Monday, 24 December 2012

A Kambia Christmas

The toukel is decorated, the presents are wrapped and away beyond the latrines a goat nibbles absent-mindedly on some old orange peel, oblivious to the festive Sword of Damocles twinkling o'erhead like the Star over the Stable.  It's Christmas Eve and I'm singing along to 'A Christmas Gift For You', trying manfully to outdo the somewhat incongruous strains of 'Mysterious Girl' that have been drifting across the compound since dawn yesterday.  Eeh, Kambia! It's been a very strange festive run-in, all told- the heat alone is enough to disorientate and even as I type sweat is rolling down my temple onto the table. Nice. There really won’t be snow in Africa this Christmas.  In fact, there's been no rain either for weeks now and all is dust; feathery red dust caking every spare square inch, glittering in the headlamps and the torches.  This is the Harmattan, swirling down from the Sahara into the Gulf of Guinea as it does at this time every year.  The other thing that’s strange is the complete lack of any recognisable Christmas paraphernalia.  No decorations, no special foods, no presents, scarves, mittens, bells, no window displays or sparkle, no cards, no carols, no Slade (small mercy that last one)- the list is endless.  Even in church Advent has underwhelmed-no candles? No crib? Surely to God they’ll sing a Christmas carol soon?!  Bah humbug!  But then again, most of this is stuff is, well, just that-stuff.  Padding for the commercial horror that Christmas can so easily become if not kept on a tight leash.  And of course they don’t have it because it’s 40 degrees outside and nobody has any bloody money anyway.  It’s different somehow- simpler- after all, peace reigns in Sierra Leone and surely that’s what really counts.

Having said all that, we do actually have a really lovely day planned out-carols in the toukel with mulled wine and mince pies (I know!), then onto Midnight Mass.  Tomorrow it’s church again followed by secret santa and a big cook-off/feast with friends and family.  Charles is going to teach me the secrets of perfectly caramelised plantain and I’m going to show him how to, errr, boil a Christmas pudding....  Secret Christmas foodstashes have survived the ravening attentions of volunteers and mice alike, and-glory be! There's not a turkey in sight! There's a chicken, mind, a juicy moist, tender little chicken strutting about…

[Exciting interlude! 4pm Christmas Eve and who should call at the base but the postman!! Christmas parcels all round! Can’t hardly believe it!!]

And we do seem to have rather a lot to celebrate-Dr Mary has arrived to join our motley crew and has instantly proved her worth with all manner of ingenious homemade decorations-Toblerone wrapper nativity stars? No problem!  Intricate snowflakes crafted from scrap?  Coming right up!  Very impressive J  But that’s not the half of it ladies and gents....... Big News in Kambia!  The lovely Grace is being visited by her fella, the equally lovely Borja, and he’s only gone and proposed!  On the veranda if you please!  Of course we had to have a party and duly gorged ourselves on engagement beans, engagement cucumber and engagement mayonnaise, all washed down with engagement wine-in-a-box (don't knock it!)  Best of all, we got to serenade the happy couple with 'All I Want For Christmas is You', a capella first verse then breaking out into the Full Mariah with an, ahem, 'freestyle movement section'.....  Well worth popping the question for, eh? In fact they're probably not even engaged at all, the whole thing was probably just an elaborate hoax so they could see the Show of the Century.  Probably.

Back in England Mr. and Mrs. Garner will be celebrating a matrimonial Christmas for the first time, as will Mr. and Mrs. Bennet.  Emma, Luke and Nora are spending their first Christmas together with Baby Woody, while Wills and Kate (what?! I'm happy for them!) …well, actually they’ll probably just be stuck in a rut of hair holding and second-hand stollen, but I’m sure they’ll be very happy and excited notwithstanding.  Right. I’m going to be serious, just for a moment if I may-the very reason I miss Christmas so much is because it reminds me how much I miss all of you.  Life isn’t always straightforward and some familiar faces will forever be absent from round the Christmas table, but they’ll never be missing from our hearts and nor will you from mine, no matter how many millions of miles away I might be. That’s really all I meant to say, but there. You know what I’m like.

Merry Christmas to all and to all a good night,


Ps; dashing off to the tailors now to (hopefully!) collect my Africana suit-just in the very St. Nick of time!!

Sunday, 2 December 2012

A Day in the Life - 1st November 2012

A Day in the Life
1st November 2012

Evening all.  Well, it seems like it's been an unconscionably long time since last I sat to put finger to key, as it were.  Three breakneck months lie scattered behind me already and somewhere in the hurly burly whirlwind of it all I find that I have become deeply attached to this place, my place if you will, if only for a short while.  So perhaps now is a good time for me to try and paint a brighter and more vivid picture of Kambia for you, to lead you down the narrow bush tracks and sun-bleached corridors,  filling out a little more of the colour and the shape.  A picture paints a thousand words or so they say-well, what do I care about that? Give me a thousand words any day, and a thousand more besides!  If you know me at all you’ll know that I’m really not joking-loquacious might as well be my middle name- sitting comfortably are we, dear readers?! Then I’ll begin…..

