Wednesday October 30th 2013

Living in this "city", you actually forget that the real world is out there. Andrew and I call it the " Jubble" - the Juba Bubble. Whilst here, I have described as best I can, the strangeness of it all, the juxtaposition of the modern world, encroaching on the harsh realities of day to day life for most people. The laptops, the mobile phones, the huge UN cars. The children in rags with no shoes, the young women with polio, the war wounds, the regular violence. In Juba, you will see the ex-pats spending $200 in one shopping spree, in one of the only Kawadja food shops, on items only slightly recognisable from home ( Fava beans are called " Foul Medames" ), a bottle of Gin and some thrice frozen meat. Two steps down the road there is a shack selling 2 eggs, some potatoes , and some sad looking tomatoes .

Today I caught up on a fellow blogger's experiences - "Landlocked and Proud " link on the right. I have met her a few times, and our experiences could not be more different, and yet, somehow there are similarities - after all, ....we are in the same country. Where she is, on the frontline of the actual reality for most of the population in this country, she asks the same questions, and struggles to come to terms with the same questions as I have.

I met a woman tonight from one of the largest NGOs here in Juba. She was in her 40's, Italian, and had served her time in Malawi, Nigeria, and Uganda. She told me she no longer tries to speak to those who have just got here, or those who have been here too long. or those "beautiful types" (her words, not mine) that want to " Save the World". I wondered who she DOES actually speak to. She told me that she found her job interesting, and rewarding, and if she saved herself ,after all this time she would consider herself lucky.

I have met a lot of people like that here. Saving the world is just not an option.  It's enormous, this task that people set themselves. In my Jubble, I am on the periphery of all of this, but close enough to understand.

This 9 months or so that I will have spent in Africa has, and will, change the way I see everything , for ever. I don't mean to sound trite, or be one of the "beautiful people", I'm way too grounded for that.

As I mentioned in my last post, I don't regret a minute of it.

Sunday 27th October 2013

So it's been a while. Partly that has been because not very much has happened, just the day to day clinic work, some patients sicker than others, some days longer than others, and partly because I wanted to wait until I had finally made up my mind what exactly it is that I want to do. So I made up my mind last week, and resigned on Monday. I had always planned to see out the year contract, but then, of course, the unforeseen happened, and as I mentioned in my last post, I fell in love, and all that changed. So now I will stay until Xmas is over, and embark on the next adventure, and see where that leads me.

Now, of course, the search begins to find my replacement, and I've been sifting through CVs wondering how I can explain the reality of being here, while still filling my post .

The clinic has been quite busy, and this week I evacuated a poorly malaria patient, who luckily has insurance, and was able to be flown out of here at the earliest opportunity (which happened to be a good 20 hours after he arrived in clinic, thanks to the airport being shut overnight). The following day we admitted a sick local girl, who was really very very sick, with untreated malaria. She had kidney failure, liver failure, hardly any red blood cells left thanks to the malaria parasites invading them all, and needed a blood transfusion, dialysis and intensive care - none of which are available in this country. Her family were not rich, and could not afford the money necessary to get her evacuated to Nairobi (the nearest place that could do those things), so took her instead to the local hospital in the hope that they could at least do a "person to person" transfusion, in order to get her well enough to stand at least. This would give her some chance of getting on a commercial flight the following day. I very much doubt that happened. It is the harshness of these realities that I find most difficult to take here. It is something that we, in the UK take so much for granted, but here is the difference between life and death . If I take nothing else away from my time here, it will be a renewed faith in the NHS, despite the best efforts of the British Press, and a sharpened sense of perspective.

On a lighter note, went to a Halloween Party last night by the Nile, where the first band was a Gangsta Rap outfit from Kenya, rapping about, amongst other odd things, "Disabled Rights", and encouraging them to "rise up" - pure Juba.

So I have 4 weeks left until I go on leave, then 2 weeks back here until my contract ends. Then...well I'm going to try a bit of flight nursing, repatriating sick folk back to the UK, and a bit of agency nursing, and just enjoy being a nurse again, without all the people management and logistics that clutter up my day here.

I have met lots of very interesting, and very odd people here in the 6 months I've been away, and had experiences that I will never have again, and I regret none of it.

Onwards and upwards to the next adventure......

Sunday 6th October 2013

Another week in the Big Brother Compound..... busy with the usual malarias and typhoids, along with the associated emergency colds and sore throats that are the life's blood of any GP type practice. That's one of the things that is so tricky to manage here - without any other decent health care facility, the range of severity of illnesses is huge, and sometimes it is difficult not to sigh when you have a person with a blister on their foot from ill fitting shoes in one room (honestly!), and a person with a fever of 40 degrees C in the other, having rigors.

Had a trip to the Ministry for labour this week, to iron out a few questions about the labour laws here. The laws are quite decent, actually, and do offer local people a degree of protection against unruly bosses, so we set off to ensure that we are doing the right things. We arrived at a small wooden structure, in the middle of a dusty field, with kids playing football outside with a home made ball. The minister, as all the ministers are here, was courteous and charming, if a little intimidating ( I looked after one this week whose body guard was at least 7 feet tall - eek !). He rifled through a stack of yellowed papers on his desk before assuring us that we we had understood the regulations correctly, and bade us good day. Not quite the same as trying to get an answer out of the government in the UK - it all took us about half an hour.

The one bit of excitement this week was our emergency call out to a drowning by the Nile. Being a private clinic, our "ambulance" (transit van) is only on standby for our members, we'd open up a whole can of worms if we went to everything, we just don't have the facilities. However, the call came through from one of our members to say a girl had fallen into the Nile and had been fished out, could we help? We made a judgement call and decided to go - after all, who else would? So after retrieving our driver ( a wonderfully crazy Indian with more bling than Bollywood) we set off into the night - I would say lights flashing, but none of us knew where the switch in the van was.....
Goodness, Juba by night on the roads is another thing all together - no street lights, LOTS of cars and poorly lit Bodas (motorbikes), and hundreds of people in dark clothes, REALLY difficult to spot, wandering all over. Having gained his license in India, however, it was a piece of cake for our driver.

We arrived in a packed car park, with lots of people shouting and waving, all trying to direct us to a different place - it was poorly lit and all a bit surreal. Out jumped Andrew and I, with our trauma bag, looking all important, and made our way to the poor girl sitting on the ground, who had clearly swallowed a great deal of the unsavoury Nile water. She was alert, but certainly looked as if she would develop a nasty pneumonia sometime soon...

It soon transpired, however, that things were not all they seemed. The chap who had fished her out appeared to think we had arrived solely to give him a cash reward for his services, and the person who had phoned us melted into the background rather quickly. The friends and relatives surrounding the girl looked not too pleased to see us, and there seemed to be more and more of them with every passing minute. Then the police arrived, and we began to wonder what we had let ourselves in for.  After some consultation with each other, we decided it may be best if we stood back a little and watched to see what would happen. As soon as we did, she was scooped up by relatives and carried away, followed by large group of people, including the police. In that situation, we thought it best to melt away as only we British can do (read "hide behind an SUV"). Back into the van we got, and hot footed it back to the compound, still unable to find the switch that worked the lights. It was all over in less than an hour, and frustrating for us, as our nurses hearts would have taken her back with us and tried to make her better, but in that sort of situation, personal safety has to take priority, which was a difficult lesson to learn....

A lighter moment was finding my ridiculously tall Dinka Dr singing happily away to Dolly Parton in his room ( he is now christened " Dolly Deng ", much to his annoyance), and his gift to me after a trip to Uganda of a baby tortoise we have called Trevor (picture above) who he rescued from the road and brought back in his car. My menagerie is growing daily..

So another week, another steep learning curve, another invaluable life lesson. See you all next week !

Sunday 29th September 2013

So, here I am, back from 3 weeks lovely leave, and back to clinic life . Had a wonderful time, visiting Dubai (hot, sandy, deserty), Spain (hot, sandy, Benidormy) and the UK (cold, wet (well mostly) and ever so British.). I ate fish, vegetables and drank good wine, had baths with bubbles (thanks Helen!) and ran about like a lunatic seeing all my favourite people, barely having time to recover from some viral illness I appeared to have packed in my oversized suitcase.

