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

Saturday 18th January 2014

What do you see, Dr, patient, ward nurse, when you see my uniform? If you are a  Dr, you see yet another agency nurse, who very probably doesn't know what she's doing, who's not familiar with the protocols, who is probably not very bright (after all, why on earth would you not want a full time job and the opportunity of promotion up away from the shop floor? Why would you not want a career ? ) You have less patience with me for not having done the things you asked me to 10 minutes ago, as you have  a relationship with the ward nurses you work with every day, and you understand them, you've talked to them, you know that they have 20 other things to do first. You sigh with annoyance and tell me it's not " rocket science" to know that I should have brought the dressings down to theatre with me that my patient was due to have done under anaesthetic. Well, it IS rocket science, Dr, if no-one told me that was how it was done in this hospital. I'm an agency nurse, remember, I work somewhere different every day.

And what do you see, patient? You see a white uniform, or a blue uniform, a uniform you don't understand as it doesn't match those of the ward staff. You don't know my rank, my experience, or even if I'm actually a nurse. You think I may be a Physio, an OT, or a Radiographer. Actually, you, the patient, are my saving grace - once I tell you who I am, you don't really pass judgement as long as I look after you well.

And you, the ward nurses - what do you see ? You see yet another member of the workforce that morning who will need supervision. Another one who will need to be shown where everything is, lent your pass to open every single door that is locked with security keys , another member of staff who won't be able to fill in the paperwork properly . It's hardly surprising you are not always delighted to see me, when I'm one of 4 agency nurses that day on your team of 6 . You see that I am being paid more per hour than you, to do probably do half the job.

You don't see our stories, our experience . You don't see the reason we work for an agency, the family responsibilities that make it impossible to work in a team where your rota is random , the personal lives behind us, that mean we have to be able to take days off at a moments notice to sort out our elderly relatives/children, even pets.You don't see that even though we get paid more than you per hour, that if we get sick, or can't work, we don't get paid. You don't see that we have to work double shifts if we want to have a few days off. You don't see that our experience is valuable, as we know a little about a lot of things - we have to .

There is a certain camaraderie amongst agency staff. We compare wards, hospitals, the friendliness (or not ) of the staff, the amount of patients we were expected to care for in each place, how late we left work on that ward, or this ward. We have to belong to some sort of team, so we make our own, ever changing one.

So what DO you see , all of you ? I'll tell you what you don't see. You don't see me. 

Sunday January 12th 2014

Thought I'd just post a few things about life back in the NHS before signing off for a while - after all, "Travels with my Stethoscope" doesn't really have a great deal of relevance when I'm not actually GOING anywhere..(for now).

Being back in the system is much harder than I thought it would be. Working for an agency is fine - I get to choose where and when I work, which is a big bonus, and the pay is OK, but the work is really really hard. I really don't want to sound like a bleeding heart, but I'm finding it really difficult not to snap at complaining relatives, angry at the time they have had to spend in A&E because the hospital is oversubscribed and understaffed - yes, Brighton people, it's endemic. It's the same everywhere.  I want to tell them about the young boy who died in Juba from an asthma attack, because the hospital had run out of oxygen. I want to tell them, when they complain that Dad's medications are 20 minutes late because their nurse simply has too many patients to care for, about the 40 year old man who died from a hypoglycaemic attack (low blood sugar) because he was too far from anywhere that knew what to do . I want to tell them, when they complain that their relative has not been seen that day by the tired, harassed junior doctor , about the young girl with advanced malaria, who was almost certainly going to die because her family did not have the money needed to get her to a hospital that could look after her, or the money needed to pay that hospital even if they did get her there. My tongue is becoming quite raw from all the biting of it I am doing.

Back on the shop floor of nursing, working as a junior staff nurse again after so many years spent being in charge, has reminded me of how bloody hard these nurses work. This is no surprise to anyone, I suppose, but experiencing it first hand again, hour after backbreaking hour is actually making me a bit sad. Sad , that as a junior staff nurse, your main job seems to be ticking boxes on the endless " yes Mr Cameron, I have ticked that box to show I care"  reams of paperwork . There are piles and piles of it. Tick a box to say I asked my patient if he was comfortable every hour. Tick a box to say I have looked at his pressure areas every 2 hours. Tick a box to say I've managed his pain every hour. Boxes for food, drink, positioning, happiness....... By the time you've ticked all these boxes for your 8-10 patients you are caring for, it's time to start again. The sad thing is, the health care assistants are actually DOING those things. They are the ones washing your patient, looking at their skin, feeding them, turning them. As a staff nurse you are just the box ticker. There simply is no time to actually carry out the care yourself.  You are relying on second hand information, because you are doing the drug round that takes 2 hours, or placating the annoyed relative because your drug round has taken 2 hours and their Dad was at the end of it . I've worked in Care of the Elderly, Orthopaedics, Surgery, and the Acute Assessment Unit so far, and it's the same everywhere. Too many patients per nurse, too much paperwork, and not enough time to actually CARE . Having worked for so long as part of a team of senior nurses, who were all brilliant at their job, I had forgotten what it's like to go home every night wondering if you'd actually signed for that drug that was prescribed to be given 5 minutes before the next shift started, or if you'd remembered to tick all your boxes, or if you'd remembered to tell the next shift all the things you hadn't managed to do ( and hear them sigh with annoyance).