There being only 12 and a half hours of daylight at this latitude the day begins in the grey pre-dawn.  Such is the heat and humidity that only during about two of those hours is the idea of exercise even bearable, so accordingly cock-crow finds me doubled over tying the laces of my running shoes.  We all run a lot, really, considering (all four of us because, of course, with the arrival of Grace last week we are now four J) and this morning’s route takes me round the old town, through a tunnelled path of reeds and rushes and down to the banks of the mighty Kolenten river.  I grant myself a minute to appreciate the beauty, naturally, but the scissor jaws of Simulium damnosum (the 'damned black fly', carrier of Onchocerciasis or 'river blindness') soon get me trotting again, ruminating vaguely on the wonders of doxycyline… Wending my way back up the dusty, rutted hill I approach ‘Checkpoint,’ this being the end of the bridge spanning the river to Guinea.  The newer settlement of 'Kambia 2’ sprang up round the checkpoint during the war as people flocked to live under the auspices of government troops stationed here  (the rebels, by contrast, were camped in 'Kambia 1’).  Late setting off this morning, I know I’m in real danger of being caught by the rising sun and so I speed up, trying to outrun my fate.  No chance!  Enter the Orb of Fire, her majesty heralded by a thousand strong avian choir-breathtaking, yes, but in more ways than one!  The last steep slope before home sees my legs begin to wobble alarmingly beneath me as my internal needle starts to oscillate wildly towards MELTDOWN!!  In England the sight of a jogger, beetroot red and wheezing painfully as any number of jaunty pensioners and one legged domestic animals glide past them with apparent ease, is enough to invoke a sort of awkward pity; embarrassed faces are quickly turned away.  Well, not in Kambia!  A group of elderly women (decidedly jaunty) engaged in ferrying empty yellow jerrycans (used to transport the various fluids of the versatile palm tree, notably blood red, sticky palm oil and poyo, or palm wine) back up the hill, espy me and (good grief!) leap nimbly over the concrete storm drains (careful Tash!) to grab sticks and branches from the bushes.  Jerrycans now become drums as voices are raised in a song which I can only assume is designed to exhort me to greater efforts.  Certainly as I pick up the pace (argh! My legs are now doing a rather good impression of a newborn Paula Radcliffe!) so they, too, up the tempo and I do get a big cheer when I (finally) crest the hill.  In another world I think these ladies could make badass personal trainers!

Anyways, ordeal over, I collapse gratefully back through the metal gates of the base where by now the kids are bustling about getting ready for school.  In contrast with teenagers back home Ibrahim and Almamy would never be seen dead heading to school in trainers-shiny black shoes are the order of the day here, accessorised with natty white ankle socks.  Almamy also has a fancy waistcoat (wiskot) of which he is very proud and which he can nightly be found scrubbing out with a little packet of soap power.  FOM! Dirts are not attached back!!  Meanwhile, outback, Abbas is fussing round a charcoal stove heating the water for breakfast.  He’s wearing a flannel on his head (‘flu, apparently), but notwithstanding this sartorial setback has conjured a very welcome whistling sound from the kettle.  This signifies coffee-proper coffee, mind, in a proper cafetiere- and I am instantly rejuvenated.  Hmmmm.  I wasn’t actually going to mention the coffee in the blog as I wouldn’t want anyone to the get the wrong idea about the rigors of life out here…..  But there.  The coffee kitten has escaped from it’s beany little bag.

Arriving at the hospital, the gates swing open to let us through and there follows the obligatory ritual of greeting anyone and everyone who happens to be sitting about by the gatehouse that morning (this is a proper little social hub and one of the first places we quest after any errant staff members...).  Parting company with the girls I stride off towards Pickin Ward, skipping nimbly over a fresh pile of goat poo as I go.  On its day our hospital is a regular little menagerie-we have vultures nesting on the roof of outpatients, a tribe of goats headed up by The Pregnant Goat (although as the months go by sans progeny we are becoming increasingly concerned that she may not actually be pregnant at all-Tumour Goat? :/) and, less appealingly, a pack of dogs who periodically have to be chased off the wards.  Of the rats we do not speak.

