Villages, moving around, playing and working...

Sunday was a great day spent at a tin tin-shack church, swimming and canoeing in the full-to-bursting river and watching Kambia 1 giving Kambia 2 (or the ‘new town’) a good beating on the football pitch... amazing how quickly rivalries can appear – I was definitely a Kambia 1 supporter!

Canoe

We got paddled upstream in a half-tree trunk canoe. I’m glad to have actually seen one after buying a load of mini-replicas in Freetown’s big market...

Football

Come on Kambia 1!

Monday was a day out in the villages... it was really quite an amazing experience. Driving through this beautiful countryside in a white 4x4 (now this is what they’re designed for) we pulled into a village and were met by the local chief. After a few discussions and the gathering of what seemed like ALL the local children, we were led into a thatch roofed roundhouse where we were able to interview people connected to the ambulance project. After a while we bought some sweet oranges straight from the tree, and ploughed on with the work. As the sun was coming down we moved to a second village where we were told that the interviewing would be happening ‘under the mangoe tree’.... you couldn’t make this stuff up!

On the drive home the sun was going down, women carried sticks on their heads and their children on their backs. At one point I turned round to see a woman pumping water from a well into one of the many yellow jerry cans with her child tied in the traditional way to her back. You couldn’t have pictured a more ‘typical’ scene and it really was stunning. I’m very lucky to be here in Kambia...

Unfortunately, but i suppose necessarily, all this fun stuff running around villages collecting data means that there’s now tonnes of data to look at. Which basically means sitting in front of the laptop and tap tapping away. A bit of a shame, but I suppose the elective isn’t really meant to be a holiday! No lack of fun though, a couple of friends from the UK ‘popped in’ on their way from London to Freetown in a Landrover Defender. Quite jealous of their 6 weeks or so meandering down here and am feeling quite inspired to do the trip again, this time with more time to enjoy and fewer cramped taxi journeys...

Week one - tick!

So, Kambia week one is over. It feels amazing to think how much has happened in just a short amount of time.

Kambia is clean, green and brilliant. It’s a fantastic escape to the countryside really. Kambia town is the administrative centre of Kambia district, which makes up Sierra Leone’s northern border with Guinea. The roads are all ‘Africa red’, definitely the colour I would imagine from films, TV etc. There are hardly any cars, and just a smattering of motorbike taxis around. People are really interested in meeting, chatting in broken English and trying to teach me Temne...

Cycling round the town here I’m greeted with shouts of ‘Oporto’(White Man) from children at every turn...attempts to explain that I am not usually considered to be a ‘White’ man are met with incredulity. Perhaps I need to learn the Temne for ‘Black child’...or maybe not.

Home for the month is peaceful, beautiful, with an awesome set-up. It’s the old Medicines Sans Frontiers base – complete with lots of living space, proper good ex-pat design long-drop loos, people to cook and clean for us, bikes, everything you could want. There’s even a bloke doing carpentry in the grounds who’s teaching steve.

I can see why people from the Kambia Appeal fell for this place. It’s really rural, and beautiful. As with everywhere round here, there’s not many doctors... or medicines. I had a tour round the hospital, and was a little sad to see that the patients have dried up for various reasons, but having said that – there seems to be loads of primary care type stuff going on... child vaccination drives, mother and child clinics, you name it it seems to be going on here. Can’t wait to get out into the villages to check this stuff out some more.

So it’s been a great start to the rural part of the elective. Here’s a few photos.

Cycling round Kambia on donated ex-Royal Mail bicycles, what a world...(and LOADS of health promotion billboards around the place!)

And, after the focus group, the real reason the women were keen on coming to see us “We have answered your questions, now can you please examine our bellies!”

The ‘office’

Ambulance

The famous life saving ambilance!!!

Under tree

Interviewing under a mangoe tree, you couldn’t make it up...

Moving on to Kambia

The freetown end has come to an end. I’ve grown quite fond of the place, and am getting used to being here... but definitely looking forward to making it out of the city and into the countryside... who knows, maybe I’ll spend less time on the internet and more time being with people ;-)

So it’s good bye to Freetown, goodbye to the Connaught (and medicine)... now for some researching for the Kambia Appeal in the north of Sierra Leone.

A few photos of the last week or so...

Dr Rogers surgical firm

Me, a couple of med students... and a patient (permission to put on blog duly granted!)
Fun fun

Fun and games on the beach!

What am I going to do when I grow up...?

Spent the last two days with a British surgeon. A really nice guy, he taught lots about the old surgery... and my knowledge levels are definitely up. But even more interestingly I've had the chance to have a peek to around 10ish years in the future... might I want to come back once I've grown up?

Well, working as a doc here would certainly be a clinical challenge... a whole load of new diseases, people presenting at a much later stage of their disease, having to charge for services and turn away those who can't afford... but what of the non-clinical aspects? Well, skills like managing a workforce, accounting, and knowledge of drug procurement aren't things I've learnt so far at medical school but it looks like they'd definitely come in handy... maybe that's where the dreaded international NGOs come in handy, in doing all that stuff for you.

I think I'd like to come back... it's too difficult being here and having to just watch.

A week on...

Spent last week in the surgery department at the hospital here. The operations are reasonably familiar, and techniques are based on the same surgery that I know from home (and that the surgeons learnt in various places abroad). The setting is quite different, and the availability of equipment is quite poor... no need for further details.

I suppose the hardest thing is always seeing people die in a way that I'd term 'unnecessary'...as subjective as that might be! I would expect to see that here, really. But the hardest thing on this trip has been those people who - by good fortune, money, or something - have made it to the tertiary referral centre for the whole country, they then spend loads and loads of money before dying. What a way to go unnecessarily - surrounded by trained healthcare professionals, drugs, equipment and a bankrupt family.

Plenty of patients of course dying that I wouldn't like to put in the unnecessary (or immediately unnecessary perhaps?) category... and there's loads of underlying reasons why surgical patients end up presenting way too late, or without money to pay for their operation, or can't access investigations or medications post-operatively. Hmmm.

Confusion

Thanks to everyone for their kind words about the blog! Its very rushed, and not too thought through so I've been quite pleasantly surprised that people are enjoying it!

I really want to write about the hospital, and the differences/similarities... but to be honest the reason I haven't is because I'm finding it too difficult. I was prepared to enter into a low-resource healthcare setting... and expected to find a lack of equipment, drugs etc... but I suppose I had this kind of idyllic thought about the people being the saving factor... battling away against the odds to make the best of a bad situation.

What I now realise is that of course resource affects people and their ability to do their job massively... healthcare worker motivation isn't just something that people write about in international health journals, it's a real problem... in addition to poor support and pay, many just don't have the training for the jobs they are being asked to perform.

So, I suppose it's difficult to write about, because I don't really understand the problems, their causes and the effects that they have on patient care. What I'm glad I do realise is that when people don't act in the way I'd expect, I need to think think think, and definitely not judge judge judge.

Rain rain rain

Over the last hour, Freetown's roads have been turned into rivers. As I sit in this internet cafe I am looking out over a petrol station and road. One side is completely unusable and is flowing fast enough that to be on it in a canoe would be quite a lot of fun.

Anything smaller than a 4x4 is not bothering to use it, and people who try to cross and being pushed further and further downstream. The irony of the taps that have been dry for 8 days hardly needs pointing out, but the World Service did lead their news bulletin last night with "Water Water Everywhere, but not a drop to drink...".

According the BBC, average rainfall in Freetown in August is 902mm, this compares with the rainiest time in London (I think November) of under 50mm...