Tuesday November 24th 2015

Another rest day at the lodge yesterday , then today some of us trekked up the nearby ridge, on the hottest day yet. 36 degrees centigrade, and up, and up, and up we went, scaring the Baboons off seconds before we arrived. After 2 and a half hours, we were rewarded with the most incredible view over the vastness that sums up Africa for me. Flat pains, and in the distance mountains, more mountains.....it was beautiful. We could see the camp, and entertained ourselves for a while by shouting down to the those who had decided tho take the day off to rest. Apparently we looked like little ants , we were so high up. I don't think I have ever lost so much fluid on a day's walk, but it was worth it.

So that's it. I've laughed so much my sides hurt, I've cried, I've felt more useful than I have for a long time ( and mostly I was just running about trying to keep an orderly queue). I've been dive bombed by enormous  "George's"( the nickname we have given to the huge dung beetles that flap about clumsily at supper time- completely harmless, but a bit of a surprise when they fly into your ear). I've washed my hands in a sink with tiny  beetles in it , and apologised to them while I dry my hands. I've waved, and Jambo'd my way to remote schools, blown bubbles for children who are a bit confused by them to start with, then start laughing with delight and trying to catch them. I've cuddled lovely babies while their mothers have treatment, pulled thorns out of children's feet , been laughed at by rows of women and teenage girls as I try out my Kiswahili -   I've loved every minute of it. We have given consultations and medication to over 1500 people, have dewormed around 3000 in total and have extracted over 150 teeth......If any of my friends and colleagues fancy joining us next year, please do, you won't regret it. To those of you that have shared this very special experience with me - thank you,   and see you all next year !

Saturday November 22nd 2015

Our fabulous local staff.

As predicted, today was emotional. We went to Kisimenyi school for the first time. Clinic was busy, very busy in the afternoon, and again we saw some very sick infants and adults. Then "wrap-up", our end of clinics debrief. We all sat in a classroom at tiny desks, facing the blackboard like oversized kinder garden kids. Project manager Peter thanked everyone, and we gave each team , and each member a round of applause " pickupmycoffee" in Kiswahili ( I am clearly phonetically spelling these words!)  then the goodbyes to the local staff, which set us all off again, with hugs all round, and promises to see each other again next year. Thankfully, one of our team has been making a film for Camps( he used to be a cameraman), and he needed us singing the "Jambo" song one last time, so we cheered ourselves up by singing along at the tops of our voices.

After dinner we had a talk from John ( the ex- cameraman), who is now a psychiatric nurse. We will arrive home at Christmas time, after having been in one of the poorest areas in East Africa. We have treated people with no shoes, kids whose school uniform is all they own, with the arms hanging off, girls whose threadbare skirts have been passed down so many times they are either way too big, or way too small. We complain that we are hungry before the lunch truck arrives, only to remember that many of our patients are lucky if they have one meal a day. We may have only been here a short time, but the commercialism of Christmas, what we have, compared to those we have looked after, is likely to be difficult for some to come to terms with. John reminded us that we were to feel thankful for what we have, to appreciate and love our families and friends,   and to remember what we have achieved here.  A bit more leaking at the eyes all round....

Tomorrow we have another rest day at the posh lodge, then Tuesday some are on Safari for the day, and some of us ( who have been on Safari before) are trekking up he nearest peak with some local rangers for a little look about. Wednesday the greater part of the group are going home, while Rach and I are ,rather smugly, going to the beach for 6 days. As Peter reminds us daily, there have been challenges, the weather changing the best laid plans daily, but the staff here have been amazing, and we have finished the programme having completed the amount of clinics we set out to do. As I write, there is much screeching of laughter coming from the bar, games being played, and general rowdiness. 

I'm loving it, but I'm glad I've packed my earplugs.

Saturday November 21st 2015

"King George"

Today we ran another clinic at Bugata, where much sicker adults turned up. We saw a poor old gent with what looked like Parkinson's, who had had a stroke 2 years previously. He was brought to us on the back of a motorbike, and staggered in, supported by our staff. There is little chance that he will be able to access Parkinson's medications here, and even less chance that he can afford it.

