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

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