Tuesday August 27th 2013

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

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

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

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

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

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

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

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


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

Saturday 17th August 2013

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

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

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

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

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

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

Except when there's a cat about.

Thursday 15th August 2013

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

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

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


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

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

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

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

Monday August 5th 2013

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


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


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


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


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

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

Monday 29th July 2013

It's been a strange old week.

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

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

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

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

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

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

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

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

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

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

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

Monday 22nd July 2013

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

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

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

Monday 15th July 2013

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

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

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

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

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

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

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

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

 Funnily enough, it's all OK.