 We saw a young autistic boy, who had an old wound from being gored by an elephant- you could see both the entry and the exit wound. The local eccentric spent half an hour with his feet on my lap, being treated for "Jiggers". He is amazingly inventive, fashioning hats out of old pieces of metal, and stilts out of pieces of wood, with CDs attached for decoration - he is a true mad professor- in another world he would probably be considered a genius, and be running a lab discovering the cure for something. Here , he is tolerated with a certain fondness, although some of his masks frighten the children. 

I also saw a lady today who made me giggle. She was an ample lady, in her late 50's, who , when asked what we could help her with, became a bit shy, giggling herself. It turns out she had hurt her hand- falling out of a tree. Picking leaves for her cow, apparently. Luckily, nothing was broken ( she had already been X- rayed at the local hospital)  and just needed some pain relief- as she left, she told us she had sold the cow .

Most impressive wound of the day was a snake bite- the poor lady had been bitten by a Red Spitting Cobra - just the name is enough to make you shiver. She had only recently been discharged from hospital after a month, and now had a huge wound that needed dressing daily.

Tomorrow is supposed to be our last clinic, but as we arrived home a huge storm broke, washing away the newly repaired road to our camp. There has not been this heavy a rainfall as the last week, for 20 years. So again we are at the mercy of the weather as to what we are able to do. The Camps staff, as usual, are running about madly trying to sort everything out, always with our safety paramount, alongside the needs of the community. They are amazingly resourceful, and somehow we'll do something. The emotions are running high, with the end of the programme in sight. Our group of strong , bright, amazingly experienced people have become firm friends , and leaving for another year will be very hard. Knowing that what we have done, is sustainable, the knowledge and data we pass on is used to improve the lives of so many, does help. Already we have plans for fundraising for next year, and I have a very long list of things to bring next year - staplers, staplers, definitely staplers. Oh, and some medical stuff too.

I

Friday November 20th 2015

The Wirral !

REST DAY !

We spent today at a lodge swimming, drinking cocktails, sunbathing, and sleeping. Lovely .

Our neighbours on our little level of accommodation at camp are the "Wirral Girls" There are three of them, two sisters, and a good friend. They make me laugh a lot. Bernie told us a story tonight about a lady in clinic the day before. Two of our clinics are run in conjunction with the Kwale Eye Clinic. This is a massively important part of the programme, with a lot of the community suffering from anything from cataracts, glaucoma, foreign bodies,to simple short sightedness. You can see them in the queue, the old ladies squinting, the young boy with nystagmus, the cataracts, ...people my age who just can't read any more. ( I know how those people feel - and I have glasses). 

There was a frail old lady needing to see the eye doctor. Bernie took her by the hand( by this point the elderly lady clearly thought Bernie was a bit bonkers) and led her towards what she believed to be the eye clinic. She led her into the schoolroom, sat her down at a tiny desk, and on turning round , was faced with a class of children, and a teacher, marking their work. She had inadvertently wandered into an exam- the old lady was clearly not the person who needed the eye clinic.......

Tomorrow we go back to Bugata, then maybe on Sunday a school the program has not been to before. It all depends on the roads and the weather, but whatever happens, we'll be back in our scrubs.

Thursday November 19th 2015

Another clinic, today in Bugata, a school of reportedly another 500 or so children . Today I worked on skin - probably the most physically demanding of all the jobs. Each class lines up, to be told to "osshamagushi" ( or something like that ) - basically " wash your feet" , in bowls of water in front of 6 or 7 nurses. We inspect their feet for imbedded thorns - I got a huge one out today, to my evident satisfaction, which my poor child patient found very funny. We look for ringworm, scabies, tinea, pretty much anything unusual on their feet, hands, scalp and anywhere a else we can see. Many of these children have half a shoe, and the children whose families were a bit more wealthy were immediately apparent from their feet- those with no, or poor shoes had scars, thorns, burns, athlete's  foot, verrucas... Those we referred to our consultant nurses, the others we dressed what we could, and sent them off to play.

One child had a shoe that was flapping in the wind, the sole completely separated from the main shoe, and terrible feet. Di and Sophie, two of our nurses, ingeniously repaired his shoe with compression bandages, staples, twine and scissors.

