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,
Katie

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,
Katie
x

*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?!

Spiders - 19th August 2012



Spiders
19th August
Anyone who knows me will know that when it comes to irrational and life-limiting fears, spiders are my Achilles heel.  So when it came to the question of Giant African Spiders, essentially I just flipped into Ostrich Mode- I mean, I could have done some pre-trip research but seriously,  what would have been the point?  “Sorry, Kambia Appeal,  I was really keen to spend six amazing and life changing months volunteering for you, but I’ve just google-imaged ‘The Spiders of Salone’ and almost had a heart attack so…….. I’m gonna stay in Blighty if that’s ok….?”*   

So, what’s  to do? There’s only so many times I can come screeching out of the latrine and wait, arms folded  in the pouring rain, to be rescued by Ibrahim (the master spider catcher) or Abbas (less skilful, but armed with super-strength Raid and a cheery smile ‘Oh, Kate, no worries, that spider, he can easily die!’)  And, of course, what happens when there’s no-one to help me?  Trembling in the dead of night (from impending  bladder rupture, likely as not!),  fateful imaginings taking flight….… Pincer fangs dripping with foul poisons! Abdomens bulging with a million translucent spiderlings! Glittering eyes!! Thick hairy legs spanning wider than dinner plates!!!  All lurking, waiting to pounce and devour me eyeball by eyeball!!!  Honestly, what kind of self respecting toilet allows itself to degenerate into some kind of hideous  Shelob’s Lair?!! 

These thoughts, they trouble me.  Essentially the only solution available is not to look for them.  Back of the door, ok sure-can’t have the escape route blocked off- but then-glasses off, squint a little, focus on my shoe, just the shoe, nothing else, definitely not the walls or the window ledge and definitely ,definitely not the ceiling. I know they’re there but if I don’t look too hard I can cope, I can survive.

And do you know? I caught myself thinking today that it’s really not all that different at the hospital. There are so many issues, so many problems (chiefly stemming, I think, from the double whammy of scant resources and a lack of effective leadership), that a forthright appraisal simply serves  to generate a slice of instant apathy with a sprinkling of mild paralysis to go.  But a squint, askance in the face of all the chaos, and certain things, certain people start come into focus.  Things that work, things that almost work, things that can be changed and people who are trying to make it happen.  So you pick your battles.  Cleaning the wards and getting observation and drug rounds going are our top priority this week, and Victoria’s been working hard on getting the malnourished kids fed overnight (and in the day!)   Later I’ll think about other stuff like antibiotic use and blood transfusion policies.  

Having said that, we have been to the last two weekly staff meetings.  These, I gather, are a sort of  emergency measure put in place by the District Medical Officer,  trying to keep things functional  until the new Medical Superintendent arrives (date TBC).  On one level this stuff is almost out of our remit, but then again, it’s proving an invaluable way to not only to show willing, but also of acquiring vital info-who’s  supposed to clean the wards,  how to order more antibiotics or blood grouping reagents when the paeds ward runs out, how to get the generator on for emergency oxygen…..just little things, you know J   It’s also quite handy for identifying who’s pushing for change behind the scenes, so to speak… And lo! More ampicillin did descend from the heavens, and the chlorinated waves did part upon the freshy scrubbed floors!

Maybe that’s enough about the admin for now-time for some clinical snippets (at this point I’d just like to apologise if any of the following is utter gibberish to non-medics…)  Case of the week was definitely the women, two weeks post partum, presenting with acute ascites (fluid in the belly).  There aren’t  many tests here (understatement!) so after much chinwagging and belly-prodding we tentatively agreed that the most likely cause was a clot in one of the veins draining the liver (James was convinced that she’s taken some pro-coagulant  native ‘erbs’  featured  in the Trop Med handbook!)  Which was pretty bad news for her, given the complete lack of any treatment options.  Nonetheless, we did drain some of the fluid, partly for her comfort but thinking also to then send  it for dipstick and microspcopy.  Well, oh my goodness-I’ve never seen anything quite like it- two litres of frank pus, the colour of rancid custard, almost too thick to even aspirate…..tuberculosis, surely, but that’s not what the book said it should look like…nobody was really sure…. Mr Francis was duly summoned -had he seen anything like it during his 20 years manning the hospital laboratory? Yes, yes he had-TB.  And- get ready for the really crazy part-having a belly full of pus was actually a good outcome for this poor woman, because TB is treatable and, more to the point, the drugs are free. It’s the same with HIV-in a topsy turvy way making the diagnoses can actually seem like a positive step (although how much of that is just the comfort blanket of a definite diagnosis-so rare here-with a definite treatment I don’t quite know).  Incidentally nobody here will actually call it HIV-VCCT, RVS, ‘slim’ –honestly it’s almost like something out of Harry Potter-The Disease Which Must Not Be Named…

Over on the paediatric ward things are ticking along-hearts were heavy when we couldn’t find a child who’d been brought in sick as a dog the previous day, only to discover-joy of joys!!  that he was simply so much better, transformed by a quinine drip, that he was recognisable only by the puncture site where his cannula had been!! It’s not always such a happy ending, but when  it is it really does make it all seem worthwhile.  Erm, what else…a live chicken joined the ward round on Wednesday after  Sister  purchased it from a relative!!  I’ve also had my first taste of the operating theatre.  Anaesthesia was  just ketamine and diazepam - very disconcerting  to be sat holding up the jaw with one hand, feeling for the pulse with the other, the  patient still wriggling about eyes wide open!  There’s a sphygmomanometer, an oxygen concentrator and a sats probe but that’s it.  No ventilator and nothing to intubate with anyway.  It was scary, definitely, very scary, but Sister Conteh, our nurse anaesthetist, knew what she was about.  Knew the limitations of the technique, too, lamenting the lack of even basic equipment, but I guess at the end of the day these were life saving operations (caesarean and strangulated hernia)-and both those patients survived.

In other news we’ve also started teaching the  CHOs this week (community health officers-they take the role of doctors  after 2 years training) and are on schedule to start the Volunteer Nursing Aide program a week on Tuesday-the posters are up and ‘sensitisation’ (African buzzword) has begun!  Natasha joined our merry band last Sunday and the three of us-Suzanne, Tasha and myself,  are keen beans to crack on with training now, as it just seems by far the best way to improve things.  On a sadder note-James and Victoria are entering their last week here in Kambia-next week we’re all going down to Tacagamu chimpanzee sanctuary for the weekend but then they’ll be off back to the UK and we’re gonna miss them lots L
Right then, Ramadan ends today and there’s a party in the offing-I can smell it! So it’s a fond farewell from me ‘til next time.  Loving you all, God bless,

Kate

*Salticus , the ‘Tarantula of Rolleston’, your reign is ended!