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...

What would it be like to be a doctor in Freetown?

Medics here 'take a history' from patients who present with stories or sometimes symptoms. They then 'examine' the patient thoroughly. So far, so normal, for me as a UK-medical student in training. As usual we don't know where our patients come from or the often tortuous journey they've been through till the point at which we 'clerk them in'. That too=pretty normal. But it's the next step that's different.

In Leeds we send off a raft of (or - hopefully - a few highly targeted) investigations, receive the results and use these three things (History, Examination, Investigations) to formulate a management plan. Here in Freetown (1) patients often can't afford to pay for their investigations, (2) the investigations take till the next day to be processed and (3) even if they point to some manageable medical condition there's no guarantee re: availability or affordability of the necessary medicines.

Obvious points, perhaps. But the cost of this is not only seen in lives lost and families bereaved, but in a seemingly endless negative spiral where highly trained, highly competent staff have to struggle to fulfill their professional duties, to serve their patients and to gain the satisfaction of a job well done.

Here we've been taught the great value of the first two parts - History and Examination - as well as the massive benefit of a decent clinical judgement. Each person can only act to the best of their abilities in a given situation but it must be difficult for people here having constantly to swim against the tide.

Beach

Freetown baby! Paradise + odd concrete block= great place!!! P.s check out those clouds... when it rains here it really really rains!

Breaking down.

No words required!

Broken down. Check out that back tyre.

Broken down, again. We spent two days in...this. Manda Droit to Conakry in 42 hours...

Quite an odd feeling

It’s quite strange being here... there’s obviously so much medical need, there’s a lot of ill people and a health system that struggles. Obviously what needs to happen is that there needs to be loads more facilities, medicines, operating theatres, staff etc etc... and all infrastructure that’s needed to support that. BUT...what of these thoughts of working as a doctor here in years to come. Would there be any point? If you work in medicine you need medicines...if in surgery, equipment. Hopefully will meet people doing just that and be able to think a little about the future. I suppose the answer may lie outside the government hospitals and in the NGO sector... which seems a shame (although they do have lots of nice shiny jeeps).

Freetown Baby and nice people & English.

Not your standard first night in Sierra Leone... we arrived at the border at 5 past 9 (closes at 9) and slept in this 'interesting' hotel. Not the best...

Woop woop! Made it!!!! What a horrible night. And what a horrible morning (border guards not that pleasant shall we say). But we made it to Freetown. It’s great to be here, and absolutely amazing to have James here to look after us – just what the doctor ordered after all that travelling. He has sorted us out with a room for the night, food, water, a phone, internet access... (all the ancient & modern basic necessities).

EVERYONE here loves talking to us. They just look or say ‘hello’ and if you say hello back, you enter into this whole ‘how are you, I am fine, how is your day, my day is fine’ thing – incredible, and it’s amazing how people genuinely just want a little chat... I’m sure this is real.

It’s also fantastic to be in an English speaking country... we really are able to get around with no problems – Krio is really similar to a basic form of English, obviously with different vocab (eg food = chop!!!!)... but we really can communicate – good decision.

Charles Taylor

Went to the Special Court for Sierra Leone today. Amazing to see the place where justice is trying to be done. Sat on Charles Taylor’s bed (He’s in the Hague now).

NGOs (Non-governmental organisations for the uninitiated)

Everyone in Freetown knows what an NGO is. In the olden days they were known as charities. Freetown has representation from every single person and organisation that wants to do good. Oxfam and here, so are ActionAid, plus what feels like a trillion others! They have white 4x4s and offices in the West part of town. I might be a little sceptical of the benefits they can bring to a place (all theory though, just from reading!) but I never questioned their motives. I assumed it was understood that they are the good guys trying to do the right thing. Since arriving in Freetown though, people have not agreed with that. I’ve mentioned to lots of Salonians that I’ve never seen so many NGOs in one place... and it’s always been responded to with a comment along the lines of ‘well...they’re only here for money’... strange, but there seems to be a feeling that NGO pay and conditions (white 4x4s, breakfast lunch & dinner in fancy restaurants, best apartments in town etc) is the reason for the work rather than actually supporting local people. I obviously don’t believe it, but there’s surely a bit of work to be done by these organisations on improving their image...