Outside the ward I get a big hug from Nkoya, one of our Kambia Appeal trained nurses and a long-term stalwart of PW (we’ve all been given African names by the staff and mine is ‘little Nkoya’ or ‘Nkoya 2’).  This is lovely, of course, but once inside I find things a touch more chaotic than I would ideally like-Ryan is here already and, together with one of our new VNAs, is doing battle with a very shocked-looking child.   So far so standard but today’s twist is that there are no keys for the drug cupboard and no drugs except the drugs in the drug cupboard.  Sister Patricia (keeper of said keys) is not in her house and there is a rumour that she was last seen whizzing out of the gates on an ocada.*  Meh. This ridiculous situation has arisen a few times of late and is the consequence of a visit from some Freetown Ministry bods.  They were evaluating the free health scheme and ended up doing quite a lot of shouting about ‘missing’ drugs and corruption.  In reality I think this is a documentation issue-the ward is so hectic that drugs are often distributed, quite legitimately, but not recorded in the big drug ledger.  And so, whilst I’m all for better documentation and accountability, we are now at an impasse as the child is clearly in dire straits.  Solution: break the lock.  This is easier said than done and after some faffing with a Swiss army knife, Ryan loses patience and smashes it off with a rock.  Such wanton vandalism is a ’bit’ out of character for Ryan and causes a fair bit of giggling amongst the VNAs, which I must admit we are not above joining in with once we’ve overseen the treatment plan!  However, much of the rest of the morning is then taken up with repairing a) the lock and b) our relationship with Sister P who is, shall we say, a trifle miffed on her return….

Of course she forgives us in the end, but alas! It takes a great stripe of yellow baby shite down my scrub trousers to do it.  I have to be taken outside and sluiced vigorously by Nurse N'Gadie (where has this water come from? And the soap?!!), an indignity to which I submit meekly (ever tried resisting a determined nurse? Pointless). The whole debacle occasions great mirth, naturally, and in the face of such severe provocation even Sister P is unable to keep a straight face.  And so Ryan and I, erstwhile black goats, are finally restored to the fold and peace descends once more over Pickin Ward.

Next door to paediatrics is the cholera ward, its Finnish Red Cross barricades festooned with lappas drying in the sun.** The ward is empty, but it's stockpiles of soap and iv fluid are ring-fenced and so inaccessible to the rest of the hospital....not for the first time it crosses my mind to wonder about this cholera epidemic.  Supposedly at the epicentre of the worst cholera outbreak in West Africa for 50 years, I myself have seen only two patients who could, potentially, have had cholera.  Seen a fair few who clearly didn't have it, mind, but there-I’m sure it’s just the cynic in me joining imaginary dots between vast amounts of foreign aid and crucial upcoming elections…….

Taking a short cut round the back of the hospital past the ’sterile’ theatre drapes drying in the sun (30% wound infection rate) and the ambulance graveyard, I encounter our Med Super, Dr George.  This is fortunate as I had really been starting to suffer from sexism withdrawal symptoms-I’d been feeling empowered, worthwhile, useful-the works!!  Honestly, that man!  If he's not busy telling us that we're not real doctors as we're 'afraid of the blade' then he's bellowing down the ward that we're killing children by not transfusing everybody to a haemoglobin of 18 (!) and, whilst we're at it, why are we not breastfeeding them all-are we not women?!  White women at that, and as everyone knows, white milk is the best!!  Arrghhh!!  I could peck his eyes out!  Except that wouldn’t be very professional, really and we do still have to work with him.  How much of it is banter and how much not I’m never entirely sure-I find him difficult to read and Lord only knows what he really makes of us whippersnappers-four bright young things (ahem) bombing around his hospital not always doing exactly what we're told.  Anyway, today I give as good as I get and he seems satisfied by our quid pro quo.  Sexism and the cultural issues around getting the professional respect you need to be able to do your job are thorny subjects that I intend to return to in subsequent blogs, but for today I think we’ll just go on with our journey.

Ah.  Except that, dear reader, here I must ask you to leave me be for 5 minutes or so-get a brew, pop a crumpet in, whatever takes your fancy.  For i have suffered an alarming failure of my patented fluid intake/output management system (codename 'Nor Piss Na Hospital') and I won fo' wet.  Damn. The KGH latrines are less about the colour and the shape and more about the stench and non-touch-technique, so I’ll be kind and spare you the more gruesome details....

The afternoon finds us in the classroom with our volunteer nurses-today’s topic is blood transfusion.  I love these teaching sessions, I really do.  Ok, so sometimes it is a bit like having multiple dental extractions whilst simultaneously auditioning for the job of Blue Peter presenter, but honestly! There is always something, some stand out moment, that makes it all worthwhile. Today’s comes during the ‘SAFE OR DANGER!’ transfusion game when a rapid-fire burst of Krio soon rights a wayward would-be transfuser of O+ blood into an O- patient  (sorry non-medics but this is definitely in the ‘DANGER!’ column!).  We don’t even have to utter a word J  Undoubtedly the teaching program is improving standards on the wards but I’d like to think that it helps boosts volunteer morale as well-apart from anything else we’re explicitly recognising their value to the hospital.  What I’m less certain of, however, is whether any of them have twigged just how much it lifts our spirits to see them all come marching in their navy dresses, hair intricately plaited, past the palm trees and down the path to the training school. Well, maybe they have.  Let’s hope so, hey.

