the one I am currently entering, is the "everything is under control, I'm ok, make lists and start being efficient" phase, whereby I get a grip, suck it up, and get on with it. Yesterday was Day One of Phase 3; I spent 5 hours driving all over Melbourne whipping out my credit card, moving with determined focus through pre-Christmas retail madness, and filling the boot of Ding-Dong the Car, with bags and bags of necessary yet indulgent things.




Finding a car park in central Melbourne is an exercise in frustration at the best of times, not to mention cripplingly expensive, but I perservered through throngs of vehicles and masses of swarming shoppers in order to position myself in the centre of it all for maximum efficiency.

I don't shop often and only out of necessity; I have retail self-discipline which, if applied to Paris Hilton, would probably result in the collapse of the major designer labels.



So, I brutally executed a complete overhaul of my underwear, a chat with HSBC, replenishment of my Aesop products (body and hair products, highly recommended by me - expensive but lasts an entire mission in a range of conditions from mountainous mud huts to dusty deserts), craft supplies, and bags of Asian foodstuffs so that I may make Udon soup, sushi, Madras curries and Thai delicacies in the jungles of Ghana.

Phase 4 will commence just prior to my departure.... stay tuned :-)