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.

Saving Lives...

Firstly, if anyone wants to the check the weather in Juba, we suggest here.

Now follows the real stuff...

I wanted to just follow-up our previous post a little. Matt wrote about life on the Emergency Medical Ward in Juba and some of the difficulties and frustrations that that can entail – some of the patients are extremely sick and like many nations in the developing world (due to a multitude of factors) many people die in Southern Sudan who perhaps wouldn’t in the UK with our education, ambulances, hospitals, intensive cares and the like.

Look at that handsome devil

But we’re keen not to give the impression that clinically it’s only very bleak. Quite the opposite in fact. The immense and very real challenges of dealing with such desperate situations generate an immense sense of teamwork, friendship and almost family feel amongst the hospital staff here. (“Communitas” one of my favourite authors would perhaps describe it.) Without meaning any offense to any in the UK,  it’s one of the best working environments (from a staff morale perspective) I’ve ever worked in any hospital. There’s just not this much laughter back home. This is extremely rewarding in itself of course, but the medicine is also extremely professionally satisfying, as illustrated below:

Cleaning day

We’ve been having a good couple of days – the doctors are dribbling in again from the strike and the patients have all been quite stable and many clinically quite interesting. Today, Sister Anna alerted me to a patient outside, whom had not registered on my radar on my initial early-morning-ward-triage sweep. The reason he was outside as a new admission is because it’s Wednesday cleaning day, which is a whole other story... (I think Dave dealt with this on the blog last year. In summary: patients out, ward cleaned.) His story was one of 3 days of persistent vomiting and diarrhoea without the ability to maintain any oral intake. Examining him, I’ve never seen anyone quite so dehydrated. Very dry, Sunken eyes, reduced skin turgor, the works. He was also drowsy, unable to stand, freezing cold and clammy to touch (despite the >30 heat) a blood pressure so low he just didn’t have any radial (wrist) pulse to feel. In short, textbook signs of hypovolaemic shock.

Anna, being the awesome nurse she is, had already got two intravenous cannulae in and was fetching the fluids when she got me. Anyway, the point is this guy was at death’s door on arrival and thanks to the great team on the EMW was immediately picked up, and prompty fluid resuscitated. I couldn’t honestly believe the change after just 1 litre of fluid given IV – his warmth came back, the clamminess disappeared, his peripheral pulses returned and his heart-rate fell nicely. He actually told me “I feel much better – thank you. I thought I was going to die.” And he was right.

Some monkeys we saw at breakfast one day

 Now, I’m under no illusions here – the hero of this anecdote is of course Anna, who basically saved his life and my role as a doctor was more of a formality :o) However, the point is that it’s tremendously satisfying to treat patients like this. The stakes are high – most people are very very sick. But simple things done well and promptly can really save lives. It’s important to remember the success stories along with the sadder ones.

So there we are. In other news, we had a great evening the other night, wandering home in the evening to the mess, we saw a couple of the consultants (Mergani and Kajomsuk: O&G and Chest Physician respectively) just hanging around, having some tea. One of the many things I love about this place is how some of the best experiences just come along “unlooked-for” (to use a Tolkienien word). We cancelled badminton and just sat and just sat and chatted and laughed and the lady gave us some soup stuff she was cooking to try... it was great. They’re such good fun.

Anyway, that’ll do for now.

James & Matt

PS The following photos are mainly for Dave Attwood's benefit. Compare and contrast the progress of the landscaping from 2008 to 2009!

 

Week 3

A fine week in Juba. I feel we are acclimatizing to life, work and indeed the climate quite well. After a humid morning on the emergency medical ward (EMW) this morning a spot of lunch in the nearby Central Pub was in order. Being the wet season, sudden downpours are common and heavy with thunder, lightning and power outages.  The sight of two Kawajas (white people) scuttling back to the hospital taking shelter from the storm got plenty of joyful laughs from the school children we passed.

We got caught in the rain on the way back from lunch

The shouts of “Morning!” (whatever time of day it is) and “How are you?!” from small smiling children greet us on most of our trips out and about. We are quite a novelty. Although it turns out the little ones that come to the hospital from the villages far afield are less sure of us – often never having seen Kawajas before.

Emergency Medical Ward
This week on the EMW started dramatically. If you don’t mind, there’s a bit of a medical case history here – a bit involved but paints a picture of some of the patients here.

Shortly after arriving on the ward, one of the excellent nurses Sister Anna pointed out a very sick man who had arrived the previous day. 31 years old, he had rapidly progressing fever and reduced level of consciousness. Treatment for malaria and widespread infection of unknown origin had been started.

