Fire and Food

So it turns out Hollywood has been lying to us. For years I’ve been lead to believe that a couple of stray bullets here and there, or maybe even taking a speed bump too fast, is enough to make a car explode in a massive fireball. We now have reason to question these assumptions.

Whilst walking to dinner the other night, we found an (empty) car in the middle of the road with flames coming out of the bonnet. (People were around and no one seemed to be injured.) In anticipation of the potential imminent explosion, we scuttled on past to address the more pressing issue of dinner. The hotel where we ate was only a little way down the road and we were sitting outside so we certainly would’ve heard something if it did go off. We essentially sat down, had a drink, ordered food, ate it, had another drink and chat, paid up and walked home. And still not even a pop from the burning vehicle. And this afternoon, on the way to lunch, it was still there roughly intact. Hence the photo.

Tearfund's Compound

Unfortunately for the poor contractors, this incident took place on a road that’s currently being re-surfaced. It’s a process we’ve been watching with interest for a couple of weeks now. It’s a main road, and there’s usually at least a couple of massive juggernauts digging and flattening the earth. The road is blocked off at either end of course, but there’s seemingly a more relaxed attitude to health and safety and related regulations here. Often cars will remove the barriers drive down the work-in-progress nonetheless: “How dare you stop me driving down that road...can’t you see I’m in a Land Cruiser?! Out of the way – I’ll dodge those bulldozers...” So everyday it’s flattened and every night churned up again by traffic. And now there’s a burnt-out wreck there to cap it off! Poor guys.

We had a nice relaxing weekend.  On Sunday after having been to church and had lunch at Comboni (and watching Napoleon Dynamite), spent a fine evening (beautiful weather) in Tearfund’s compound playing guitars. We eat there every day so I thought I’d put a photo up or two to show you the place. It’s very relaxing (if the Guinea Fowl are absent, there’s no call-to-prayer, and Jasper’s behaving.)

The particular dinner I mentioned in the second paragraph was a weekly special treat – pizza at the Paradise hotel. (5 mins walk away from our house.) Parma ham and olives. Delicious. That’s our Sunday evening treat of choice. For the sake of completion, I’ll share our other routines:

Breakfast is had in the office before work (where we have our fridge.) This is either weetabix, or bread (bought on the day) with processed cheese or some other (marmite, peanut butter etc.) with instant coffee. The mid-week treat is on Wednesday, when we go for the omelette option, again at Paradise. Their coffee is also excellent which helps.

Lunch revolves between the Sisters’ Kindergarten Restaurant and Central Pub. Both about 10 mins walk from the hospital. Sisters’ sells proper Sudanese food and it’s generally beans and rice. We’re not up to eating one each (big portions) so we share one. That means we eat for $1.5 each. Job done. Central is a Lebanese restaurant and isn’t good for much, except they bake fresh pitta bread throughout the day which is excellent. Combined with a humus dip and green salad, you have the makings of a very refreshing lunch in the heat. Way more expensive though at around $15 each, so we only go for that twice a week.

Friday lunch is another treat. Again, the sisters, but it turns out their chips are superb. I’d be extremely happy to be served chips of that quality in a UK chip shop. Combined with the beans, you have a winner.

(Evenings Mon to Sat we eat dinner at TF for a bargain price of $5 each per night which is very nice.)

So there we are. Hope that clears that up. I’m planning to come  up with a more serious and reflective post soon, but we’ve got quite a bit on this week so hope that’s ok.

James & Matt

Week 5 (Boring title)

Hello all. Week five is here already, hard to believe. My time in Juba continues to provide wonderful insights into a different culture, climate and continent. We are both learning a great deal, seeing things I’ve only read about in textbooks and remain grateful recipients of the kindness and good humour of the people in Juba.

Here follow some events and observations of mine from the past week or so. Those who know me will be all too familiar with my enjoyment in discussing all sorts of random facts and I’m afraid James’ blog gives me ample opportunity to do just that...