 The cabin fever, funnily enough, seemed like a distant dream within about 3 minutes of arriving at Juba airport to wait for my plane to Dubai. Oh how I wish I had been able to use my camera! Below a faded picture of Jesus, hands held out in benediction, was a selotaped notice asking you to present your bags for inspection - it was as if Jesus was demonstrating that if he could present his bags, well then, so could you. I had made the mistake of getting there far too early, expecting chaos and guns, and in fact, I was treated with extreme courtesy by everyone, and managed immigration in 10 minutes. This left me to sit in the departures room for an hour and a half, trying to understand why, when there had already been two security checks to get that far, those passengers travelling on Ethiopian Air had another little table set up at the gate, 5 metres from the previous check, and were asked to present their bags again, just before boarding. There seemed no obvious hiding places in that 5 metres.

Dubai really is a funny old place - by night all sparkles and shininess, by day..well...deserty. The heat is constant, 40 degrees (we were lucky - it had been MUCH hotter) during the day, with no respite at night, the temperature an even 40 . It is, of course a shoppers paradise, and shop we did. Not being a traditional "girly" girl, I eschewed the handbags and shoes, in favour of buying a lovely Macbook Pro, on which I now write. Despite the PC purists protestations, it really is a thing of beauty, and something that I would never have been able to afford before, so I count myself very lucky. We chatted, drank ridiculously potent cocktails, even went for a little dive on the coast - a lovely, proper catch-up with one of my favourite people.

My flight back to the UK was wonderful. I had decided that I would ask at the airport if there was an upgrade to business class available, having heard great things about Emirates Business. I had set myself a figure that I was prepared to pay, and was determined to stick to it. Of course, when that figure came back at almost three times what I had decided on, with very little hesitation, I said " yes please !"
So off I trotted to the business lounge, got myself a little glass of Moet, and enjoyed the peace and tranquility away from the madding crowds. " How long will it take me to get to the gate from here? " I enquired of my  solicitous  waiter - "Oh, Madam boards from the lounge...". I LOVE business ! As I entered the plane, on my right I could faintly hear the sounds of children crying, as I turned LEFT, and settled into my fully reclining , wide armchair with a widescreen TV. "Would Madam like a glass of champagne before take-off? " Why yes, Madam would....... "Steak and a cheese platter? " Yes please !
Having spent less that $700 in 13 weeks in Juba, treating myself to a bit of luxury was definitely deserved.


The next few weeks passed in a whirlwind of hugs, catching up and good food. I also, rather unexpectedly, managed to fall in love, with a man who I have known for a very long time, but not seen for many years. This of course is going to put a rather different slant on working abroad. Previously I had only myself to consider, but now all that has changed. Of course, with the internet, and Skype, the world is a smaller place, and it is easier not to feel so disconnected, but let's face it, it's not the same as actually being in the same room .

The situation here in South Sudan is uneasy, with reports of isolated outbreaks of violence up and down the country . However, that is no different, it seems , from every other nation on the planet. We have good security measures here, and if it comes to it, we will be pulled out, it is to be hoped, in plenty of time.


So, back to work, back to the quirky madness that most people here seem to be afflicted with, back to warm days, cool nights, back to trying to get my supplies over washed out bridges ( or should I say " Bridge"), and back to chicken and rice...every day. This next rotation is going to present a different set of challenges and I think I will have to be stronger than I have been up till now.

I think the next 9 weeks until my next trip home are going to last rather a long time..........

Tuesday August 27th 2013

As you can see, I am fast running out of pictures that won't get me arrested. The picture on the left is my "on call" bedtime buddies. The three clinic phones, my local phone (for the alarm clock) and the air-con controller. Fascinating stuff, I'm sure you'll agree.....( and very hi-tec..)

I'm on the countdown to my first leave in earnest now. A week today I shall be jetting off to Dubai to stay with my friend Helen, who left the UK 2 weeks before me to start a job there. There, however, the similarity ends. We have made much fun of her over the past few weeks, regarding her posts about joining the "Tuesday Yacht Club", her day trips to dive in Oman, and her fabulous brunches - our lives are clearly very different from each others at the moment, but we still share the same ups and downs, missing friends and family, and adjusting to new lives, and I can't wait to see her. From there I'm off home to the UK to see family and more friends, before returning to my little compound. I've been here 11 weeks now, and the last few have really begun to feel like real life at last, and not just a working holiday.

After the medical evacuation run which totalled 3 patients in 2 weeks, things have calmed down a bit, and we have had a steady stream of the usual Malarias and Typhoids, tempered with the coughs and colds that people also seem to think we have a cure for - I have a much greater empathy with my GP colleagues now - hats off to you guys, it does require a lot of patience ! We are combating the cabin fever by trying to get out more - and guess what ?? It actually works. The compound, and everyone in it, is calmer, happier, and not quite as mad (although a bit of madness is quite funny)

We had a lovely night out with a fellow DTN (Diploma in Tropical Nursing) graduate last week - our course leader would have been proud of us, networking away. Holly has come here on a 2 year contract with VSO, to try and improve the hospital in Yei, a rural outpost "down south". We had dinner, gin and laughs, and made a great contact who we can visit - all part of the "getting out of the compound" plan. We were a little jealous of her posting, truth be told, although 2 years is a very long time. She is extremely capable and motivated though, so I'm sure she will be fabulous. I have added a link to her blog on the right for those of you that want to see what the rural experience has in store for her. We all agreed that the DTN had certainly changed all of our lives - for the better.

Our new Dr has been making me laugh all week. He is a very tall, thin Dinka (the tribe), who has a very dry sense of humour, and is still not entirely sure what to make of us all. I think he thinks we are all quite certifiable. I made it very clear from the start that nurses in the UK do not tidy up after doctors, did I look like his Mother? To which he just looked puzzled....until I showed him where the laundry was, and how to change the bedclothes between each patient...then I think he got it. I think he's still wondering why I think I look like his Mother though. Although his English is very good, on occasion things do get lost in translation, and Andrew has been taking great delight in the fact that he asked me if he could stay in my room. After a slightly horrified look from me, he did then qualify that with "while you are away!!!" Phew. That was not helped by him asking me if I would "Like to go to Nimule" (a game reserve by the Ugandan border). Amid much giggling from Andrew, turns out he was merely asking me if I'd ever been there, just out of interest.

I even managed to get to the pool this weekend, to lie about out of the sun as it was just too hot, and try to ignore the plethora of Lebanese men prancing about in unfeasibly tight Speedos. As the sun goes down, they come out to play - it really is quite disconcerting...

I met a very nice colleague of a friend of mine, a Syrian chap, who looked a bit miserable. When I asked him how long he had been in South Sudan, he swiftly said " one month and 20 days". " Not counting the days then?" I asked innocently enough, to which he replied - "every day, and I'm Syrian, and have worked in Egypt for 6 months..." For those of you following the depressing news, you will realise that he really is not having the best time.

 It is certainly not a happy place, this new country I have chosen to live in. A huge proportion of the population (something like 75% I think) are under the age of 25, having been in conflict for so long. There are few children on the street, and those that are, are suspicious and shy - completely the opposite of the children I met in Kenya. But I am beginning to find that I am finding my place here. My short walks to the local shop, are now met with cautious "Hellos" from the Boda Boda drivers who hang out on the corner waiting for business. The guy on the other corner waved at me this week. A few kids shouted "Kawadja Kawadja!!!!! and giggled (generic name for foreigners). A couple of elegant ladies in simple wraps, smiled at me and shook my hand as I went past. Slowly, but slowly, I am becoming part of this place.


Still, can't beat a bit of R&R.

Saturday 17th August 2013

Am breaking with tradition and posting a little update ahead of time, for no reason other than I can. On the left there is my old boss, Patsy, and me, before her leaving party - only a month ago, but feels like years - we miss you Patsy!

I am writing this in a bit of a haze, as we had another very sick patient in overnight, whom we had to evacuate this morning. On paper, evacuating in the morning should be easier, as you have 12 hours to organise things, what with the airport being shut overnight and all.  In reality, no-one seems to get the fact that we are not really a 24 hour facility, and I have a clinic to run in the morning, so being called throughout the night is a bit tricky
. The three of us that live on the compound (all nurses) cared for this very sick man for 20 hours, Rosemary being the main nurse, Andrew "sleeping" in the clinic for backup , and me , on the phone to AMREF all night. I managed to get to bed about 0230 hrs, only to be woken at 0400hrs with more things to organise. I have to say, we did a brilliant job. By 11am this morning, he was strapped to a stretcher on his way to Nairobi.

