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 !