It's quite emotional, being here. Sitting on the bus in the morning, driving along a red dirt road, through endless fields of poor crops that have been starved of rain until the last few days, the true magnitude of the landscape is difficult to describe. The fields are ploughed as they have been forever, with two oxen , driven by a man or woman or child, under the hot sun, who will stop and wave at us, smiling broadly as if there was nothing wrong with the world. The children run down to the road and squeal with excitement, jumping up and down, waving madly. Every shack has a family, brightly clad, who smile and wave.
We arrive at a school and are mobbed by children, so excited to see us. The teachers proudly show us their offices (one office looked like Dumbledore's Study it was so full of dusty exercise books),we are asked to sign the visitor's books, have our pictures taken . It is hugely humbling. It is a world so different from our own, it's almost impossible to believe that it coexists with our gadget , wealth, power driven lives back at home.

 What we are doing here, really, truly makes a difference. Everything we do, everything we find, is logged by us,  and analysed by the local health officials. If we find Malaria- the government spends more in this area for malaria. If we find Schistosomiasis, the government looks into how it can be can be prevented. We did some cervical screening, thanks to our nurse who specialises in sexual health. This may mean the government sends someone out here to screen regularly. It is inspiring.

Wednesday November 18th 2015

Today was Kale school, a little further away, but the other way out of the camp, where the road was not so damaged. Across the fields we went, piled into the truck, and set off again across stunning landscape. We passed fields being ploughed with oxen, cacti that had burst into flower with the rains,  Bruce Springstein blaring out of the speakers. The younger members of our group were not so word perfect as the rest of us....
I got to do some consulting today, alongside a Kenyan nurse who nurtured me through the " waist pains" , the " I feel pain in my body" , and the daunting sight of mothers bearing down on me with 4 children, all needing the "Daktari " eek ! The drugs are challenging, but it was a great learning experience- I looked in ears, listened to chests- everything I never do in my everyday job . I may even be let loose on my own when I've spent a day in the dispensary learning  the drugs.
In order to catch up for our lost day we are running a third clinic tomorrow at Buguta, then there is "rest day" - weather permitting, a day in a lodge with a pool and cocktails, near a watering hole. We've only been here a week, but it already has achieved mythical status, with Pina Coladas, handsome pool boys and blazing sunshine all day. Let's just hope the road is still there by then.

Tuesday November 17th 2015

So after a few plans ranging from A to E, we settled for plan F. The Camps staff worked tirelessly to make sure we ran a clinic somewhere, having to bear in mind not only our safety, but the fact that the community was depending on us. A bunch of frustrated medics probably didn't help, all of us desperate to get on with what we came here to do. They had managed to get one of our trucks to the far side of the huge chasm that had opened up in the road to one of the schools. The road from our camp to the main road was impassable, so we were to walk a few kilometres to meet the truck, open clinic, and dive back at the first sign of a downpour. We set off in single file across the fields, the neighbours having kindly allowed us access over their crops. Then the singing started. We sang all the way to the truck, and once in the truck, a constant chorus of the "Jambo" song saw us along the red mud road, past houses and shacks, the local people clearly thinking we were quite mad. A bus full of scrub clad "Mzungos" singing at the tops of their voices is probably not a sight they see every day.

Marasi school  housed another 500 or so  children, in several small schoolhouses. The majority of the children were Somali, the girls dressed in green skirts and yellow headdresses which surrounded their faces and came down over their shoulders, framing smiling , often shy little faces. The boys leapt about shouting "picture!picture!!!" Photobombing  at every opportunity,  all crowding round to see the finished result.

Clinic was busy,  all of the children being dewormed, before having their feet checked, and being taught how to brush their teeth, alongside the adults who had come for the free clinic. At times it was almost overwhelming, the amount of children lining up, but all jumping to the sound of the teacher's voice, lining up in a very orderly fashion, and taking their medication with very few complaints - a very different world from the UK.
As usual I got many a giggle for my name, "Ali" being a man's name here, but I'm used to that now, and it meant they remembered me.
At about 1530 it started to rain, and we packed up like lighting, threw ourselves in the truck, negotiated the road home, trooped up the hill to the camp, and again, arrived back just as the heavens opened- the weather gods are definitely keeping an eye on us.
We gave ourselves several rounds of applause- one of our nurses won " largest family group consultation of the day" - 10 family members in one go - and another won best diagnosis- a clinical diagnosis, with no fever, but a "flat" baby who wasn't" quite right" - one of our two positive Malaria tests of the day.
At lunch break some of the nurses had led about 50 kids in the " Hokey Kokey" , which was great fun to watch, and even more fun for the kids, we laughed a lot, got a bit sunburnt when the sun was out, and back in the camp, swapped stories and screeched as the bugs dive bombed us( they have all gone a bit mad since the rain).
So we are back on track, and on for another clinic tomorrow, a bit further away, and a bit more of a logistical nightmare for the Camps staff, as our tables and chairs are stuck back in the school, unable to get across the newly flooded road since today's rain.
Still, there are desks and chairs at tomorrow's school, if tiny little ones, so we'll manage, although we may have to spend the day gazing up at our patients, rather than face to face.....
Just as an aside, Mama Mercy was telling us that the commotion we heard the other night was the Cheetahs/Leopards hunting the Baboons on the other side of the ridge. Well that's a relief.