For the nurses amongst you, you will appreciate how running an insulin sliding scale manually, without the aid of a syringe driver , was a challenge, to say the least. I'm proud of my team, and their clinical skills, which doubtless saved this man's life last night. And that is not an exaggeration. And no offence to any Drs out there, but we did the whole 20 hours without a Dr in sight - because we only have one (the other is sick), and he had gone home for the night.Scary, but satisfying nonetheless.

I was briefing the Country Manager for this patient, in the clinic, about midnight, being very professional, when Jones, our cat, decided that he would come into the clinic in search of Andrew (whose tent he sleeps in), and play hide and seek. I tried very hard to remain authoritative, and try and pretend that there wasn't really a cat stalking through the clinic, (he knows he is not allowed), but it did rather ruin my professional stance. That, and the fact that I was in my pyjamas at the time......

Between us, we have staggered through today seeing patients, and I have finally closed the clinic, and am off for a lie down - all those years as a CSM with no breaks or sleep stood me in good stead, though, as I'm just a bit "starey".

The other thing I have noticed, after reading through a few old posts, is that I am mentioning "cabin fever" very regularly . It's not as bad as it sounds - actually it can be quite entertaining, so never fear, friends and relatives, I am holding up, and still almost speaking in full sentences.

Except when there's a cat about.

Thursday 15th August 2013

My Father has asked me to include a picture of my accommodation, so there it is. Mine is the little breeze block hut , with the tin roof. When it rains (which frankly, for rainy season, it doesn't very often), it's lovely. I do worry a bit about the lightning though.... it's a lot better than I thought, with air-con, my own hot shower and loo, a double bed, and now the internet connection actually works it is actually very comfortable. The tents are nice too, having all the same mod cons as me, just without the shower and toilet - so I'm quite lucky really.

 It is not hierarchy that got me the hut over the tent, just sheer luck that this was the one empty when I arrived. That's one of the nice things about our little compound - we are a close team, with no silliness going on. That in itself is a godsend, as frankly if we didn't get on it would be very difficult indeed. I think it's become quite clear to those of you that have been following me, that cabin fever is setting in, and has led to an emotional week here in the "Jubble" (our name for the "Juba Bubble" that we all live in.) What I had not prepared for was the highs and lows of living in such a small space.Some days we laugh at everything, and some days we wonder how our friends and co-workers will survive another day without going completely mad.

 My boss is off on a well deserved break tomorrow, and we have almost had to surround him with bubble wrap to stop any more disasters happening to him before he leaves..not only did he wake up to find a friendly rat peering at him from his cupboard, but the final insult came when he brushed his teeth with mosquito repellent......


We had a busy week last week though, and medically evacuated two people to Nairobi (which was a bit challenging when the airport was on fire...). It all went smoothly, and I have the utmost respect for AMREF, the Flying Doctors, for their professionalism and expertise. It's a tough call to make, to realise that actually we cannot manage what is in front of us, and we need to get them to a proper hospital.  As a Sister I have great respect for would say - "I gave them the " eyeball" test" - one look and it's off to Nairobi for you.
The system works well, although is a little fraught when you are pushed for time. The AMREF plane has to leave Nairobi by 1430 at the latest, or there will not be enough turnaround time in Juba, as the airport here closes at 1800. So you have to contact their insurance companies, convince their Doctors that there really is no medical facility here that we can transfer them to (No, the local Hospital has no electricity, or oxygen, or beds, or staff), they have to send  a guarantee of payment to AMREF, who then have to get ground clearance and permits - all by 1430. If none of this happens in time, the very sick patient is with us until the next day, with our very limited facilities. I never cease to be amazed that some people do not have insurance to cover evacuation here - there is no way out otherwise, as an evacuation costs $20,000, just for the plane.

.
It is a very different story for those without money, or insurance. They have to be taken on a commercial flight,(if they can make it through security), propped up by relatives, and hope for the best. It's a sobering thought.

On a lighter note, I now have 2 and a half weeks before I go on leave, first to Dubai, to catch up with a friend working there( and hopefully a little dive in Oman) then home to see family and friends (with a brief sojourn on the beach in Spain).Andrew is planning on filming me next week to see how coherent I remain, and I am dreaming of a haircut, a bath with bubbles, and proper belly laughs and story telling.

Bring on the cabin fever - I can handle it !!!!

Monday August 5th 2013

That is Andrew's garden, over there on the left. All the tents are the same, except for Andrew's, which has got a small Kew Gardens sprouting in front of it. We all deal with the stresses of compound living differently, and Andrew has embraced nature. Every time we go out his eyes are scanning the local flora for anything that he can take a cutting of, or trying to knock down one of the huge seed pods that hang from the trees, to sprinkle about and "see what happens". The locals, of course, think he's mad, as what he sees as plants, they see as weeds. Still - it helps to keep him relatively sane I suppose.....and it looks nice...


We were very pleased with ourselves this week, as we diagnosed a hookworm in the foot...one a local Dr, trained in the field, had diagnosed as scabies, and prescribed calamine lotion for ! We were very smug. That expensive course in London paid off after all.... Some of the things you hear are quite worrying - I saw a girl who had had the most awful cellulitis on her leg from an insect bite - and the Dr had given her Deep Heat. Good grief - imagine smearing raw chilli on a huge paper cut. That is how much the deep heat must have hurt.....


We popped down to the Nile on Sunday, and now I can actually say I have seen the biggest river in Africa. It was quite majestic, with small islands covered in Egrets, and children and adults doing their washing and having a bath. We decided NOT to join them, thinking of the huge fish on the back of a motorbike we'd seen, which I now know is a Nile Perch. Jeepers - don't want that sucking at your toes....


On the way there there is a "IDP" camp, or "Internally Displaced People" - people who used to live in the North, but now after the fighting are re-located to the South, to live in tin shacks held up with stones and sticks, with old clothes/sheets/tarps as makeshift roofs.This is not the first IDP camp I have seen, but it is the first I have seen located on a graveyard. Amongst the shacks, and half-naked children playing with a bit of old cardboard, there are stone tomb-like markers, half covered by the scrubland. Here and there are tin poles, with bent signs, handwritten with names, and dates of death. I am still not quite sure what to think - whether to be glad that a place up to now reserved for the dead, should have children and families breathing life into it, or to think that is was the most depressing thing I have ever seen. It was certainly something to think about.


On a lighter note, along with the cabin fever that is creeping in, comes a bit of hysteria - the laughing kind. I absolutely cried with laughter this week in a moment of extreme silliness, at the idea of all of our little compound "family", in the event of a proper coup, filing out after our German boss, like the Von Trapp family, gaily singing "Doe, a deer...." on our way to the Ugandan border.

Our accountant is even called Maria........

Monday 29th July 2013

It's been a strange old week.

 On Tuesday, I was startled out of my reverie, by a sharp rap on my metal door at about 2230. Now that is practically middle of the night round here, so as you can imagine, I leapt out of the chair where I was just about to finish the last chapter of an exhausting, brilliant and quite traumatic book. It was my German boss, telling me to come to the yard as there was something he needed to tell us all. It transpired that the President had just sacked the entire government. An internal coup, if you like. Information was scanty, but we were advised to pack a small bag, our passports, and be ready to be "extracted" if the need arose. Andrew and I dutifully packed bags, plus, being the ever ready nurses, a first aid kit and some strong drugs- you never know.....

We then sat about in the yard 'till midnight, drinking tots of whiskey (for courage, obviously), until it became apparent that the only thing to do was go to bed.

The following day it was eerily quiet. The clinic was open, but it appeared that most organisations had ordered a "lockdown" and very few people were travelling anywhere. The general consensus was - stay inside until further news.

Our local Doctors, however, brightened the atmosphere, by turning up at work in carnival mood, happily telling us that this is just what South Sudan needed, and not to worry, there would be no trouble. We still slept with one eye open that night.....

The next day there were reports of riots in one of the markets a few miles away. The news spread like wildfire, and phones were ringing madly - we found out a few hours later from Martha, our "Head of cleaning everything that you put down for a second ", that actually it was just two stallholders having a scrap - just shows what the rumourmongers can do....

So here we are, a week later, and frankly, (and I know this is bad), I'm a little disappointed. Our extraction plan had us in the back of a truck owned by the burly South African de-miners opposite, heading for the Ugandan border, where a charter plane from Nairobi would pick us up. I'd even packed my travel pillow ! In reality, it's business as usual. The people here appear so tired of conflict, so worn by it, that they are just going about their daily business, trying to survive.

