Safari heaven - a final word!

No neon signs just a simple gate and sign welcoming you to the Serengeti – but what a wonder of delights awaits. Like a child in a sweetie shop I felt like an owl with my head on a swivel trying to take it all in. The name Serengeti translates from the masaai into ‘endless plains’ and it is not hard to see why. On these endless plains ‘piles’ of animals – a new collective noun for a group of safari animals spotted from your viewing platform riding high in the open topped safari jeep.

Animals just getting on with their daily business – a leopard snoozing in the tree with a paw nonchalantly swinging, lions lunching on wilderbeast or sunbaking, elephants taking a dust bath, giraffes chewing and chewing and chewing and chewing some more, hippos playing their tireless game of ‘now you see me now you don’t’ as they dip under the water to keep cool, zebras migrating in their thousands as far as the eye can see yet all in single file across the road like a true zebra crossing….

Every day something different to see, something exciting waiting around the next corner, all wild and unpredictable; a real delight. For me a true treat and a perfect way to round off my time here in Africa. I strongly recommend it to all. Already have a strong inkling that there may be a return trip …. so better start saving hard!

Time now however to fly home and see puss puss my own wild animal, family and friends!

See you all soon

C x

The mentors have left the building!

The day has come to pack up our little house at Kolandoto and wave goodbye to all the friends we have made over the last 3 months – it has been a lot of waving! Folk were at our door from 6.30am this morning; I’d like to think to wave us off, not just to check we were going! Last night Cosmos (our pharmacist) and Mary (our lovely home help) invited us to their church for an hour to say cheerio. Four hours later, after much ‘joyful marching’ down the aisle, we were still there being treated to a full on African style farewell party with all its little customs. A night to remember – particularly as Grace and I were made to strip down to our undies and bra outside the church under the light of the moon in order to try on the new dresses that had been made for us as leaving gifts! We have been spoilt and have some gorgeous tailor made, African outfits to come home with which fills me with girly glee!

I have mixed feelings about leaving. Obviously I will be sad to leave behind some very special people here but I am equally excited to be seeing those people who are special to me back home. We have been living, breathing, eating and sleeping this project and it will be weird to relinquish control and put our trust in others to nurture that which we have sewn. But this is what we must do. For those who have been reading my whiffle over the last few months you will recognise there have been ups and downs and challenges a plenty but I feel very positive about the overall state of affairs we leave behind. I think we are leaving on a really high note having put our heart and soul in right to the end.

In the last week we have set up 6 individual income generating projects for the volunteers using money kindly donated by Grace’s church. The idea is that by providing the volunteers with a small business opportunity you are supplying them with an income from which they can choose to support themselves and their families or their patients or both. It is a motivation tool to try and enable them to continue with their sterling palliative care work. They currently received the equivalent of £1 month which even by Africa standards is insulting and this is likely to stop when the budget ceases. It is our way of trying to induce some sustainability into the project and it feels like a really important thing to do. Pigs and chickens were their request as they breed well and money is generated from selling the eggs, meat and manure. So having purchased 13 pigs and 124 chickens we have learnt a lot about pigs and chickens this week and can now add animal husbandry to the role of a palliative care mentor! If laughter is good medicine I think everyone should be encouraged in their lifetime to round up pigs!

The cherry on the cake for us came on our last day. We managed to meet with the RMO (Regional Medical Officer) and after productive discussion he agreed that adding palliative care to the regional medical budget proposal was both important and necessary. He is meeting with the powers that be within a month and will discuss this further. Inner cartwheels of delight! If this comes to fruition this will be a huge success story for the Shinyanga palliative care project.

It is funny. I looked up mentoring in the Oxford Dictionary – verb; ‘to advise or train (someone, especially a younger colleague)’ or noun; ‘an experienced and trusted adviser.’ From what I know of ‘mentoring’ in Africa I can promise you - it is about so much more than this. And to all those who ‘mentor’ me in life (both at work and home) I thank you. I now appreciate all that you put into the role.

But for now these two mentors are hanging up their boots for a while. You will find them over the next week gawping at animals in the Serengeti and trying to make sense of all that they have seen, heard and experienced over the last 3 months. The final test I think will be saying goodbye to my mzungu partner in crime, Grace, as we go our separate ways at Heathrow airport. It has been a journey in life shared and all the better for it.

Can’t wait to see you all and share with you more stories when home.

Sending some final love from Africa

C x

and then there was Mishepo....