Teaching done-done, our thoughts start to turn to the weekend and the possibility of a cheeky sundowner on the veranda-it is Friday, after all!  Lovely thought, isn’t it?  Oh, but it's not to be....proving once and for all that is in fact a hospital and not just a series of filthy rectangular rooms , KGH synchronises it’s watch with healthcare facilities across the globe, bides it’s time until half past four on a Friday afternoon and then….Boom! Crisis o’clock!  A ‘hot’ appendix, burning up an 11 year old boy from the inside out.  Dr George has by now left the building so the only surgeon in town is Dr Sesay, the District Medical Officer.  Scrabbling around collecting up the theatre diaspora takes aaaaaggges, but that’s not the real problem-the real actual problem is that, despite the strictest instructions translated in every language ever spoken in this Tower of Babel, the kid has just been fed an enormous plate of rice. Disaster. With no way of securing the airway during the operation and no ventilator, this effectively means it’s too dangerous to put him to sleep and the operation, which shouldn’t really wait a moment longer, has to be postponed until morning.  Round about now my Oxford Handbook of Tropical Medicine becomes a victim of circumstance and goes skittering down the ward like a bowling ball.  I take this as a sign that I should probably go home.

[A happy footnote.  Even though the infection had caused both his appendix and small bowel to ‘pop’ by the time we operated the next day, Mohammed eventually went on to make a complete recovery.]

By the time I leave the hospital daylight has given way to dusk and the most beautiful hour of the day is upon us. Tatters of orange and purple silk frame the setting sun and a soft amber glow settles over the town. It’s a shame in a way that it has to be so fleeting-no sooner is the temperature bearable than the place is completely dark, and on a purely practical level it certainly makes it difficult to do quite as much here, even with our two hour quota of electricity.
Beautiful it may well be, but this is also the time when Kambia is at its noisiest. Mercury falling brings the world and his wife out onto the streets and the general rule seems to be that any speaker, radio, mobile phone etc. is automatically turned up to eleven, pumping out distorted bass long into the night (can still hear it now).  One set of speakers in particular is so buggered that every day the mangled sounds become less and less intelligible-we’re holding out for the day they finally explode!  Makes a top-deck-back-seat bus rides across Manchester seem positively Bodleian by comparison….To this general hubbub Mother Nature can add bullfrogs, crickets and dogfights, and in a cotton tree off Hospital Road live a colony of weever birds whose banshee squeals are so intrusive that conversation is impossible for a good 10m radius roundabout-a distance, I should add, that encompasses several homesteads.  Then of course there are the people-lots and lots and lots of people packed into flimsy dwellings and living out all the dramas of life.  Not for them the double glazing unit or closed door to bicker behind.  The ‘Noise of Poverty’ is a phrase that’s come down to us from the book-set in Sierra Leone- that Tash is reading at the moment, and I really don’t think it’s too glib to use it here.

Back at the ranch the water pump is playing up so it’s a bucket wash to freshen up before dinner in the toukel.  Mmmm! Eau de deet!   This is always a nice time of day, discussing the day’s events and unwinding with the girls.  Not long after and it’s time for bed.  A quick scout round my hut for undesirable animals (large cockroach on shelf, duly removed with trusty 'cup and cardboard' technique...) and it's under the mozzy net I go, not a moment too soon as the generator grunts and splutters it's last, plunging all into darkest indigo night.

There. Day is done. Well, almost-one more thing happens before morning which seems noteworthy to me. Getting up to brave the latrine, I happen to glance skyward and am rewarded by the most breathtaking display of stars that I’ve ever seen, glittering far above me in the heavens.  I don’t recognise them-the constellations and swirling galaxies are strange and this makes me feel very far from home.  But there is also something profound and quietly reassuring about them-fetching my glasses from beside the bed I step back outside into the perfect stillness and sit awhile on the concrete stoop, gazing up into the great eternal.

*motorbike taxi
** brightly patterned cotton fabric, quite multifunctional but usually worn like a sarong

Monday, 8 October 2012

Somewhere beyond the Barricades - 22nd September 2012

 Somewhere Beyond the Barricades

22th September

POOOOOST!!!! I got a letter!! Me!! In Kambia!! Guusje came to find me on my rounds last Tuesday waving a crumpled green slip, much adorned with fancy stamps and reading, quite clearly, ‘Dr Kate Wilkinson-please report to The Postmaster, Kambia Post Office, to receive one letter.’  A small boy had been sent as a runner to the hospital and had given the paper to the first ‘aporto’ he’d come across…..hell, it works!  Only took 28 days to traverse the seas from far-distant York (even the postmark was a thing of wonder to this lonely exile….) That’s twenty-eight.  Not twenty-nine, twenty-eight. Ahem.