The hospital

Starting to understand a bit more about the hospital now. There’s some things that must be really frustrating for patients and health workers here... for example, patients can be admitted and seen by the medical and nursing teams... but not have the money to pay for their investigations, making it impossible/really really difficult to proceed with any decent management plan. So... suspected hepatitis? Lie in your bed until your relatives find money to pay for liver function tests...it’s difficult for everyone involved. More on the hospital once I’ve figured it out a bit more!
p.s – saw a 27cm liver today.

Being a medical student

Today was far less scary... we joined the student intensive coaching class again. Dr Deen asking questions as is his want... today ‘the 7 serious manifestations of malaria’ amongst others... good day of learning, although I didn’t see too many patients. Today was diabetic clinic day – it’s quite amazing how many people seem to have diabetes and high blood pressure – way way more than I would’ve expected.
I’m obviously aware that diabetes is not a ‘rich man’s disease’, and know about the ‘double burden’, but didn’t think that SL would’ve have been that far along that path as of now. We discussed lifestyle modification with the houseofficer who mentioned advising patients to cut down from their usual (say 1.5pints (pint here=330ml)) to half a pint of OIL. I thought this was e.g per week, but it turns out he was talking about per MEAL. Maybe we’re starting to understand a little bit.

First day at the hospital

After a false start yesterday (turned up, doc asked us if we were ready to start – we said no, and left) we got going today. Woke up early morning, far too early for a ‘holiday’... arrived at the hospital in our unironed, humidified(!) clothes... don’t think i’m going to be clean till Leeds...
On arrival we joined the back of a gaggle of medical students (right pluralisation) for the morning ward round. First up I was asked to present an x-ray... not my area of expertise unfortunately and the nerves took over. Never mind.
We were soon incorporated into the gaggle, with Dr Dean feeling free to ask us questions and everyone happy to teach us lots. There are some final year students around who’ve just got one small exam left so they’re pretty much at the peak of medical school knowledge.
Clerked in a girl with a sickle cell crisis and saw lots of presumed malaria cases... it’s going to be real interesting!

Housing – is this ‘how it works’?

Hard to believe what happened today. After all the discussions and thinking about how to get a flat, it turned out that talking to lots of people was what won the day. After visiting a few places (Phoned one agent, who picked us up in a flash white pickup truck, dressed in a sharp suit & gold watch, within 4 minutes... another gang of blokes took us to a flat up a hill which they didn’t have the key to and then said “wanna move in?”... unlikely without seeing it!?) we ended up waiting for a taxi...
...instead of a taxi, a normal car pulled up and offered us a lift. Slightly confused, we walked away but people shooed us back so we got in. Turns out the couple in the car were a policeman and counsellor from the Sierra Leone Special Court (trying Charles Taylor...big UN thing). After mentioning our housing desires to them we ended up with a phone number... 20 minutes later we were at the Special Court security checkpoint and 5 minutes after that we were chatting away with someone there who ended up being able to put us up...in his colleague’s house. Odd – but people keep saying that this is how things work here...(maybe for foreigners!)...

House, beach, rain, wet.

Woke up early. Today is the day to find a house. Mr Jalal said “if you see it, you will move in”, and others were similarly happy... but the COST!!! It seems that Freetown is full full full of NGOs and the UN, and costs are way higher than expected... $1000 for a month seems pretty standard...yuck.
Got our first views of the beach today – what a great city, beach sea hills –I like it here!
But the RAIN... it pours, and it pours most of the time. And the air is thick with moisture. I don’t think I really appreciated the extent to which things can be wet. I’m sure clothes don’t dry on the line, they rot.
No house yet...

House, beach, rain, wet.

Woke up early. Today is the day to find a house. Mr Jalal said “if you see it, you will move in”, and others were similarly happy... but the COST!!! It seems that Freetown is full full full of NGOs and the UN, and costs are way higher than expected... $1000 for a month seems pretty standard...yuck.
Got our first views of the beach today – what a great city, beach sea hills –I like it here!
But the RAIN... it pours, and it pours most of the time. And the air is thick with moisture. I don’t think I really appreciated the extent to which things can be wet. I’m sure clothes don’t dry on the line, they rot.
No house yet...

Army checkpoint in Guinea.