The President has yet to announce the new government, so we remain on standby, but the general feeling amongst the Embassies (and I look after lots of people from the Embassies, so this is straight from the horse's mouth) is that this is a change that is wanted, and needed, and it will be peaceful.  The plan from the President is to reduce the Ministries from 28, to 19, so there are bound to be some disgruntled folk, but it appears to be a change for good. In an apparent typing error, he forgot to appoint a minister for health, but that appears to have been rectified,so we await the announcement with bated breath... The ministry for "Roads and Bridge" still stands though ( bless him - there IS only one bridge...)

I wasn't sure whether to post this or not, as I don't want to scare my family, but it's an important part of the strange life I lead now. I'm safe, well looked after, and surrounded by people who have been in a lot scarier situations than this for many years, so deep breath Family - I'm fine.
In fact I couldn't even manage to get Malaria this week, the headache and achey feeling I had, was, in fact, a cold. In Africa. I'm even recovering from that quickly, and am nearly at 100% again.

There is a national holiday again tomorrow - "Martyr's Day", so the clinic is closed, but with nowhere to go we are planning on eating the best food we can cook again, and lying low.

I am now getting to the point where I am experiencing the first rumblings of cabin fever, and am craving decent cheese, a nice glass of wine, and a nice hot bath. With bubbles.

If only something exciting were to happen.....(only joking Family!!!)

Monday 22nd July 2013

I received an email from a friend today, and amongst other things, he asked me why there are no longer any pictures with my blog. So I thought I'd put one in. There. On the left. That's it. Honestly, that is , actually, just about it. It's not that there aren't things to take pictures of - there are, in abundance. A few days ago I was out for a walk, a real, actual walk (more of that in a minute), and we saw a moped wobbling down the mud, hazardously hole strewn, "road". On the back of this moped was the biggest fish I have ever seen (well, when out of the water, anyway). This is not a fisherman's tale, I really am not exaggerating when I say that nose to tail, this fish was at least 8 feet long, and about 4 feet wide. It had a huge , open, mouth, and was obviously some bottom feeder type thing, which had been dredged up, god knows how, from the bed of the Nile. It was hanging over the back of the moped like a pillion passenger with no body, and a fish for legs. As the driver wobbled away, if only I had had my camera to capture it. The thing is, I DO have my camera, safely tucked away in my cupboard, in my room. The fact is, I'm not allowed to use it. There is no photography allowed, anywhere outside the compound (unless you are at a private function, and even then the local dignitaries are not that keen, in case they end up on Facebook). Officially, it is because you may inadvertently take a photograph of a sensitive building/landmark/army chap/cow. I say cow, as one of the South African de-miners was encarcerated for several hours after taking a picture of a cow, until someone bailed him out. There are stories of cameras being confiscated from diplomats, money exchanging hands to assure the officials that the pictures have been deleted....it is just not possible to photograph anything in Juba town. So I am going to have to content myself, (and my friend) with a picture a week of anything that doesn't get me arrested. And that's it, up there, on the left......

So - back to my walk. The Guerilla Researcher took Andrew and me for a stroll around town a few days ago. This may not seem like a big deal, but it actually the first time we've been anywhere not in a car. We pottered around a market selling hundreds of second hand shoes, shirts and dresses, past stalls with one lit light bulb to show that they had a generator and could charge your phone, past goats, children yelling "GOOD MORNING !!!" in unison, and for pretty much the first time since I got here, I felt that I was actually in Africa.  After eating breakfast from a stall on the side of the road - fresh Japati rolled up with a freshly made omelette inside - mmm, we ended up sitting in the shade of a tree drinking spiced coffee made from freshly roasted and crushed coffee beans, out of little glasses, sitting on plastic chairs, goats nibbling at our feet. It was far from idyllic, there are piles of rubbish everywhere, empty plastic water bottles strewn recklessly about, and the children are in rags, but it was Africa. In my little compound it is most definitely an alternate universe, or a worm hole into another dimension. Oh dear, I'm getting carried away, I think I may be getting the beginnings of cabin fever........

Just to end, for anyone who has been reading regularly, the poor Dutch girl I looked after in my first few weeks, came in today. She was a different person. She had been home to Holland, eaten well and slept, and had been looked after by her Mum.So even if I do go crazy here, I know I can rely on my friends and family to put me back together again so I can do it all over again....

Monday 15th July 2013

My lovely, larger than life, funny, practical and very competent boss, Patsy,  left today. After 5 years here, from working with an NGO, living in Tukals, dodging snakes (both the animal and human kind), bullets, malaria, Nairobi fly (they are REALLY evil - go on, Google the pictures), to taking on this clinic when it was a single room with the odd pot of paracetamol, and turning it into what is the safest place to be in Juba if you're sick, she has finally moved on to new adventures. Leaving  Andrew and me  to carry on  - scared? us? OF COURSE WE ARE !!!. Crikey, what a name to live up to. She knew everyone in this town, from the entire cabinet it seems, to every local cleaner/driver/groundsman - and treated everyone with the same respect and consideration. I only hope we do her legacy justice.

We had a great weekend - out with the EU army on Friday, which turned out to be a slightly more, shall we say, lengthy, evening than I had planned, to partying on Saturday night in the infamous "Bedouin's" - the local meat-market/dance hall/shisha bar.

Everywhere you looked there was a character, from the 7 foot Dinkas ( I know, they're getting taller every week - but they are!), to the middle-aged ex-pats, eyeing up the local talent ( I use the word "talent" loosely), to the usual crowd of NGO's letting their ruined hair down and having a laugh. It was hilarious. At one point, some of the local "ladies" decided to have a bit of a scrap ( a nightly affair apparently), and no-one even noticed the wigs flying about and the screeches as the hair extensions were yanked . My boss told us a story of a similar night in there, where one lady's hair extension had come flying over the bar and landed in her friends drink. He calmly pulled it out and continued on with his conversation

. 

The music ranged from Madonna, to dance-hall, to rave, completely WITH seams, and by the time we left everyone was having a great old dance (especially the local "ladies", who were really showing off their wares by now). Being slightly broken from the festivities the night before, I was off at 1130, only to sit in the yard of the compound 'till 0230, giggling to yet more "you wouldn't believe it if was in a book" stories from Patsy. Hilarious. Poor Andrew was a bit startled by the whole experience, and has sworn never to enter "Bedlam's" ever again. Very apt.

With Andrew safely retrieved from Nairobi, we are really going to crack on with the things that need to be done in the Clinic. The logistics of getting the things you need are mind boggling, and we really have to sort a system out that will work for us, and the clinic. Lots of hours ahead of us, with the realisation that we're on our own now, and we have to learn even more quickly than we have had to so far.

All this positive thinking was a little dampened when I put my request for leave in today, happily thinking to myself that I would be off on a plane to catch up with friends in 5 weeks, only to actually COUNT the weeks, and discover that August seems to have lots more days in it than is strictly polite, ( I know it's only 31, but WEEKS wise...), and recalculate to 7 and a half weeks. I'm not wishing my life away ( my Mother cautioned me against that at every given opportunity), but here, in this funny old place, you have to have a glimpse of another world every now and again. I was going to say the real world, but it's no more real than here. Here is  definitely real.

I'm not sure I've mentioned it enough, but I am very glad indeed that Andrew is back and I can share this experience with someone who gets what is going through my head - I got overly excited at the arrival of some Typhoid reagents from Nairobi today, all cold chained properly, and only a few hours late. 

My world has got a lot smaller,despite living in a vast continent. 

 Funnily enough, it's all OK.

Thursday July 11 2013

Bureaucracy. You’ve got to love it, just for its sheer pointlessness. Yesterday I had to go to the Immigration department, to renew my monthly visa (It can take anything up to a year to get a work visa processed). So we trotted off round the corner, my trusty Filipina receptionist/finance officer and I, armed with a sheaf of papers and $80. The Immigration building is housed in a compound not 100 metres from us – a selection of darkened rooms, in a dusty square, with lots of people in important uniforms, standing about, being important. So important, that it was tricky to work out exactly which important job they were doing, but it may have been top secret. I certainly couldn’t quite work it out.

We queued for about an hour to get into one dark, heavily curtained room, behind other assorted ex-pats and NGO’s from all over the world, grasping similar sheaves of paper, and all looking a bit hot, but resigned. Most of them did this every month, so were quite used to it. I am mustering up that  look of resignation for next month.

A man of imposing stature, seated behind a wooden desk, studiously read my papers, closely examined my passport, studiously examined me, and laboriously signed my papers and handed them back to me, gesturing me out of the room with a flick of his large, gold ringed, fingers.