So that was all very exciting J Back at Kambia government Hospital we’ve had a few memorable cases recently.  One little lad came to us in a terrible state, fitting uncontrollably.  He’d been comatose for the best part of a day by this point, but his family, trusting to tradition, had brought him to the native healer rather than the hospital.  Well-I’m no expert on traditional medicines-that I freely admit-but I do not and never will believe that they can cure cerebral malaria, this being a very severe form affecting the brain.

The next day found him deeply unconscious-if anything his condition was slightly worse.  A glance through his medication chart revealed only ominous gaps where neat signatures should have traced the regular life-saving injections of quinine and fluid. Crap. Cue stern remonstration with nurses.  Except that, midway through said hand-wringing a rather strange fact came to light-mum had actually been hiding the drugs from the staff! Basically, any adult patient (5 and over!) buys their meds at pharmacy and keeps them in a plastic bag, usually under their pillow.  The boy’s father had bought all the stuff the day before so I knew it was there, but mum had been insisting otherwise to the nurse doing the drug round.  ‘What the bejeezus?!’ I hear you cry, ‘why would she do that?’ Ah.  The same reason she didn’t being him to hospital in the first place.  And the reason she had neglected to sponge him down with water, keeping his fever from burning out of control (turns out someone else’s Grandma had been doing that).  In fact, the very same reason she was just gathering her few belongings together and preparing to take him home.  As far as she was concerned he was already dead. He had a devil inside him and that was that-she was already grieving.  Well, what are you supposed to say to that?  Maybe a minute passed while we sought to dissuade her, but the boy’s limp body, glistening with fever, gave the lie to our hollow reassurances.  His heart was hammering desperately, frantically-you could see beating out it’s final tattoo through his skinny ribs.  She didn’t believe us, couldn’t.  Looking down at his little body, I barely believed it myself.  She picked him up to go.  And then I quite clearly heard myself say, “if you take him home he’ll die.  But if he stays here he’ll survive.  Definitely this boy will not die if he stays in hospital.”  Nurse Esther translated, I barely had time to think ‘oh, shit’, and then she placed her first born child gently back down on the bed and looked up at us, hopefully.  Shit, shit, shit.

Obviously, as a doctor it’s never great to lie.  False hope is one thing, but over and above the purely humane element, I sensed that this particular lie had also put all of ‘Western’ medicine, my medicine, on trial.  Would she trust the hospital next time around, would her sisters and the other women of the village? Where would she take the infant presently swaddled to her back when he got malaria (as he inevitably would)?  ‘well’, I thought ‘at least we have this window of opportunity.  Maybe God (that’s the God of Western Medicine, of course!) will smile on us.’  We bustled to reconnect the drips, I left some very explicit instructions (most of which I ended up carrying out myself, but I like to think of that as the ‘see one’ in the ‘see one, do one, teach one’ educational model……:s) and moved on to the next patient.  Out of the corner of my eye, I saw mum quietly dip her cloth and bend to the little brow.

The boy lived. Two days later no fewer than three of his family stopped me on my way to work -‘de pickin done better, doc. Tenki, tenki!’  Still quite a moment though, coming round the corner to see him sitting on the bench outside the ward, eating a boiled egg!  Children, eh?  Remarkable creatures.  And so that particular round of hoodoo Vs.  quinine went to the quinine.  Tash has also been trying to kibosh ‘country medicine’, extracting promises from her patients to foreswear all ‘erbs in the future……we’ll see!  I don’t want to sound like a git but these bloody native herbs cause us docs nothing but bother-festering wounds,  burns from hot poultices, bloated bellies and-worst of all-crucial delays coming to hospital in the first place.  Witness above.  Hmmmm.  Victoria and James went to visit the traditional healer when they were here. Maybe I should educate myself and do likewise-know your enem……errrrr, I mean, ummm….not being a git and all it would be, err, interesting to see it from the other side.  Yes, that’s it.  Ahem.  Anyway, even Dr. Gitface here has to admit that the hospital itself is hardly the shining beacon I would like it to be, so maybe I should focus on getting my own house in order first.

The hospital itself bumbles along, seemingly in permanent crisis mode.  We’ve had no more hospital staff meetings since week three and there’s still no sign of a new medical superintendent.  The ward sisters have all been on strike over conditions and were summoned to Freetown last week.  They’re back now but Matron won’t speak to them or go onto their wards-it’s dagger eyes all round.  KGH has also been in the national press this week-scandal over the lack of oxygen and electricity for the patients.  It’s perhaps worth mentioning that the management offices do usually have electricity (fans!), at least for some of the day, but over on paeds ward the oxygen concentrator has lain derelict for so long now that there is  RAT living INSIDE it.  A rat.  Inside the oxygen concentrator.  Two feet from the children.  Apparently it isn’t really anyone’s job to deal with this so I’m off to pharmacy tomorrow morning to try and source some warfarin.  Not sure how I’ll get the ratta to eat the warfarin-the only cheese here is Laughing Cow….do rats like Laughing cow?  Let’s hope so-Le Rat Qui Mort! Ha!