There is a certain amount of relief, not having to keep an eye on everyone else, and make sure they're doing their jobs properly, frankly it's exhausting enough, keeping an eye on myself,and making sure I'm doing my own job properly. And the sad fact of it is, I'm not. Not to my own satisfaction, anyway. I'm experienced, organised, and sensible, and I can't manage to leave work these days feeling that I've done a good job. My heart goes out to the juniors, who must think that this is the way it will be for the rest of their careers. The sad fact of it is, they're probably right. With the advent of the compensation culture and the tide of opinion directed against the public sector by the popular press, the decline in numbers of decent, practical, caring people applying for nursing, is bound to continue to fall. It makes me very sad.

So, happy days ...... hopefully the aviation medical course I am doing in February will open up some avenues into flight repatriation, and I may get the odd contract as a medic at Shepperton Studios if I'm lucky - quite frankly, I can't do this ward work for ever or I will become one of those embittered, uncaring, miserable nurses that exist on every ward. And that was never why I did this job in the first place.

It may not be Juba, but the NHS is a different kind of war-zone.

Wednesday 8th January 2014

Well, what a whirlwind that was..... How to put into words the last few months - I'll give it a try..

I feel able to be a bit more honest about my time in Juba now, as it really is so far away. The  month after my last post was really tricky. Things at the clinic were certainly not all sweetness and light. I discovered that managing difficult people was not my forte - sad though it is, I would prefer to be liked than disliked, and prefer not to make unpopular decisions. Strange one that, as having been a Clinical Site Manager for ten years, I was used to making unpopular decisions daily, the difference being, I had the support of my team. In Juba, I had the support of my Deputy, and that was it. As so many people point out, it's not a popularity contest, but I hated it. My senior Doctor and I fell out irrevocably, to the point that we stopped speaking to each other unless it was to do with direct patient care. I admire her immensely - being a South Sudanese female doctor is not easy, in a male dominated culture, and she is a strong and opinionated woman . Sadly, so am I, and that led to stubborn clashes that just could not be resolved. She had strong family ties to the local dignitaries, and the government, which meant she was invaluable to keeping the clinic afloat in a society that relies on such ties. It also meant she was untouchable - when faced with a flat "No" to any request I made of her, I had nowhere to go . The on call rota became a bone of contention, with the local staff complaining that they felt it was unfair the amount of on-calls they were expected to do, despite me painstakingly writing out exactly how many everyone was doing to show that it was equal (except for mine, as I did almost a third more than everyone else) . It didn't matter - they didn't live on the compound and ( I suppose quite reasonably) felt that nights away from their family sleeping in the clinic were harder for them .

The security situation began to deteriorate, with reports of robberies on Kawadja cars out at night - the suggestion was that no-one went out later than 10pm, even then, there were reports of cars being held up not 200 yards from our compound earlier and earlier. This was not surprising really, the police and the army ( those responsible for most of the robberies) had not been paid for 3 months, and had just heard that they would not be paid in the foreseeable future as the government " Needed to pay its debts" first. They were hungry, desperate and had families to care for. We Kawadjas were an easy target, with our mobile phones, and our wallets full of dollars for an evening out, that would feed a family for weeks .

Andrew went on leave for a month, and pretty much everyone else that I could have a laugh and a joke with, went on leave at the same time. I was left at the clinic on my own, virtually in prison due to the security situation, with staff who resented me - it was a very long month. I was bored, and couldn't wait to come home on leave. On average we saw about 20 patients a day in the clinic, which, when we were all there, was about 3 patients a day each. There is only so long you can chat to a patient who has come to clinic because he stubbed his toe on the way home the night before - really. The Malarias and Typhoids livened things up a bit, but at the end of rainy season, they were becoming far and few between. The odd repatriation kept me up all night - I volunteered just to break what was swiftly becoming monotonous .