We then headed to the army green container, which housed the finance chap. My trusty Filipina friend had already got in line for me (she’s done this before), so I slipped in halfway down the line. To find all my fellow queuers ( who had been behind me in the previous queue) had had the same plan and were actually in front of me. I paid my $80 dollars, received my handwritten receipt, and moved on.

We then travelled to the next room, on the other side of the compound, to wait in another queue, behind the same people as before. By now we were all on first name terms – I met a very nice boy from Dublin who I chatted to for a while. This room had 3 desks in it, behind which  were sitting  3 people to a desk. It appeared to be training day. Oh good. The lady on my left seemed to be picking it up very quickly, and beneath her rather fetching hat, was very beautiful. I was not so lucky. In the time it took her to process 3 of my fellow visa-hunters, my chap was still typing my name into the computer, letter by painful letter. He really did have his tongue poking out in concentration. To be fair to him, his “helpers” were making it worse by knocking his hands out of the way and typing over him, then deleting what they had just typed so he could do it himself. On my right one of the “obviously top secret” (or presence without a purpose) workers, scraped a table back and forth across a dusty floor for no apparent reason. Teeth on edge, I consoled myself with the obvious top secret-ness of the operation. Honestly – he spent at least 15 minutes repositioning that wretched table , only to put it back exactly where he found it. As you can probably tell, my bonhomie was beginning to wear a little thin. And I had forgotten to bring water. Schoolgirl error.

After what seemed like an hour (but was probably only 20 minutes) I received the same sheaf of papers back, after being fingerprinted, and still trying to smile

.

It wasn’t over yet. THEN, we got in another line, this time being ordered into  line with an imperious “STAMP!” command. Finally I was admitted into the same room as the first one, this time to a desk on the opposite side, where, after careful consideration, my visa was pasted into my passport, and we were allowed to leave. We had actually, geographically and metaphorically, gone full circle.

The whole thing took about 2 hours, which is nothing in the great scheme of visa appropriation, but it felt like half my life had passed by...Possibly the most wearing thing was trying not to look fed up, smile nicely at the officials, and just resign myself to it. Next time I will definitely bring water.

Not that the visa is foolproof. Oh no. My poor friend and colleague, the deputy head, was coming back from leave today, but wasn’t allowed on the plane to Juba. He is currently residing in a hotel in Nairobi until we can get him back. Although the visa is single entry, so, on paper, if you are given it in the country, you are allowed back in once, the rules appeared to have changed since yesterday and we have to start all over again with him. Still, he’s having a nice stay in a hotel, and off to see some Elephants tomorrow.

South Sudan had its 3^rd Independence Day celebration on Tuesday. Now for all our local staff, that meant a day off,but, with Andrew on leave, left me as the only person to run the clinic. Although we were closed, there is always the possibility of an emergency. That said – no cars were allowed in Juba, and the phone lines were cut for several hours, so mercifully it was all peaceful. For security reasons, we did not leave the compound – I had been out the day before with Okello, and every few yards there were roadblocks being set up, by huge groups of soldiers with very big guns indeed.

It’s very tricky politically here at the moment, as someone said the other day “a toddler country, bashing into things and getting hurt”, so security was high. It all passed without a hitch however, and we could hear the sounds of celebration drifting over our barbed wire, late into the night. We consoled ourselves with eating all day – a fantastic brunch cooked by our German manager, and roast chicken, roast potatoes and gravy, cooked by my N Irish boss, and me.

So it’s my birthday tomorrow. I’ve spent many a birthday abroad, but definitely nowhere as odd as this. I am planning on spending this one, my 44^th, working and going to yoga, then on Saturday, after work we are all going out for a meal, then onto a restaurant by the Nile called “Bedouin’s” for a few drinks. This is also my boss’ last hurrah, as she leaves on Monday. Thank goodness I am not on call on Sunday – it promises to be a late one.

After a small sense of humour failure on Saturday, and a tiny burst of homesickness – entirely due to burning the midnight oil and working hard, I have pulled myself back together, and will face my 45^th year (good grief!) with a song in my heart !...well, a little ditty, anyway.

Happy Birthday me !

Monday 1st July 2013

I’m gradually settling into life here. Daily I meet the widest range of people I would ever hope to meet – the slightly mad Australian  psychiatrist professor with the self confessed anxiety, who insists on calling me “Alexander”, the 7 foot tall South Sudanese minister for something important, with the most beautiful voice, the hard working and hard playing South African miners who are our neighbours, and are to a man, polite, funny, and ever so slightly crazy. There is a theme here....

Last week I went to a leaving party for the miners, who are all going home as it’s coming into rainy season, and they can’t work. They’ll all be back in 2 months, but for now they were singing, cooking the most wonderful BBQ’d meat, and inviting me into their free bar. They live on the compound next door, and welcomed me with open arms, kindness and gin. (There is also a theme here don’t you think???)

So much so that one of their number, who has only one leg due to a landmine incident, professed undying love for me (bearing in mind that there were only 2 women there, my boss, and me ), then promptly fell over. Few too many whiskeys....we “nursed” him into a low chair that he couldn’t get out of, and left them all singing along to Culture Club and Bronski Beat .....really....

Work-wise, it’s certainly a steep learning curve. Being Head of Clinic, and managing staff is not such a jump from my previous job, but I’m currently buried under purchasing/ordering/stocking..... There were several “fillers in “ before I got here, each with their different systems, some with none, and I spent Sunday’s on-call (mercifully no patients) unceremoniously “filing “ 2 years worth of stuff into a plastic bag and starting again. I’m consoling myself with the thought that at least I will know what I’m doing. The poor deputy head, on his return from leave in the UK, will, however, not have a clue where anything is – I fear I’m making a rod for my own back...

One of my jobs is the “Pharmacy Run”. This involves getting my patient Kenyan driver, Okello, to drive me round all the pharmacies in town to try and find drugs that we have run out of. Now this is a perilous endeavour, not for personal safety reasons (I’m getting to know them all, so It’s actually quite good fun), but simply because you have to check every drug to see where it’s made (China – don’t buy, Arabic – be deeply suspicious, Kenya – probably OK ). This is to do with the vast amount of counterfeit drugs for sale. Pretty pointless to get a drug cheaply, and then find out it’s chalk. Occasionally you have to ask them to show you a pill, then crush it, to see how easily it disintegrates. A lot of the drugs are near to expiry, hence being sold on in bulk, so you have to check every expiry date – if you’re not going to use it quickly, no point in buying. All of this is new to me, along with exactly how much we use of everything and the fact that I only find out that something has run out when it’s gone (bit like putting an empty carton of milk back in the fridge). Why don’t we have a system ?  We do, but again, it’s not perfect and I’m still wrapping my brain round it.  The nice thing about these “runs” is you get to talk to local people, have a bit of a laugh, and in one pharmacy, watch the most awful Nigerian soap opera (in English) on the ubiquitous TV that sits in the corner of every shop that has walls. It’s over the top, over-acted, and very funny. I’m sure it’s not meant to be....

You do get to see some odd sights on these runs though – today I saw a “Boda Boda” driver (motorbike taxis, who are constantly being run over) driving down the road with his motorbike encased in bubble wrap. He, of course, was not even wearing a helmet. A sign for “Big Boyz” (that one for Brighton folk) and an old lady, her face shrunken like a little old prune, wearing a baby’s cap on her head to ward off the sun – made of wool.

Tonight I went to Yoga. I’m not a stranger to yoga, having practised a few times on and off over the years, but this is YOGA. 2 hours of contortions, standing on one leg, twisting yourself inside out , and it’s really tricky. Last week we were in the very posh EU compound, in a little air conditioned hall, but tonight we were on a rooftop. A flat one, obviously – heaven knows it doesn’t need to be any more difficult that it is . On the rooftop was what appeared to be the whole staff of Marie Stopes International, The International Red Cross, and several assorted other NGO’s, all stretching the fatigue and the stress away under a clear night sky.  As we lay down for a particularly tricky pose, (it was dark by now), I saw a shooting star – honestly the first one I have ever seen. Down below the streets had become alive with music, tooting horns, laughter. I could see the fledgling city stretching out to the foothills of the Jebel Kujur ( the hills in the distance), half built buildings silhouetted against the clear, starry sky, and for the first time since I arrived, I appreciated that I was part of a  living, breathing,entity. Hidden behind rolls of barbed wire and travelling by car everywhere you miss it.