A note on language
The most commonly spoken language here is Juban Arabic – quite different from the classical Arabic spoken in the North, with its own vocabulary and pronunciation. Even to the untrained ear it is relatively easy to tell the two apart (even if you can’t understand what’s being said). We are picking up a few words – mostly medical I suppose. Hello is “salaam” thank you is “shukran” and pain is “waja”. As in, “waja-ras” – headache. At times our history taking is reduced to pointing at parts of the body and inquiring “waja?”

Since white folks here are called “kawaja” I certainly hope “ka” isn’t the Arabic for “arse”.

The language of medicine, including patient’s notes and prescriptions is (thankfully for us) English. Most of the staff in the hospital and a few of the patients have a very good command of English which is infinitely useful for us in our daily work.

Along with Arabic there are numerous tribal dialects spoken, reflecting the cultural diversity of this part of Africa. The Dinka, Nuer and Bari languages are spoken by those respective tribes along with many others, sometimes instead of Arabic. One of the medical officers (SHO doctors) revealed the other day that he speaks Arabic, English, Dinka, Nuer, Bari, Spanish (he trained in Cuba) and can even get by in Finnish!

As well as regional dialects, Juba attracts workers and travellers from all over Africa. We’ve seen several Kenyans and Ethiopians in particular with whom we speak English.

Today we witnessed a four way conversation from a Nubian to a Somalian to another Somalian who spoke in Arabic to Dr Andrew (the medical consultant) who kindly explained to James and I exactly what was going on in English! I think all of us, especially one of the Somalians, saw the humour in this somewhat bizarre interchange – especially as it was, rather predictably, about poo.

Sunday Morning

Last Sunday we had the pleasure of a trip to the Juba Cathedral with Father Joe (one of the Comboni priests that Dave and James stayed with last year). We arrived just at the end of the Arabic mass and watched Father Jo lead the English mass to a packed congregation. The cathedral itself is a huge concrete structure and the largest building I’ve yet seen in Juba, with a high arched ceiling, grand tropical hardwood doors and a fine aroma of burning incense.

There were hymns, prayers and bible readings from Father Joe and several members of the public. Also the President of Southern Sudan was present and walked directly past us on his way out!

I particularly liked the part at the end – I think it’s called “sharing the peace” - which is typically Juban I think. Everyone in the cathedral embarks on an attempt to shake hands with their neighbours and each person who is even remotely within reach. A break from what I would think of as the formality or grandiosity of some church services I found it to be quite a touching demonstration of brotherhood and togetherness. 

Above all of this I will probably remember the singing the best. The small choir sat in the front row led each of the five or six hymns in beautiful harmony that filled this vast building. With no instruments other than an occasional drum and with no preamble, they launched into perfectly pitched song with effortless timing and impressive volume each time. Having rarely been to church, I have dim memories of half hearted choruses of “Oh come all ye faithful” from early school. This was a world away from that and I would like to see (and hear) a lot more while I am here.

Work
This last week we have been involved in some research regarding caesarean sections in JTH. Each caesar – elective or emergency – is recorded in the operating theatre logbook along with indication for surgery, type of anaesthetic and the baby/ babies’ weight and sex. Dr Murgani (consultant obstetrician and all round lovely man) asked us to look into some of this data last week as the information has been dutifully recorded for some time but not fully analysed.

After a flurry of digital photography of the logbooks, a crash course in Microsoft Excel (for me anyway) and some time and effort we have catalogued the 430 caesarean sections performed at JTH from October 2008 to September  2009. Today we also summarised all non-operative births over the same period – over 3500 in total. Phew. We are currently going through the data and generating a report on indications for surgery, foetal and maternal death rates, anaesthetic used etc to present to the obs and gynae department.

As I’m sure Dave and James alluded to last year on their trip to Juba, opportunities for learning, teaching, research and hopefully being useful often come unlooked for and from unexpected sources.

On last week’s blog
Just wanted to point out that when James said “you might think from the above...” in last week’s entry, I’m fairly sure he wasn’t speaking in reference to the picture of the monkey scratching his bum which, by pure coincidence, was placed directly above. This would be terribly rude and not at all in line with the kind of serious image of ourselves we wish to portray. Hope that clears that up ;o)

Week 4

So here we are at the end of week four, and I don’t think we’ve been looking forward to a weekend break this much for a while.... Work’s going well but we’re upping our level of responsibility clinically on the Emergency Medical Ward. We’ve tended to employ a rather deliberate strategy of hanging back for the first few weeks whilst we observe and figure out the place (and the pathology) but now our role is naturally growing and evolving (certainly in terms of pure clinical service-provision for the hospital) rather well.