I digress.  The most basic problem is, of course, money.  Spondoolies, casheesh, dolla-whatever you want to call it-there aint any.  Money done-done.  Inquisitive souls that we are, we’re trying to understand why this should be.  And the more questions we ask, so the iceberg starts to hove into view.  It’s election year-17th November to be precise.  Apparently, it’s quite common practice for foreign donors, the World Bank etc. to tighten the purse strings around elections, keeping a steady hand on the political pulse to ensure the next incumbent will continue to honour agreements.  And so the UNICEF feeding program for malnourished kiddiwinks appears to be disintegrating.  I can’t tell you how distressing this is-the children need very specific fortified milk to recover and it just isn’t there.  They’re starving to death, quite literally, before our eyes-little wizened old man faces atop ragdoll heaps of skin and bone.  Suzanne, bless her, has spent literally hours this week organising crisis meetings, scrounging for funds from local charities, designing a recipe to make substitute milk with just the right blend of nutrients, teaching the ward staff how to mix it up….. Despite every kind of red tape, excuse and set-back known to man (easily a whole blog in itself), I think she has, finally, succeeded.  It’s the strangest thing-I mean, these people that we work with every day, they’re not bad people-far from it!  They don’t want the kids to starve any more than we do-it’s just so difficult to understand sometimes.  By the way, if any of this stuff sounds overtly judgemental, that’s not my intention-it’s as much a stream of consciousness attempt at comprehension as anything.

It’s not just the aid money that’s dried up, either-the hospital should receive a quarterly budget of government funds from the district council-one payment and counting so far for 2012…..Elections again, we think.  The political rallies-cum-late night raves are becoming more frequent now as candidates vie for popular support, ‘political party’ seemingly a literal translation!  And so we’re stuck on this merry-go-round where most of the hospital ground staff don’t get paid a penny.  It’s generally accepted that the paediatric volunteer nurses can sell i.v. cannulas to the patients (everything else is free), as the tiny ones we need are ‘never in stock’.  I had thought this a form of permanent stop gap (!) but a couple of weeks ago our fragile ecosystem was suddenly threatened by a predatory influx of free cannulas for the children.  As news of their arrival spread the ward started to resemble the Marie Celeste-it did cross my mind that we might be about to lose about 75% of our workforce-well, I don’t known many people who would be willing and/or able to work for free, year in year out.  Fortunately-I don’t know quite what happened-they all started turning up for shifts again within just a few days.  Turns out I might know one or two of those people, after all….

And on that front, our teaching program for the nurses is really starting to gather momentum now.  We still have to round them up before each session but these days all it takes is a cocked head and raised eyebrows before they condescend to be shepherded, laughing, to the classroom.  I was even admonished for being late to teaching myself last week by Jariatsu (one of our more senior paeds VNAs)!  It’s hard to appreciate day to day, but looking back to when we first arrived, we’re all agreed that standards on the wards have improved.  For me, personally, I think that this is the only way we’ll be able to make a lasting impact here-the bureaucracy and higher workings (above ward level) are so impenetrable that it’s going to have to come from the front line.  Well, so be it.

Our Krio (the Salonean lingua franca) is getting better small small as well.  How de pickin sleep? De body de warm?  He de shake so? He de cough, he de vomit, he get rum belleh? Repeat ad infinitum…. :) And I can now more or less do my paeds ward round in Temne (the local tribal lingo) if needs be. Ha! Well, I say that, but what actually tends to happen is that I’ll ask a question and the patient will just look baffled, prompting the nurse to repeat exactly what I’ve just said with some added attitude +/- volume.  Hey presto! Patient understands perfectly and trots out a reply which, although perfectly intelligible to me, still gets ‘translated’ back by the nurse.  Still, I’m getting there and everyone (else) generally seems to find it hilarious!  Mende, Fulla, Susu, Maringo, Limba, however….

One rather surprising source of tuition has been the local church-St. Augustine’s, if you please!! (not a particularly well-known Saint, he was nonetheless also the patron of both my junior school and childhood church back in Nottingham!)  The two incarnations are very different-drumming, clapping and unfettered singing lend a wonderful rhythm to the mass here, and certainly the offertory processions back home do not include dancing or bunches of pink plastic flowers being waved aloft by the alter-servers!  The sermon, delivered here in English by a Polish priest, is never translated line for line into Krio, either (hence the language lessons).  Oh, and Jesus is black here, naturally.  So-a lot of differences, but still, of course, essentially and eternally constant.  It’s actually surprised me how comforting I’ve found the church, and how grounding.  Yes, it reminds me of home and family but at the same time also why I’m here, so far away from them.  To see the congregation colourfully but so carefully attired in their Sunday best, leaving the struggles of daily life behind to exalt so joyfully, is to be gently reminded to do likewise.  Truly an unlooked for source of strength.