I’m lying on a bamboo bed, at an army checkpoint in Guinea. Quite a surreal experience really. Surrounded by leafy green trees, little thatched huts, people milling around...chickens, a beautiful sunset... it kind of feels like had I been here 50 years, 100 years ago, it would’ve been exactly the same(And have photos to prove it, but on my phone!). And yet, this is supposed to be Guinea, it’s supposed to be a dangerous place... everything seems to be working out. The taxi we’re in is loaded up high, pretty entertaining as usual... although the driver has just left in the taxi and I’m not sure when he’ll be back...

Postscript... he came back 4 hours later. Bloody hell what a ridiculous night. We ended up driving in the pitch dark over horrible potholed roads (average speed around 10mph)... not only that, but the Peugeot 505 was full (9 passengers), sweaty and hot. AND it was raining. AND we stopped in a village in the pitch black (literally – couldn’t see Steve sitting next to me) and were expected to sit for the night (or so we thought). It ended up that we were waiting for a 1am ferry... but our driver and fellow passengers decided not to tell us that part. Claustrophobia took over and I really felt quite sick crammed into that tiny box in the back of the Peugeot 505...I had to be let out, got completely soaked. What a horrible night.

Arrival at the Guinea border

Entering Guinea – even though “FCO say NO”
So, sitting here at the Guinea border. Funny little place. Dusty area filled with shopkeepers, policemen, banana sellers and military. Usual array of people milling around – not quite sure what they’re up to...
We’ve arranged a taxi to take us to Conakry direct from here, there’s been a bit of chat about how there’s some bandits around and how people need to travel by convoy – but we don’t seem to be doing that...fingers crossed I suppose.

Steve getting a French lesson...

Back to it.

Got my book, got my Steve - and we're back on the road!

Last night was quite crazy – left Dakar at around 5pm by bus (after missing the ferry – “full”!!!), unfortunately broke down on the outskirts of the city – leaving about midnight,... we arrived this morning 11am, about 10 hours late... as the guy in St Louis told me “C’est la charme de l’Afrique”!!!

Back on the road... Dakar to Casamance by bus. No back to my seat, crammed in between two ‘traditionally built’ ladies. P.s – this is me pretending to have a clue about car mechanics.

Dakar, Senegal

Have had a great week off in Senegal. St Louis is a fantastic little old town... once the capital of French West Africa, it now feels little a sleepy place! We drank, made friends, wandered around, went to a national park and generally had a good time. Claz came up from Dakar – really nice to see her. Then we headed down to Dakar, the big capital city. Bit of a big city – and I think they take a while to get used to really. Anyway, it was nice to relax in Claz’s pad, see a bit of the city and we had a day trip to the Ile de Goree – most Westerly point of West Africa... famous for it’s role in the slave trade from these parts. We were shown round by a fantastic guide, it really is a historical place. Not nice though.

Holidaying!

On arrival at the youth hostel in St Louis there were a bunch of Frenchmen sitting around drinking beer and chain-smoking. What a gang. Without showering or even thinking we had a nice cold local lager sliding down. Amazing how time can fly.Lots of chats with the Frenchmen and there’s a couple of English girls here. Eeating drinking and being merry – definitely don’t want to leave for quite a few nights, I reckon it’s holiday time. Maybe we won’t have to go to Dakar at all.. especially if we can convince Claz to come up here to meet us.

View from the back of a desert car... woop! No more of this left!!!

Senegal arrival

We have arrived in AFRICA... the food has changed, the people have changed and the way things happen seems to have changed quite rapidly. After breakfast in our taxi driver’s family home(What a nice man, and more importantly what a smooth talker Sebastian is!) we crossed in a little pirogue(boat) and were ‘helped’ through customs by a ‘friend’ - probably unnecessary but who knows...
...sat on a bus in a bus-park for 6 hours... in the heat. Well, obviously you can’t just go – have to wait for the bus to fill up! Goodness me. And we’re going to a place I haven’t even heard of St Louis apparently.

’brushing my teeth’(with a twig) on the way into Senegal...

The desert

Quite an experience. We knew there’d be a desert to cross, and that it’d be hot. Don’t think I really understood how hot though, and quite how deserted a desert can be! On the other hand, the roads were fantastic – straight, new tarmac roads all the way. Basically you’ve got absolutely nothing on either side, just scrub, wasted land. White, yellow... no green, no blue and nothing else all day. We got a coach all the way down to Dakhla, then taxiland through Mauritania.

Only problem=no dunes. Only barren wasteland...(lets see if i can get these photos to work!)

This is desert...where’r the dunes?! I think we must've gone the wrong way...