 But there it was, and I liked it.

Tuesday June 25^th 2013

Impressions week two.

Has it really only been two weeks ? Feels like much longer, thanks in part to how lovely all my work colleagues are, and how completely at home they have made me feel. The days are certainly long, and the patients sick, but it is interesting and I’m learning lots very quickly. I’m challenged again, which is a nice feeling.

Juba itself, what I have seen of it, is truly a funny old place. There are a hundred stories, every day, from people who have been here since before the war.

 “ I remember when there were 2 motorbikes and one car here “.

Difficult to picture when you’re stuck on a lawless asphalt road struggling to turn right amongst the UN armoured cars, the local battered cars, and the poor little “Boda Bodas” (motorbike taxis). Every now and again you see a shiny white uniformed traffic guy, standing in the middle of the road, literally taking his life into his hands, desperately trying to restore some order. I really hope they’re being paid something.

The town itself, from what I have seen (which is not much) is quite grim. As you drive along the few paved roads, you can see little collections of “Tukuls” (mud and thatched conical huts), completely dwarfed by buildings, all partly under construction. You can clearly see where once there was a tiny village, now totally overtaken by “progress”. And my, the progress is surely happening at the speed of light. I swear that where there was no building yesterday, today was two stories high and had the beginnings of a roof on it . I’m not kidding.

It’s happening so fast, that the more enterprising folk have even been seen to set up shops in the partly completed buildings, while building is going on around them. I was chatting with a fellow blogger (The Guerilla Researcher – link on the right) about how it would not be unusual to see a business man, on the second floor of a half finished building with no walls and no roof, sitting at a desk with a mobile phone

“ Come over to my office – the air conditioning is great and I have a wonderful view”

There are over 300 tribes in Sudan, and over 100 different dialects. Down here in the south, the most predominant tribe are the Dinka – characterised by their size – they are extremely tall and statuesque. A lady who came to the clinic today must have been 6 feet tall, in a wonderful dress, and was quite awe inspiring .Our beds are WAY too small for them, their feet are at least a foot over the edge – I really must try and find some bigger beds!  

Then there are the African foreigners, here to find work – the Ethiopians who are also VERY tall, but unlike the Dinka, very very thin. The women are beautiful. The Westerners, the Indians, business men here to invest in a new city and make a quick buck .The NGOs, trying to help in some way whilst putting themselves right on the front line of violence and disease, people like me who provide a service for all the above. The EU army (yes, there is one!) here to try to improve aviation security. The pilots, here to teach the South Sudanese to fly, the Italian chefs, here to capitalise on the lack of good food here ( I had the best cheesecake I have EVER had tonight). The miners (there is gold here) – the UN, the Embassies.

None of this was here 3 years ago. None of it. Except the little mud Tukuls, and the families and communities that existed around them.

While ugly buildings rise out of the dust, violence erupts. Where once there were only cattle to fight about (and frankly those fights got very nasty), now there is the ever shining dollar. Suddenly there are people on the street with cash in their pockets. There are mobile phones that access the internet, there are laptops, watches, iPods, opportunity. And these people very recently were fighting a bloody war of independence. And they have guns.

We here in our compound are well respected thanks to the hard work that my predecessor put in over 5 long years. We are protected by our clients, some of whom are officials in the government, and to whom we have given the best service over many years. It is an education, and a bizarre privilege to be here.

Living in Juba I am privy to watching a capital city being born from a village, on a time-lapse camera. 

Tuesday June 18^th 2013

I just thought I would post my impressions after a week here in Juba, if only to have something to compare it to in 6 months time, when I’m sure my impressions will be very different.

 Work here in the clinic is quite punishing, more so than I thought. It’s not the crazy busy of my last job, where I hardly knew my name from night to bonkers night, where I was frustrated at the lack of autonomy (except where it suited), where I ran from one crisis to the next. It is a steady trickle of really very unwell people, coming to us as we are honestly, and I’m not biased, I’ve seen the competition, the best in town.

There are those who have been out in “the field” ( I intend to go into that in a later post), for months, and return to “civilisation” (Juba) , dry, exhausted, mentally and physically burnt out, and as a consequence of all the above, usually with Malaria, Typhoid, Giardia, or a combination of all three. They come to us as their company pays for them to, for a bit of sanity, a bit of a chat, and of course, for us to make them better. We have the drugs – mainly – we’ve been waiting for vaccinations to arrive from Nairobi for 2 weeks now, all to do with the paperwork of getting liquids that require a cold chain through customs, we have the knowledge (well at least the others do, I’m still learning) , and we have friendly faces. Sometimes I think it’s the friendly face they come to see...

There are those who are local staff, whose company pays for them to have treatment, and who shyly come in, looking a bit embarrassed, with the most raging Malaria, and are so grateful that it almost hurts.

Those who expect to be treated like royalty because they are paying – the most hilarious Indian man today who was “100 per cent!!!” insured ! (he had more exclamation marks than that, honest)

Those that are so tired of being ill they become angry – my best advice to a young Dutch girl this morning who had been ill for 3 months was to go home for a bit – she came in this evening for a check-up and told me she had booked 2 weeks at home leaving Friday – she just needs her Mum.

I love it.

The schedule is tiring itself – everyone works a 6 day week, plus we at the clinic do 2 on calls a week. Last night was my first one on my own. The clinic closes at 5, and after that it is only emergencies that come in. The last few nights there had been a few phone calls and nothing else. I had the poor Dutch girl in at 11pm, till 0100. I probably would have kept her later, but after 0100 she would not have been able to get home – she works for Oxfam and their curfew is 0100 – after that you’d be pressed to find a driver that will negotiate the road blocks (and the bribes that have to be paid to get through..). I got to bed about 2. At 0430 I was woken by a young girl from an NGO who thought she had appendicitis. I asked a few questions, advised painkillers, told her to call me in an hour if she didn’t feel better. At 0630 the Dutch girl came back, weeping, fed up, and no better. I then worked a full shift, and just as I was closing the clinic at 5, got a chap in with a temp of 41 – proper Malaria. Although I was not on call, my colleague who was on call, was busy with the Dutch girl (who had gone home and come back again), so I stayed with him until 2000, when he finally felt well enough to go home.Nothing compared to a 12 hour crazy shift in a busy acute hospital, but steady, 2 hours sleep at a time, and tiring nonetheless. That is pretty much the reality of it, for everyone in this town. It’s no wonder the rotas are usually 8-10 weeks on, 3 weeks off. You’d go mad otherwise.

I love it.

To end today, I got a fit of the giggles. We have the lovliest lab technician, who is South Sudanese. His grasp of English, when asked a technical question, is superb – he gave me a lesson on which bloods I could safely store without being haemolysed today, with all the appropriate jargon. When challenged with social English however, he struggles a bit. As I was asking him if he minded working Sundays, as our other lab guy is a Pastor and needs Sundays off,  we got a bit confused over the issue of him needing to take a day off during the week to compensate.

“Which day off during the week would you like off ? it doesn’t need to be the same day every week, you just need to tell me a bit in advance”

He nodded and smiled. Good.

“So, this week, it being Tuesday, which day would you like off?”

Long pause.

“Monday please “.

Long pause.

“But it’s Tuesday, you need to take a day off you haven’t already worked....”

Long pause.

“OK. I’ll have Tuesday off”

I think I have convinced him to have tomorrow  off, but I will not be at all surprised to see him in the morning. 

Wednesday June 12^th 2013

Arrived in Juba yesterday, after a perfectly acceptable flight to Nairobi, a very nice flight to Juba, and a scrum at the airport to be allowed in. I had been warned, and thank goodness for that, because if I had no clue as to what I had to do, it would have been bewildering to say the least. Juba airport is the perfect example of the “tin shack” that travellers beguile listeners with when telling  their intrepid tales. It is hot, dusty, noisy, and sits next to a part completed much larger stone building that, apparently, is to be the new airport, when it is ever decided who hasn’t run off with the cash (again). There is no indication of what it is you need to do to be allowed through the wooden archway that leads to Juba itself. There is a dusty glass fronted box, in which 4 uniformed officials sit, and in front of which there are 6 or seven “queues” of passport waving nationals, and confused looking non-nationals. The idea is you give your passport, entry permit, and a crisp $100 bill (no marks, no earlier than 2006, it is carefully examined)to the guard on the left, who nods curtly at you, and mutters something that could be “move to the right hand window”. After fighting your way to the right hand window, you then wait an hour or so for your passport, and carefully handwritten receipt for your  $100, to be examined by the official on the right, who fills in another piece of paper, and hands it to the official on his left. Once it gets to the top of HIS pile, your name is called out (I usually have to listen really carefully at this point as no-one can ever pronounce my surname – it is usually something like “AAW-ES”), you are fingerprinted, and granted entry for a month. Phew. After having your bags opened, checked for goodness knows what, and marked with a bit of chalk, you are finally allowed through the hallowed wooden archway into Juba itself.