Religion really is a big part of people’s lives here.  It doesn’t seem to matter very much which one, exactly-in fact, Sierra Leone represents the closest integration of Christians and Muslims that I’ve yet come across.  ‘God is Allah’ is one popular slogan painted on cars and buses, and they really do live cheek to cheek-even intermarriage is common.  You can’t even tell from somebody’s name which book the read-Sister Agnes, for example, is a Muslim, whereas our carpenter here at the base proudly declared himself to be ‘the only Christian in the world called Mohammed!’ when we asked if he was off to Mosque for Eid!  This everyday tolerance just doesn’t bear comparison with all the world news currently filtering through to us on Aunty Beeb….

Right then, I think that’s quite enough for now-bit of a bumper instalment this week!  Ovaltine and lesson planning await (!) so I’ll take my leave now if I may.  Loving you all,

Alleluia is my song, alleluia is my song. Whatsoever comes tomorrow, alleluia is my song.

Culture Shock - 28th August 2012

28th August

Culture shock

Quick note: some sad stuff this week, guys, and a few graphic medical details.  Don’t want to catch anyone unawares.  x

Walking home today and, as usual, cries of ‘Aporto aporto wat ees yur nem? Aporto aporto snap me!!’* punctuate the buzz of village life. This is closely followed by a troupe of ecstatic toddlers who proceed to dangle from my every limb, a pantomime which has never failed to make me smile.  Today, however, is an unusually pensive day.

Work was the pits this week.  A new and all consuming crisis every day-total fire-fighting mode.  I can’t say I ever wanted to find myself yelling at people in the middle of the ward,  but when you’re running with a(nother) fitting child that you’ve just found in the far corner, watched by a flotilla of nurses  who move not one muscle to help you….

-Quickly!  We need diazepam, a cannula and a bolus of dextrose for starters, and where are the pickin’s notes?  (pickin=child)

- We haven’t got any dextrose

-Go and get some then!! Please hurry!

- But we haven’t got the key

-Either get the sister (keeper of the key) out of her house (opposite the ward) right this second! or go to the next ward and get some!! It’s really REALLY urgent! Where’s the diazepam??

-We’ve run out of diazepam. And needles.  And syringes.  

-Oh, really? Is there a hole in your ruddy bucket, too, by any chance? (Ok, so I didn’t actually say that.   Just thought it)

Nobody moves, nobody being   1 trained nurse, 3 final year nursing students and several nursing aides. Child continues to fit. All necessary items are within 50 yards of the spot, locked in a cupboard and you know this.  Everybody knows this.  It is common knowledge. 

- %&@@#!!**!*!!!!

 Arrgh!! Then you find out the child has been in hospital for almost a day, convulsing all the while, and has a) received no treatment and b) not been brought to your attention, despite very specific questioning brought on by yesterdays identikit experience.  It’s the strangest thing –you’re there working up a sweat over this kid, really panicking, but it’s like you’re the only one.  Guusje described it as feeling ‘so alone in your emotions,’ which I think is very apt.  Even so, I’m still a bit cross with myself for shouting like that- it’s hardly model professionalism now, is it?  But the worst bit has to be the sense of a chaos so all-consuming that it leaves neither time nor space to address the underlying issues-like I said, just fire-fighting.  The next day brings a man, a young man god love him, completely naked on the filthy stone floor, blood spurting from his guts in a terrible red-black tide of wasted life.  It’s beyond words, all you have to offer is a little comfort and dignity at the last.   And so it continues-a 10 year old boy came today.  Two months ago he fell from a mango tree and broke his back-now he’s paralysed from the waist down and has bed sores through to bone.  These have been freshly packed with herbs and dung by a traditional healer, so first and foremost I ask for the wounds to be cleaned. “No water,” comes the reply.  There is water, I know that, and so I insist.  But returning ten minutes later I find the boy’s father with a bucket of water, daubing at the sores with a filthy rag.  The nursing students (no qualified nurses on the ward) are sat by, texting and chatting.  Well, on one level, who the hell thinks it’s acceptable to staff a hospital with unsupervised students and untrained volunteers? But even so….  It’s as if the hospital exists to drive me mad and my sole job is to stay sane. Unstoppable force Vs immovable object? Ha! I’m definitely moving…

So now it’s Friday. I’m sloping home from work and I’m feeling the strain.  Looking around me it’s quite heartbreaking to see the vestiges of pre-war Sierra Leone.  Before the war Kambia had electricity and running water, a telephone box and working post office. Walk a hundred yards down any street in the old town and there are the ruins of the most beautiful houses, all colonnades and ornate verandas, now slipping inexorably towards a vine strangled and mossy oblivion.  These days the best on offer is tin-roofed concrete, though of course many people don’t even have that.  Our Appeal Base is a rare example of a house left standing-it was captured and used  by the rebels during the war, then subsequently by MSF in the immediate aftermath (it’s still called ‘old msf base’).  The former address is still just visible in faded paint above the door; ‘Kingdom Palace, 1, Sibikie Lane.’

