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