A Royal wedding, Bin Laden no longer and my baby brother being accepted to do a phD at Birmingham University. Go away for 3 months and the world goes crazy! So back to the sanity that is Africa (chortle chortle) and to Mishepo…

An hours bumpy ride on untarmac dirt roads (supportive bra mandatory!) to be greeted by the biggest welcoming committee I’ve ever seen. Oh how lovely thinks I. Except it quickly transpired that this ‘welcoming committee’ was indeed our own outdoor patient waiting area and we were about to do a ginormous GP style surgery. Now I have to be honest if I’d wanted to be a GP I wouldn’t have gone to the trouble of squirming through an interview to become a palliative care registrar. And if I’d wanted to be doing hard core diagnostics in the field so to speak without proper examination or investigation facilities I would have remained a GP!! (respect to all you GP’s out there) But GP I must be this day and thankful was I for my training. I have figured in my time here in Africa that it is sometimes easier to ‘go with the flow’ rather than fight against it! So we ploughed on through various aches and pains, coughs and dysurias, symptoms that had been present on average for 4-8 years, no they had not seen a doctor about it, yes they had tried ‘some medicine’ (who knows what, certainly not the patient!) and we did some best guess medicine and signposted in appropriate directions or handed out painkillers and antibiotics appropriately. Sadly their hope for cure was one thing we could not offer – no magic wand regardless of the colour of our skin. Our efforts were rewarded at half time by a meal of fried monkey nuts, fried chicken (coated in egg) and surprisingly un-fried sweet potato! Prioritising is not a concept readily practiced here in Africa so Grace and I had to interject as we watched the waiting room numbers swell! There was the odd palliative care gem within this bunch of walking wounded; a lady with marked lymphoedema of her leg and arm due to HIV related Kaposi’s Sarcoma and I suppose one could argue that many of those with pain could fall under our remit as there is no-one else looking out for these people in the community.

Day 2 in Mishepo and off to see the really sick people in their homes. Interestingly this is where I received my first marriage proposal; Grace has already had hers! For Grace; a 24 year old lad (we think), local (we think), lives with his grandparents (we think), still at school (we think) with a penchant for bending the truth and a desire to marry a mzungu! On the plus side he makes the best donuts in Kolandoto (sampled and confirmed!) and will offer for her 1 whole goat. For me; a chap who can’t remember his age (not uncommon around here and I’m often writing 70 ish or 80 plus in the notes!), apparently a famous traditional dancer and musician. Has his own house (thatched none the less) and vegetable plot. Sadly also has all the symptoms of probable HIV and this would probably explain the use of the word ‘famous’ – is however willing to offer for me, 20 cows. I will leave you to decide who you think has the best deal!

Bundled into the visiting this week we saw a very interesting chap with fascinating health beliefs. Having had a stroke with right sided weakness 6 years ago he now has the nastiest infected ulcerating foot wound. All of this, he puts down to having been bewitched by a witch doctor at the request of his jilted lover. He has consequently not seen a doctor for his problems as he believes he cannot be ‘cured’ by medicines until the curse has been removed. Despite attempts to convince him that his problems are due to the fact that he smokes like a trooper and has a BP of 170/120 he was having none of it. Really he probably needs his foot amputating but he humoured our suggestions to seek advice from the hospital politely before saying he would think about it. So in the meantime – some pain killers, antibiotics and wound care. This man has not been out of his small bedroom for the past 4 years. Sitting there in the darkened room, lit only by a small window, across which there were bars, I could not help thinking this man was in his own prison both physically and spiritually in light of his beliefs. Talk of mobilising a local pastor to come to his home (as he cannot get to his church) was met with approval and may be his saving grace if he can be cleansed of his curse. In the meantime our wonderful palliative care team will continue to support him whatever the outcome.

It’s a funny world in which we live.

Sending love

C x

Our own royal visit!

The ‘official’ visit went rather well all in all I think. There have been several issues troubling Grace and I relating to the nature of the running and co-ordination of the project (too sensitive to document openly on this megaphone of a blog) - but having Karilyn and Richard visit; with their years of experience of working in Africa, grey hair and an ability to speak Swahili, has been a huge influence and certain issues are now on their way to being addressed in earnest. There are also plans afoot for more work in the area which is very exciting indeed.

Our royal couple were also here for our morphine training day which went exceedingly well (silly choice of word as I am now side tracked by the thought of Mr Kipling cakes…) – so anyway it went tremendously well except perhaps for the moment when I lent on a wonky desk and sent the plastic morphine bottle with its amber coloured gold elixir crashing to the floor. Heart sink panic all round as I frantically scrabbled around on the floor to check the bottle had not smashed and sent our precious morphine everywhere. Thankfully not a single drop spilt so the controlled drug book remains balanced and my character remains intact!

Following this we held our first palliative care team meeting. We have been trying to get a regular meeting off the ground since we started but trying to get Tanzanians to meet all together at a set time is like, as Cosmos the pastor put in in his sermon this weekend, “ trying to get a ‘big horse’ through the eye of a needle!”  Bless him – we have now taught him the word for camel! But anyway the meeting finally took place – I think helped only by the fact that they were promised their ‘incentives’ (pay) on the same day. So the carrot and stick approach worked and the meeting took place and a rudimentary palliative care register was formed and various issues raised and discussed. Whether this continues when we leave is sadly not so hard to predict but a ‘date of next meeting’ has been arranged in part I think to humour the mzungus!