Reports started coming in of armed gangs breaking into Kawadja compounds and stealing everything - the people were left unharmed, but laptops, cash, personal possessions, all gone. The situation was becoming more desperate as we approached Christmas. One friend of mine who was an old hand in Juba, was lying in his bed one morning when someone crashed through his window and landed on the floor of his room. It turned out that a Boda Boda driver had been run over and killed, and an angry mob was chasing the driver through a compound hell bent on revenge - this unlucky mobee had taken a wrong turn in all the excitement. Luckily my friend was fine, and the mobee went back out the same way he had come in, leaving my friend unharmed, but very shaken. He moved out of the city to a compound on the outskirts the following day.

I greeted Andrew with enormous relief on his return, and gaily fled the compound for my leave in the UK, safe in the knowledge that I would only be returning for 10 days in December, to honour the end of my contract( although I had only been required to give 30 days notice, I had given 60, knowing that the clinic would have no-one to run the place over Christmas if I didn't come back).

After a lovely holiday in the UK, I was driving back from the New Forest from a weekend break, due to fly back the following day, when I received a text from a friend saying " Look at the news - Juba is in trouble". It turned out that all hell had broken loose the day before, with rebel factions of the army fighting forces loyal to the Prime Minister. Our clinic was in Tong Ping, the very epicentre of the fighting. Emails flew back and forth - what should I do? I was very uneasy about returning with the situation so unstable. The management told me to wait on standby to see how things progressed - Andrew gave a very different story and advised me to not come back at all. I was asked to fly to Nairobi, and wait in a hotel there for further instructions - after consultation with a few of my friends  it looked like I could be there for a while - the airport in Juba was closed until further notice, and the fighting was now in the streets of Tong Ping, with Andrew reporting heavy artillery fire and tank fire just outside the compound. I declined the offer of Nairobi, and told them I would wait it out here . The clinic staff were turning off the lights and keeping their heads down, praying that the clinic would not be the target of hungry, broke looters. Our neighbours, the Norwegian Army, had offered safe haven (although, like all the peacekeeping forces there, they did not carry weapons). Although they were next door, it was too dangerous to actually go outside the compound, so a cunning plan was developed as an escape exit strategy - and here I do not joke. We share an adjoining wall, and on our side of the wall there was a ladder. On reaching the top of the ladder, there was a fishing pole and line, which was to be used to hook up the matching ladder on the other side, to make good their escape . Cunning indeed. That was, in effect, the exit strategy. With South Sudan being landlocked, all the borders were closed, the airport remaining closed,  they really did just have to wait it out.

The company eventually hired a private plane to evacuate the ex-pat staff as soon as the airport was functioning again. A plan was made, and they got ready to leave, being allowed only to take a small bag of possessions each. The day before, I received another email asking me to remain on standby, and would I consider working another month to get the clinic up and running again - there seemed to be a bit of a lack of joined up thinking here....

Off they trotted to the airport, feeling slightly smug about the private plane, when the tiny airless waiting room was full of hundreds of ex-pats, all waiting for seats on scheduled flights, desperate to flee. Can you imagine what it must have been like, to see a plane land, and nose-dive on the one runway, its front wheel completely collapsing. No-one was hurt, luckily, but  nothing was landing or taking off until the runway could be cleared - it was by now about 3pm, and there being no landing lights, the airport simply couldn't function after 6pm due to the light. Somehow, a tank was commandeered to clear the runway, and planes began to furiously take off and land every few minutes to stay ahead of the curfew. Thankfully my team got out, and I breathed a sigh of relief upon hearing that they had all arrived at a hotel in Nairobi, and were sleeping without fear for the first time in 10 days .

Andrew has returned safely, having managed to salvage some photos for me that me that were irreplaceable, although that was about all he did manage to salvage - I envisage several South Sudanese running about in my shorts much to the amusement of their friends...
The clinic was locked down, and no-one really knows if it is still in one piece. The local staff have all returned to their families, and we have heard from most of them that they are OK. With so many ex-pat companies pulling out of Juba, it is unlikely that they will have any work in the future, and I feel desperately sorry and worried for them .

So my adventure was cut short by a few weeks, but what a few weeks, and I couldn't have asked for better timing of my leave - although there is a part of me, now that I know everyone is safe, that wishes I had been there, and it would be my story to tell. Still, probably for the best !

Who knows what will happen there next, and whether URG will open the clinic again - I suspect not, although they do not appear to have given up hope yet.

I, on the other hand, am back to ward work, for an agency, and it's killing me - but that's another post, this one has been long enough already.

Goodbye Juba, it certainly was an experience.

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.

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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 !!!!