I have to say I was so tired that I hardly noticed the streets as we passed through, just a haze of dustiness. What I did notice, however, and which made my poor co-worker sigh in a resigned fashion, was that the sign on the clinic door read “closed Sunday’s”. Ooh that will have to be painted out ! I was shown to my little stone cottage on the compound where everyone who works here lives, which contains a double bed, air con, internet (patchy, but OK during the day), and a hot water shower in the bathroom – frankly a lot more than I was expecting....

First day at work today, and everyone has been so friendly and welcoming I feel completely at home already. Just getting to know the staff, and how everything and everyone fits together is going to take a few days, but so far I feel confident that it is all possible.....

Am off to bed now as I’m shattered, and was just about to pop my night shirt on, when I couldn’t find it.  I have been warned that the cleaning ladies will wash everything they can lay their hands on if you leave it lying about, and certainly my clothes from yesterday disappeared today, but I thought my shirt was safe, on the bed, by the pillow. Clearly not. I shall have to hide my second one somewhere safe in the morning , or I shall be sleeping in my uniform – I wonder if you lie in late, if they physically disrobe you from last night’s clothes.....

Thursday 6th June 2013
I am finally off. Have my scary looking permit to Juba in my bag, along with my flight leaving on Monday.My permit looks like a "Wanted" poster, with a very bad photo of me, stapled to the top right hand corner. I have been advised that it will take anything from 20 minutes to 2 hours for my visa to travel from "the left hand window to the right" at the airport, and I should stay calm, dress smartly, and visit the toilet on the plane before landing. All good advice.
I have spent the last few weeks being very anxious about being "in between jobs" - while having 3 weeks to organise myself has been useful, it has also given me a lot of time to worry about, well, everything, really. What happens if I get run over now? Eek ! Finally yesterday I settled down and started to get excited - I'm off on an adventure, and it's going to be brilliant. I hope...
I'm doing my final run to storage tomorrow, so from tomorrow evening I will not have a kettle, a toaster, or a TV. My lovely handsome cat went to his new home yesterday, and I am properly, finally, on my own. I have tenants for my flat, so on paper, everything is going to plan....
I am not quite sure how everything I have left in the flat is going to fit in my suitcase (get me - suitcase ! I've never had a suitcase! My faithful rucksack has been usurped!), but I'm going to give it a good try, 8 bottles of mossie repellant and 2 big bottles of hair conditioner are weighing me down a little...still, sure it will be fine.....
So. Lovely leaving BBQ with friends on Saturday, recover Sunday, then trip to the airport on Monday with good friends to see me off.
Here I go..........

Oh and I know some people are having trouble leaving comments - I have enabled comments for everyone, although they come to me for moderation first. Strangely, if you go to the bottom of any post, where it says "no comments", if you click on that it will allow you to comment (although it will take a while for me to accept them ). Always welcome comments people :)

Wednesday 15th May

Yesterday was probably the hardest day I have had in many many years. I took my faithful, bright, sensitive and affectionate companion of ten years, to another person's house where he will live out the rest of his doggie years. I cried for days before, and left him on her step, running away sobbing to my best friend's house, where I was given gin, lamb chops, and sympathy.
I wondered if it was too late to change my mind about EVERYTHING, whether I should just turn around and knock on her door and tell her I'd made a dreadful mistake, whether I could retract my notice at work with only three days left to go, whether I could withdraw my contract for the job in Juba. I wondered if I was being fair to him, to me, to my family.
It's not easy, this adventure lark. I wonder if I'm being selfish, or brave.
Today I've managed to stave off the tears for most of the day, telling myself that I need to move on, I knew that if I wanted to do this that there would be tough decisions to make, and trying to pull myself together. I've done a reasonable job I think, although the tears are only a blink away.
So I'm sitting here in my half empty flat with a month to go, packing boxes as I need to get the moving of storage stuff done next week -  a friend who is also going to work abroad is sharing storage with me, and we have a van - it has to be next week as she's leaving before me. My cat is pacing around looking for his friend and  I jump every time there's someone at the door as up 'till now I had been alerted in plenty of time by a bit of barking.
Any sense of excitement I had is buried deep under the great sadness that comes with missing something that has been a part of my life for so long. I wish I could just go tomorrow, but I have to wait another month for the visa and flights to be arranged, and to say goodbye to my friends and family.
I'm sure it will all be all right in the end. Won't it?

Thursday 25th April.
Gosh , what a whirlwind.Was it only 8 months ago I started the Tropical Diseases course, and made the decision to change my life? Feels like much longer. So far I've managed to pass the course, go to Africa, spend time doing something completely out of my comfort zone, and love it, come back, leave my safe, comfortable job, and get a new, exciting, challenging job in a "hostile" area (the insurance company's words) . Mad.
So I leave on the 15th June - well that's the provisional date anyway. Visas and contract yet to be signed, although offer letter signed and accepted.Currently alternating between periods of extreme excitement, and extreme "what the hell am I DOING!!!!" Plan on spending my last few weeks doing as little work as possible, catching up with friends, oh, and having more surgery on my hand. Nothing serious, but I very much doubt there will be a competent hand surgeon in Juba.....
As someone said to me today "Will your Amazon order come by donkey? Or will it be a donkey?"

Friday 19th April.

It appears that I am off to South Sudan ! Although I have not yet received the official confirmation, I have been informally assured that the job is mine, and my reference requests were received yesterday, so all appears good - or completely terrifying depending on your point of view. I'm going with terrifying.
So the great sell-off begins....I have been consoling myself on my state of torpor up until now, with the thought that until I actually knew if I had the job, there was no point actually DOING anything, so have been gazing at the mounds of stuff I have accumulated over the years, without actually doing anything with it. Now I have to decide what to take (tricky with a baggage allowance of about 30kg), what to sell, and what to store.
What I HAVE managed to do, is sort out my lovely dog and my cat. The cat is going to live out his retirement with a vet, so that worked out well, and a nice retired lady with lots of doggie experience is going to look after my Alf. With everything that I'm leaving behind, making the decision to rehome him is the one that wakes me up at night, and has me intermittently weeping every time I think about it. He is a happy , sane little dog though, and I know he'll be absolutely fine, it's whether I ever forgive myself that worries me...
Am getting regular updates from the deputy head of clinic (who I know from Brighton, and was on the DTN course with me), and he appears to love it there, so onwards and upwards.
At least when I get there I'll have something interesting to post!

Friday 5th April

Had my Skype interview for the clinic job in South Sudan yesterday. After a failed attempt the day before, due to a big storm knocking out the internet in Juba for several hours, we went ahead as planned 24 hours later. Weird things, internet interviews. First one I have ever done, and while it was less nerve-racking than actually sitting in your Sunday best in front of a panel, it also had its moments of anxiety. The very slight time delay, and the fact that you can't take visual clues from your interviewer (it was audio only), meant that at times I found I was speaking over them, which was difficult for me, and I'm sure, very annoying for them - I'm consoling myself with the thought that they do these interviews all the time, so must understand that I am not that rude face to face....
Funnily enough, for one who is normally a very confident person when dealing with people, interviews sap all that confidence right out of me, and leave me a bit of a gibbering wreck. There were several questions that I had prepared for, but the words that actually came out of my mouth were completely different to those I had planned *sigh*.While I am confident I can do this job, it is a huge change from what I have been doing, and there are areas that I have no experience, such as the financial management of the clinic. The question is whether they are willing to take a gamble and give me a chance to prove I can learn those things quickly enough for them. I think I can - it's whether I have convinced them of that - and I'm not so sure. So now I wait, and try not to check my emails every ten minutes. I'm trying to only check every 15 minutes, and that is hard !!
Still, I am consoling myself with the knowledge that I DO have a plan B, C and D. My MSF application should be answered by the middle of this month, there is a tricky job in Kenya that might be an option (although the money is non-existent, which may be a stumbling block), and there is always Zanzibar at the end of the year, which would be very nice.
I have run out of nails to bite, and excuses to surf the net (while not looking at my emails...), so I may just spend the next couple of days staring blankly at the screen. Oh actually, I am spending the next 5 days out of 6 working 13 hour shifts - at least that will take my mind off things I suppose. Ho Hum. 