It was also national Albino day whilst Karilyn and Richard were here and Shinyanga this year was hosting the national festivities. It would have been rude not to have gone for a nosey out of curiosity. Albinos are currently lobbying the government for free sunscreen which is very expensive to protect them from skin cancers. I also learnt that since 2008 there have been 15 Albino killings in Shinyanga alone as there is a superstitious belief that having the organs of an Albino will bring you riches. Doctors have even been known to fight over who will circumcise an Albino patient so that they can keep the foreskin remnants….. nasty! So all in all quite a scary prospect to be an Albino in Africa and hence necessary events like this to raise awareness and support.

So - our mission at present is now to devise some sort of ‘exit strategy’ for our departure in 2 weeks time. Our Blue Peter wall has a list as long as my tape worms (!) of things to do between now and leaving which covers things as diverse as visiting those patients on morphine one last time to ensure tight mechanisms in place for follow up when we leave, to making thank you cards, sticking up referral posters in the regional hospital after our final teaching session there on Wednesday, meeting one last time with the RMO (regional medical officer) to fill him with enthusiasm for palliative care and encourage him to include palliative care in his budget plans, to buying gloves as leaving presents, cleaning our house and sourcing pigs, yes pigs! I’ll tell you more about the pigs when and if they materialise!

Anyway - time for bed said zebedee

C x

Gremlins at work - interfering with blogging process! Will post as soon as site fixed. At present it seems very in need of some palliative care! Cx

Morphine delivery - Africa style!

The morphine delivery service continues to function – not always quite as smoothly as we’d hope. The rural service on Thursday arrived spectacularly to the patient’s home; 3 on a motorcycle and straight into a bush! Tears of laughter all round and certainly one way to make an entrance! Cosmos the pharmacist our driver is not always so handy behind the wheel and his gear changes often leave a lot to be desired. Achieving air between you and the seat not always ideal either over the bumpy roads – but all in a days work! The urban delivery service on Friday used public transport to get morphine from Kolandoto to the patient’s home in Shinyanga. So a rather tense journey on the packed dala dala bus (hiace) with a bottle of morphine stashed in my bag but it made it safely you’ll be pleased to know! Both patients are doing well in terms of their pain and have really benefitted from using morphine which we are chuffed about. A few issues with constipation to resolve but we’re working on it. Rather bizarrely whilst buying Ducolax (a laxative) in the local pharmacy we managed to catch a quick glimpse of the royal wedding party which was playing on the BBC world news service. Didn’t get a proper look so will have to catch up on some trashy ‘Hello’ or ‘OK’ snaps or something when I get home!

Interesting ward round at the regional hospital on Wednesday – full of young people with hideous pathology of uncertain origin. The lack of access to basic investigations and basic treatments means people are really poorly managed and there is an awful attitude here by staff that ‘we can’t do anything.’ Grace and I are trying to gently challenge this (particularly when it comes to basic care and analgesia) but we can see also how hard and demoralising it must be, to be a doctor in this country at times, when resources are so limited and people are so poor and cannot afford even the test and treatments that do exist. Do you know, families even take home moribund, imminently dying relatives as it costs 3 times as much to transport a dead person back to the village than a living (albeit only just living) person? To think that in your last hours you could be on the back of a bicycle or in the back of a taxi travelling over bumpy roads is horrifying but a reality here. I have never taken the NHS for granted but for sure will appreciate it a whole lot more when back home. That and running water you can drink from a tap, electricity at the touch of a switch, the privilege of having had a good education and many more things besides….

I will also appreciate

No longer having to stick ‘Mr Men Bite and Sting plasters’ all over my mosquito bitten legs to try and stop the itching. They have been a godsend (thanks mum!) but I do look a bit of a berk wearing Mr Tickle and Mr Bump on my ankles at the age of…

No longer having to light candles at night when the power has gone off using ‘Lucky Matches’ – aptly names because you’re ‘lucky’ not to take your eyebrows off when you strike them!

No longer washing my hands before I eat at the Millennium Social Club (our local in Shinyanga!) where they work on the principle that the water has to be scolding enough to take off several layers of skin in order for your hands to be properly clean…

No longer sitting down after a hard days work with the intention of relaxing or enjoying some quiet time to be greeted by ‘odi’ at the door (the traditional greeting as you enter someone’s home) followed by multiple visitations. You cannot turn people away here! We had 8 visitors the other night – the last one arrived at 9.50pm!! I felt like getting into my pyjamas but I think the subtlety would have been lost…..

Or perhaps I will miss these things? Time will tell.

We have just 3 weeks of work left here in Shinyanga. This week is an important week as we have Karilyn and Richard coming from the UK to meet us. They are key people in the running of this palliative care project and have overseen multiple projects in the roll out of palliative care over Tanzania. So we are on our best behaviour this week!  (It is possible for me to behave sometimes!) The prize at the end of 3 weeks is a long awaited trip to the Serengeti…. I just can’t wait!!

For now sending lots of love as usual. Hope you’re enjoying the bank holiday break.

C x