( The other side of the ridge is really quite far).

Our days so far have been full of challenges and laughter, good food and Tusker, and the practical, no nonsense approach to outreach healthcare that inspired me to do the Tropical Diseases Diploma in the first place.
I say it a hundred times a day, but I really am having a lovely time.

Monday 16th November 2015

We are Punctual !

The last 24 hours has been a bit of roller coaster. Yesterday we ran our first clinic, and I got my first real taste of what we are doing here. We use the local schools as  temporary clinics , and yesterday we went to Itinyi School, about 20 minutes drive down the red impacted soil road, in our open sided van .  The people at the front of the bus are responsible for shouting " BRANCHES!!!!!!!" When the sharp thorny trees make an attempt to grab anyone next to the window- and we arrived in good spirits, having waved and "Jambo'd" our way to the school. As it was Sunday, we weren't expecting too many people in the morning as mostly people would be at church, but there were already a couple of rows of colourful ladies patiently waiting in the morning sunshine. I, uncharacteristically,  had a chat and told them they were a bit early, to be corrected by one elderly lady - " No ! We are Punctual!".
 After about an hour of clearing out classrooms and setting up, 4 consulting tables to a room, a schoolroom for the dentist, a schoolroom for the pharmacy, one for the eye clinic, and one for the lab, we were ready to go.
I sat on the front desk in the blazing sunshine, handing out worming tablets to everyone over the age of two- no worming tablets, no consultation .

"Tafuna!!".."Chew!!" .......my Kiswahili is fluent......

As the day went on we saw over 250 people with complaints ranging from chest infections, to gynae issues, to ringworm and fungal skin infections, amidst other aches and pains. Our dentists extracted over 20 teeth, and the queue for the eye clinic never seemed to go down. I had a brilliant day, shepherding people around, being bossy - I was completely in my comfort zone .

As we packed up the trucks at the end of the day ,the weather started to look a bit ominous, so we cracked on, waving at the folk on the road we'd treated that day who were starting the long walk home. On reaching the camp the heavens opened, and raindrops the size of small zebras began to fall. And it rained. And rained. And rained . Our tents and Bandas had small rivers running through them ( luckily everything off the floor stayed dry) so we all sat in the bar, slightly soggy but in true Dunkirk spirit laughing and swapping waterproofs to run to the loo in.
By supper time we began to realise how serious the downpour really was. We were told that the road that connects us, to the main road, had completely washed away, and it was becoming clear that we were going nowhere tomorrow. After a few more Tuskers we went to bed, still raining, although not quite so heavily.

This morning we woke to the news that several of our neighbour's houses had been washed way overnight. The dam had burst, sweeping away a pregnant woman that we had seen in clinic the day before, she had sadly drowned, leaving behind a small child. The village is in mourning. So here we sit, the rain finally stopped, waiting to find out what we can do to help- trying to work out if we can just run the clinic from the nearest school instead of moving around ( as we can't actually get anywhere now). There is a drainage ditch that needs to be dug to save one of our neighbours houses, and the men are inspecting that to see if we can help. In the meantime we sit here, drinking tea, feeling a bit helpless. Still, as our lovely project manager Peter keeps reminding us, it is not a problem, it's a challenge. With a camp full of medical professionals who are used to improvising, we will find a way to be useful, and a way to carry on with the clinics, probably after a lot more cups of tea........

