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.

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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........