Thursday 27th March

Gosh - it's been a couple of weeks of tough and very emotional decisions. I have handed in my notice at work, and am slightly anxious about working for myself, although I'm sure it will be fine - the agency even asked me if I would do some interviewing for them (for a fee - obviously !). I have a Skype interview for a job in South Sudan (well paid) next week, my application for MSF is done, and I have a confirmed (not paid) job in Zanzibar at the end of the year. I have organised someone to come and make my flat rentable  and have found a cheaper place to live, in a village I love. It's all a bit real now.
The toughest decision, by far, was the one to re-home my dog. I can barely type it without weeping. It's just not fair to him, with the life I intend to live. I have spent the last 2 days feeling like a traitor every time I look at him. If only someone would have him part time and give him back to me when I'm home ! But that's just me being selfish. I won't go into any more detail as it is just too painful.
My excitement is tempered with an overwhelming feeling of "eeeeeeeeek!" at what I'm doing. But it's adventure, it's exciting, and it's a million times better than what lay ahead a year ago.
The world is all of a sudden an exciting place to be again.

Monday 18Th March.

It was with a heavy heart, and a slight wince, that the Captain's "The weather at Heathrow" speech was received, not just by me, but by the nice lady sitting next to me, who almost wept. " The weather at Heathrow is as follows....7 degrees centigrade, and raining ". Groan. No socks, my coat still in a flat in London, where I had left it, expecting not to need it mid-March, in Spring, when I had several sweatshirts that I had thought would suffice. It was freezing, grey, and wet. Great. Climbing on the bus to Brighton shivering, I was met by a very cheerful, smiling, Barbadian bus driver, who, as it turned out, was to be my only company on the journey home. Sensing my depression settling in, he very kindly lent me his coat, encouraged me to sit at the front with him, and regaled me with stories of  Barbados,  happy times, and his anxiety at missing any of the stops in Brighton, as this was his first run on this route. I promised to help him with the stops, and he fended off  my impending misery - it could have been a lot worse.
Once home, and reunited with my boys (my dog and my cat - who has doubled in size - immediate diet !) I turned the heating up to maximum, had a very hot bath, and thought about the future.
Doing the job I do, you see a very condensed version of life, and it's difficult not to imagine that every life-changing personal disaster that happens to your patients, will happen to you. Although we know the odds are better than that which we see every day, it still makes you think that life is shorter, often, than you expect, and every day is important . It is so easy to suddenly find yourself 20 years down the line, doing the same thing, without ever having really grabbed life with both hands. This has always been my inspiration for adventure,although with age comes the very real sense that time passes much faster, while the responsibilities seem to multiply.
I'm going to spend the next few months trying to work out a financial plan that will allow me to try and have the best of both worlds - maintaining my flat and mortgage, supporting my animals, and somehow managing to take 2-3 month trips doing what I now know I want to do - working in places with minimal resources, using my common sense and my experience, and exploring more of the world.
This is therefore my last post for a while, while I try and work out exactly how I am going to do that - but hey, nothing is impossible - right ?
Thanks for reading folks, and thanks for all the positive comments,emails, and FB messages.
Until the next adventure........ 

Thursday 14th March.
My last day here, and of my trip, before I set off on what will probably amount to just under 24 hours travel. I will be very sad to leave Demani Lodge (my backpackers) and the friends I have made here. Turns out the Gangsta Rap is a very rare occurrence, and mostly I have been lulled ever deeper into a relaxed torpor with lovely reggae music (I couldn't even really hear the music from the party last week in my new lovely hut). Africa, or the small pieces of it I have seen, is wonderful. It somehow gets under your skin, and falling in love with it is very easy. People are curious, kind, (mainly) happy, and very funny. The wildlife and the countryside are amazing, and it's a little bit addictive. There are stark contrasts here, the most obvious being between the rich and the poor. I can't count how many times we have been stopped at roadblocks by police, looking for a bribe to be allowed to pass, or how the helicopter flew in a politician to Maasai land, where small children have one dress to wear. People are surprisingly optimistic though, and there is always a new plan to improve their lives - whether it ever gets done is another matter, but there always seems to be A Plan.
I wrote in an email to a friend the other day, that although I have been completely out of my comfort zone, working as a "doctor" for small children and babies, with a culture completely alien to my own, I felt more at home than I have done anywhere for a long time. If I needed a catalyst to prove that I need to change direction then this certainly served as one. Thank-you, London School Of Tropical Medicine, for giving me the inspiration to decide how that change comes about.
Now the tricky stuff begins - trying to rearrange my life so I can actually do this full time. As I said in my very first post - Bring It On.

Wednesday 13th March
Popped up to the north of the island for a day and a night. Drove through a village called "Bambi", which delighted me, but resulted in a protracted explanation of Walt Disney films with my driver. Delighted me so much in fact, that we took a little detour on the way back to have a look, finding a beautiful village surrounded by palm and mango trees,with women, conspicuous by the lack of muslim dress, sitting about by their mud huts, sharing food and childcare. We popped in to buy some mangoes, and played a game of peek-a-boo with one of the kids (a game that translates into any culture), bought mangoes that tasted of sunshine, and left with smiles on our faces. Driving about here takes time and patience - a one hour trip is likely to take three hours, as you stop every few kilometres to buy some bananas, fresh coconuts to drink from, just to pull up for a chat. It is a mark of how swiftly I have acclimatised to African timekeeping that I thouroughly enjoyed myself and didn't worry about the time once.
Day of sorting things out and paying for things tomorrow, then home Friday. Boo.

Monday 11th March
My last week - heralded in by more tropical downpours, thunder, lightning, and clear skies and sun in the afternoon. 6 weeks has flown by as usual, except this time I think it will be more difficult to return to "normal" life. Having adjusted to the heat and humidity, I'm certainly going to be cold. I have resisted the urge to check the weather at home until now, to find it is expected to reach the dizzy heights of 4 degrees centigrade tomorrow in England. 4 degrees. That is about 32 degrees colder than I am now. Nothing in comparison to one Canadian woman I met,from Winnipeg, where the temperature, with wind chill added, was an ear bitingly cold minus 40 degrees centigrade. On arrival in Kenya, we calculated that she had undergone an 80 degree centigrade change in temperature. Jeepers.
Dived again today, where the visibility was a disappointing 15 or so metres, due to the sediment having been whipped up by the storms. It was still a nice way to pass the time however, if it had not been for The Selfish Diver. There is always one. This particular Selfish Diver was having difficulty with the concept of the ocean being a very big place indeed, and there was no need to be in my little bit of it. If you thought it was impossible to barge past someone in the middle of the sea, when there are only 5 of you in a very big space - well, this chap would have dispelled that notion fairly swiftly. " Look " I gestured, doing the sign for a lionfish - having managed to catch the eye of most of my fellow group, imagine my surprise when I was firmly pushed out of the way so he could take a (bad) photograph of it, startling it so that it swam off fairly sharpish. "Look" I gestured again, "big octopus under this rock", as he charged past me once again, nearly knocking my breathing gear out of my mouth with his flappy fins, to lift the rock up, sending the poor octopus white with fear, under the next big rock, before anyone else had a chance to see it. First rule of diving - DON'T TOUCH. Leave everything as it was, do not upset the animals. That includes the other divers. Grr. And, Selfish Diver, do not go in the opposite direction to everyone else with your wretched camera, when the visibility is poor, and we all have to go back and find you, against the current, wasting our precious air in the process. There are some gestures, when demonstrated underwater, or above it for that matter,that are perfectly clear, and the rest of the group was communicating their feelings perfectly adequately by the end of the second dive....
Just needed to get that little rant out of my system - back to calmness and serenity now. Phew.

Saturday 9th March
So today was moving day - and move I did, to a bigger bungalow at the very back of the same place . I'm going to put up with the Gangsta Rap tonight, in favour of liking this place so much now. When it's a choice between Gangsta Rap, or, in the other lodge, bad orchestral renditions of Whitney Houstons's "I will always love you"...it's a close run thing to be honest.... I now have a lovely big bungalow with my own shower and toilet  - I'm either just going to have to join in tonight, or put two sets of earplugs in.
And the sun is out (although there are ominous rumbles of thunder in the distance....). Mr Bond has been doing his job.