On Thursday, for example, for some reason there were no doctors on the ward, so we did the whole round ourselves with nurse translators. This went pretty well, and I think was an important milestone. Still, it was about 50 patients and took all day. Language slows things down, and on average people are far sicker than in the UK, and they take time. However it’s nice to feel useful and just do pure doctor stuff. These days we’re very familiar with managing malaria, typhoid and acute diarrhoeas these days which is most of the tropical medicine we see routinely. There’s actually far more interesting medicine here if you look for it - much is more familiar territory... Diabetes, GI bleeds, strokes, cardiac arrhythmias, heart failure,  liver failure, renal failure, anaemias of varying causes, epilepsy, chest infections, meningitis, asthma, deliberate self-harm (overdose), cancers...even “collapse ?cause” :o)

It’s a challenging environment to work in though; physically, it’s hot, humid and sweaty (and often a little smelly) on the ward. Clinically it’s challenging not only to know what correct management is or should be, but also a whole other level of clinical problem-solving comes into play i.e. what can be done with the limited resources we have here? (This of course applies to investigations as well as treatment.) Emotionally, it can be draining to handle the incongruence between those two particularly when most days people young people die of acute diseases who almost certainly wouldn’t have in the UK.

You may think from the above that it’s a struggle to get up to go to work in the morning, but you’d be wrong. There’s a really special sense of teamwork (not to mention humour) here amongst doctors and nurses, not to mention the satisfaction derived from patients that are successfully treated here – and that’s the majority. I’ve seen young folks literally comatose (GCS 3) from cerebral malaria one day and walking and talking the next. Quinine may well be my favourite drug. I said it was challenging, which it is, but probably more rewarding for that. It’s no holiday, sure, but who really cares?

Having said the above, it’s important to have a bit of emotional insight and get some good relaxing in too. Fortunately Matt and I share many of the same relaxation pursuits. (Many is the evening discussion we’ve had along the lines of “Those Orcs aren’t going to slaughter themselves...” :o) And there’s healthy amounts of guitar playing and film watching and coffee drinking and pizza eating all happening. So it’s good.

Personally, I’m continuing my experimentation with Catholicism and spending a lot of my Sundays hanging out with my Comboni chums from last year. Last Sunday we went over the river to a new monastery-type outfit that had just been built for its official opening by the Bishop. The Mass was really fun actually, lots of great African singing and dancing. The children in particular made me smile an awful lot. The chap at the door mistook me at first for a priest and tried to seat me on the stage (a little embarrassing as none of the other Priests had come in yet and I would’ve been on my own) but luckily the Comboni Sisters (nuns) were all sitting in the front block and understood my dilemma (with much amusement I may add) and let me sit with all the ladies. It was all in good humour though so no problems. All followed by a delicious Sudanese lunch. So that was that. I’m going to the cathedral tomorrow so that’ll also be an adventure.

Two final notes:

Firstly, one of the stray hospital dogs has adopted us and follows us everywhere now. We don’t know why and certainly haven’t encouraged it in anyway. We try and kick it away but neither of us really has the heart to actually harm any animal particularly, particularly one so mournful looking. (The attempted kick becomes reminiscent of The Simpsons’ Mr Burns’ “I’m giving you the thrashing of a lifetime...!”) I found that a splashing of cold water quite effective, but then we saw it getting all picked on by another stray pack and felt bizarrely sorry for the wretched beast. We’ll see what happens.

Secondly, at breakfast the other day we beheld a man using a modified bicycle to drive a grindstone to sharpen blades. Personally I thought it was one of the most awesome things I’ve seen for a while, so we had to take a photo. It reminded me so strongly of something one would find in the back garden/work-yard of Kitchener Road that I felt a bizarre sense of kindred. Anyway, there it is.

Thanks. Bye for now.

James & Matt

PS Also check out this huge beetle I found.