Saturday 14 th November 2015

 

This morning we met with the local nurses and volunteer workers that we will be working with over the next 10 days. We had introductions, more introductions, introductions to people we had been introduced to twice already, overviews of the programme, programme overviews......I do like a Kenyan speech ! We met lab techs, nurses, the Minister for Public Health ( who has taken a bit of a shine to our Rach), and the Community Health Volunteers, who give up their own free time to help their communities with health education, disease prevention, and most importantly for us, to act as our translators on clinic days. There was lots of laughter, handshakes, and Mama Mercy, to lead us in swearing an oath of confidentiality


So now finally time for bed, after another lovely dinner, and much discussion on what we do for each condition we are likely to see ( medication relies heavily on what we have in stock, some of which the government has given, some has been donated, and some funded by the money we have paid to Camps International.).

I am to start on the " front desk" , which basically means, as far as I can gather, counting everyone in, deworming EVERYONE, and ushering them round the various people they need to see in some sort of order, triaging  anyone that needs to jump the queue. There are 5 of us starting there, and we have no real idea of how many people will turn up, only that it will be busy- very busy.
Trying to make some order out of chaos is not unlike being a Site Manager I would think, so my plate spinning skills may well come in useful.......

Can't wait !!!

Friday 13th November 2015

View from the Camp

It is almost exactly 2 years since I left South Sudan behind, with all the memories, emotions, and a pair of quite nice shorts along with it. After the highs of my time in Kenya, in Saikeri with the Maasai, to the lows of gunfire and government officials in Juba, I always felt I had unfinished business in Africa.
So  I am back in Kenya, with a group called Camps International. I'm  here with 28 others, mostly nurses, a physio, a pharmacist, a dentist, and a couple of willing helpers. We  are all here,for two weeks,  in one of the poorest rural areas in East Africa, to run some free clinics for the local community, consulting on skin conditions, malaria, tooth hygiene, mother and baby " stuff" ( I'm not good with baby "stuff") , and whatever turns up. We are expecting ridiculously busy clinics, as after last year went down a storm, everyone local has been looking forward to the "Daktari's" return with some enthusiasm.
Coming back to Kenya was lovely. Getting in the rickety old van in Mombasa, trundling along at 5 miles an hour thanks to the road, the trucks, the dust, bouncing up and down having made a schoolgirl error and sat at the back ( KNOWING what the roads are like !), past beautifully named shacks (" Oil Cafe" ; "Jubilation Cafe";) , tiny shacks on their own in the middle of a vast landscape " Top Up Here!!!" , small children squealing with delight yelling "Jambo!!!!!!!"  ( Hello !!!!!) , my waving arm building up muscle every mile....I remembered why I loved it here.
From our camp we have the most amazing view. Miles upon miles upon miles of bush, red dust, Acacia trees, Boabab trees, other stuff I don't know the name of but that definitely still has thorns ( that much I remember) . Mountains in the distance, light changing every minute of every day. Clouds scudding by, rain sweeping in, in a minute, visible from miles away, then swooping away again. It is truly stunning.
We met an inspiring woman today called Mama Mercy. She has almost single handedly pulled the women of the community together , with sheer determination, an iron will, and incredible stubbornness . HIV is prevalent here, with the area being near to the main highway, which carries trucks driven by arguably one of the  biggest causes of the spread of HIV in rural areas - the migrant drivers. Every month here someone would die of HIV, sometimes many more. Today, Mama Mercy told us that they had not buried anyone for 5 months. This has been partly achieved by the setting up of women's groups, spreading information and education, encouraging people to be tested for HIV, reducing the stigma attached to seeking the free anti retro vitals provided by the government........in the last year there have been several babies born to HIV positive parents, who, so far, have tested negative. Her passion, her determination, her sheer bloody mindedness, made me shed a little tear. Thank goodness for people like her.

We got back to camp to share out the donations- it's surprising the flight actually managed to get off the ground from Heathrow considering what people had brought. Medicines and dressings for the clinics, donations for the women's groups, hundreds of glasses for the eye clinic, and more donations  for the schools.

Donations

Those sorted and bagged, it was Tusker time ( the local beer), chat, lovely food, and to bed, with the Kenyan moon smiling gently down on us . I know, that's a bit twee, but it's sideways up here, and actually looks like it's smiling, honest. Or that may be the old hippy in me. Still nice though.

The Team