Arrested driver, and other stories (including 3 hours sleep)...

What a crazy journey.- arrived in Mauritania early on today... our driver managed to get arrested on the Nouakchott entry checkpoint – lots of kerfuffle(spelling) and our bags fully searched... the only thing they were really after was booze (contraband in Mauritania) and what was it that the border guard wanted me to give him as a ‘cadeaux’... nothing but my hand washing gel...made from, you guessed it, alcohol... ah love ironies...
Desert taxi – this thing really moves!

Got a lift off a custom official to Nouakchott, massive hassle getting there, but on arrival...what a place! A great auberge, lots of overlanders hanging around. We dropped the bags off and went off in search of food – successful... a great little family place, and although they’d closed we had a private little dinner of chicken and chips(!) served in a tagine!!! A 17 year old girl who spoke good English served us and we chatted about the relative merits of myspace, facebook etc... what a world...We met a Frenchman too, Sebastian. He’s going our way and suggests that we go with him in about 5 hours. I think we might just do that...!

Desert taxi – this thing really moves!

End of the earth.

Left Dakhla, a.k.a ‘end of the earth’ early this morning. A rude awakening by our taxi driver at 6.30am was a little unexpected but then our French is lacking quite significantly. We bombed it through the desert... a long straight good road that allowed us to bomb it through this barren landscape. The desert certainly isn’t beautiful – not dunes and pleasantness that I might have hoped for. It’s dry dusty barren and quite eerie. Anyhow, it is amazing place to have seen and a reminder of how much space there is kicking around the world – solar panels, anyone?
p.s – had a cup of tea in the Mercedes taxi in the desert. How? Well, I had smelt gas a few minutes before being offered this hot cup of stuff but didn’t believe my nose. But yes, it’s true. Someone whipped up a brew on a camping stove whilst seated in the passenger seat...
p.p.s – the W Sahara/Mauritania border is one of the strangest places I’ve seen. It’s a no-man’s land, owned and cared for by no-man. Instead, it has become a dumping ground for unwanted car tyres, cars jeep and buses from Europe... apparently if the Mauritanians don’t allow them in there’s no point in driving them back up to Morocco so they’re left to die in the baking heat. Some incredible sights, quite disturbing actually –but no photos unfortunately, they’re quite strict about these things and I didn’t want to be told off...

Western Sahara=Morocco so say the Moroccans...

Western Sahara is covered in Moroccan flags. Quite a place. The desert just stretches for miles and miles. We travelled in an air-conditioned coach – not quite the vehicle I expected, and probably not one that really added to the experience... I think a jeep would’ve been quite adventurous or even better, a motorbike would give a great feeling for the landscape. Anyhow, I don’t suppose I should be complaining about comfort... difficulties will come, and when they do I don’t suppose I’ll be loving it...(or will I?).

View from the bus window – I think it's fair to say that W Sahara really isn’t the hip happening place of the moment...

Marrakesh comes alive!

Marrakesh is quite a great place. Last night we saw the main square in the city come alive...from around 4pm traders arrived armed with stalls, stoves, fuel and food. Out of nothing, in only a couple of hours, emerged a great array of street shacks serving food to the assembled masses of Marrakesh. Not only that, but freshly squeezed orange juice is constantly available for a measly few Dirhams... After feeding and watering, we walked round this amazing square soaking up the atmosphere – families strolling, couples cavorting – dancers, actors, and storytellers... it’s a case of ‘choose your entertainment’. And this happens EVERY night...!

Overnight train to Marrakesh - highly recommended!

Train from Tangiers to Marrakesh overnight last night. Great train, they provide sheets, blanket etc. And seem to want to look after their foreign visitors – there’s a special carriage with a man to look after you!

Day in Tangiers...

Hard to believe that such an exotic land can live quite so close to Western Europe. It feels like an Arabic place, and it’s definitely different! Drinking mint tea and watching the world go by was just about as strenuous as it got for me but definitely fun. Slightly daunted about the trip ahead, but I’m sure it’ll ‘all be fine’...right?

The famous Mint Tea.

Luxury travel...

Travel travel travel. So far it’s all been in luxury. First the National Express train from Leeds to London, then the Eurostar to Paris then a Eurolines coach to here - Madrid. Woke up this morning on this coach to a fantastic Spanish morning jingle... today’s gonna be a great day!