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