Nobody talks about the war-can’t say I blame them, I don’t think I’d talk about it either if it were me.  It’s impossible to gauge, for example, how much the seemingly disjointed family structures are attributable to human losses.  Pretty much the first thing we all did when we got here was try and figure out a bit more about the war- causes, course, consequences etc.….  Well, I’ve read quite a few books now (A Long Way Gone by Ishmael Beah comes highly recommended) but it’s still a mystery to me how things spiralled into such horror.  I don’t think anyone really understands.

The upshot of all the above is that all week I’ve been oscillating furiously between, “oh my God, what the hell is wrong with these people??!” and, “shit, these people really have nothing…”   I mean, anyone who’s around my age must have lost virtually all of their education to the war for starters… But no, dammit!! They could still be doing such a better job of running that hospital! Sigh.  Factor in the emotional lability and basically I think this might be the culture shock we were warned about. I’m dealing.  We’re dealing together, Suzanne, Tasha and I.

Ok, just made a brew and read back through what I’ve written.  A grim picture indeed.  Had a bit of a think about whether to edit some of it out but decided against.  For better or worse, it is as it is.   I can’t quite leave it on such a negative note though, especially as the process of writing it all down has proved so cathartic.  There are a lot of people in that hospital who really care about the patients.  Whether it’s for want of knowledge or skills, extreme short-staffing or a lack of basic medical supplies, day to day work is not easy.   And it’s not true that there’s no time to try and tackle the issues-we started the Volunteer Nursing Aide training this week, after all.  Turnout was good and although it’s a bit daunting, at least it feels like we’re hacking at the root of the thing.  Quite fun, too, what with Suzanne’s  hand-wash- jive! CHO Barrie is another cause for optimism-the guy’s quite newly qualified and being asked to do a phenomenally difficult job (essentially 24/7) without any senior support.  Nightmare.  But his attitude is spot on, really he’s a joy to teach and to work with.  Barrie, if you’re reading this blog…just remember you’ll be a Clinical Beast by the end of it!!

So you see, it’s not all bad. Perhaps I can even muster a few light hearted anecdotes to end on……hmmmmm….well,  undoubtedly the best thing that’s happened in the last week was the rave that we had in the Toukel as a send off for James and Victoria. There was cake! There was gin! There was Fanta! There was dancing! (black good, white not so much- oh, except Tasha who pulled out some killer moves! ) There was more gin!! There was Aunty strutting to her song (‘Fatima’) and a circle dance to ‘African Queen’!!  Small totally rocked the circle dance!!  Guusje stole someone’s silly hat and headphones and wore them all night!!!  Heh J So that was all very jolly and compensated us somewhat for the pain of losing J&V.  What else? Oh, for weeks now Abbas has been obsessing over the ratta that’s been chop-chopping our food, displaying mangled bread rolls and chewed up plastic bags with a look of dismay so acute it’s almost comical.**  Well, not any more… coffee was interrupted this morning  by a gleeful Abbas swinging the wretched thing round by it’s tail. Dead as a door mouse (ahem).  He’d bludgeoned  it to death with his flip flop…. This Is Hardcore.

Back to the hospital-I managed to completely undermine myself and the very serious point I was making to Sister Agnes (paeds sister) when I caught sight of ‘Snakespeare live in Central Park’ picked out in gems on her T-shirt and promptly got a fit of the giggles. You don’t half see some rum things on clothes out here…..‘Ovarian Klein’ anyone?!  Suggestions on a postcard!  

Ooh, on a geeky note, I found an engorged argasid tick on the porch outside my room t’other day.  Hallo Ornithodorus!  First one I’ve seen ‘in the field’ so to speak, but after all my Dagnall training I’d recognise that bugger anywhere!  Slightly less cool-it’s highly likely that it’s recent blood meal came from me!! ……warned Tash and Suzanne about my impending tick-borne relapsing fever and left an advance directive NOT to be taken to Kambia Government Hospital under any circumstances….   but then remembered I’m on doxcycline anyway for malaria and calmed down a bit-I should be ok, right?

Bloody hell, the sudden influx of giant flying ants is actually beginning to really piss me off now, and one just got inside my pants(?!)  which is clearly gross, so I think I’ll have to leave it there for now and take refuge under my mozzy net.  

Goodnight my dearhearts, missing you all and hoping all goes well with you and yours,

*Oh light skinned one, please introduce yourself then be so kind as to take a photograph of me, preferably on a digital camera so I can view it with minimum delay. Be warned: I may quite simply explode in chubby legged, sticky-fingered excitement.
**There’s a rat in me kitchen, wat am me gonna do?!