From the start, it was clear this man was very unwell. He was all but unresponsive and the snoring noise heard from the end of the bed indicated he was not maintaining his airway which was becoming blocked. He was breathing at 50-60 breaths per minute (very abnormal) and was incredibly hot to the touch (there was no thermometer available to take his temperature). It is important to remember this man had been completely well just over a day before.

James put his anaesthetic skills to good use and maintained this patient’s airway while I searched for an oropharyngeal airway (basically a plastic tube used to allow someone with a blocked throat to breathe).  A single one was found on the other side of the hospital. With the help of the medical ward doctors we gave this man treatment for this widespread infection with antibiotics, anti malarials and fluid resuscitation. There was no oxygen available to give and no further blood tests or imaging that could be done. There is no intensive care unit, nowhere in which to escalate treatment.

Despite being given all the care and treatment available he was too unwell to recover and died early yesterday evening. His case was more severe than many patients in Juba but not uncommon.

Some of the patients here come to hospital after a difficult and long journey from the villages outside the city. The standards of nutrition, drinking water and basic sanitation can be very poor and people are often very sick before they can make it to hospital for treatment. Malaria and typhoid fever, often severe and life threatening is seen and treated here every day.

The Emergency Medical Ward (EMW) in action

Despite this we have seen patients make impressively quick recoveries with appropriate treatment. They are often much younger than many of the patients I would see in the UK or New Zealand and their physiology can take much more of a battering.

The efforts of the nurses and doctors on the wards and the other JTH staff are Herculean. They work in very difficult conditions with very limited resources. Sometimes the hospital runs out of the most basic medicines, fluids and equipment. For many reasons I am merely beginning to appreciate (not least of which the destruction of this country’s infrastructure by many years of war) many of the therapies, imaging and blood tests that are taken for granted in the Western World are unavailable.

Despite these difficulties and the bewildering array of pathology seen, staff remain focussed and in good humour while working long and difficult shifts. Two of the doctors on the EMW have worked every single day that James and I have been in Juba, including weekends and several night shifts.

Matt & Dr Dobol, a very hard-working medical officer (SHO)

A Note On Hand Shaking
It’s a simple thing, shaking hands. A greeting, an affirmation of trust or of friendship through physical contact. Simple and quite wonderful. It is the culture here to shake hands with colleagues and friends on each meeting – sometimes several times per conversation for emphasis! Being stopped several times on each walk across the hospital makes for slow progress at times but is one of the many pleasures of living and working with the people in Juba.

James and Dr Maker. Note: James is 6 ft tall and has size 11 feet. 
These guys are built on a different scale!

So that’s my first attempt at blogging, hopefully not too wordy for you all... We spend our days working on the wards, meeting and getting to know the doctors, nurses and pharmacists here. We have a preliminary plan for some research into the medicines and fluids prescribed and their availability – the JTH pharmacies often run out of vital items and patients’ relatives (if they have any) have to take a prescription to an outside pharmacy to get treatment. Patients without relatives are not so fortunate. We are working closely with the staff here as we want to initiate research/audit that is:

1.    Wanted by staff
2.    Useful and important in improving patient care
3.    Replicable (we are only here for 3 ½ months)
4.    Feasible for James and I to undertake.

All the best from Juba

Matt (& James)

PS If you're reading this as a Facebook note you might like to consider visiting the blog direct at http://onedoc.blogspot.com

Quick Note

Just to let you know if you click on the photos you can get a bigger image.

If you care...

:o)

Second Week Stuff

Hi there. So here we are again – I’ll give some updates from the last week. A couple of amusing anecdotes and some other issues.
 

We always liked this old truck. It’s a nice feature in the hospital.

We’re doing pretty well in general and are settling into the hospital routine nicely. Matt and I agreed that it’s best not to rush headlong into any programmes or modifications, so we’ve been working hard in more a ‘shadowing’ (with participation) role in the medical department and elsewhere to get a feel for the hospital system. Obviously I have 4 months of experience last year but things aren’t always the same and time spent understanding and observing in the early stages is never wasted. So we’ve been working in and understanding outpatients, the emergency medical ward, chronic wards, pharmacy etc. We’re making progress, and seeing a lot of really interesting pathology.

Some interesting pathology...

In a lot of ways the last couple of weeks have been quite atypical in the life of JTH for a couple of reasons. Firstly the junior doctor’s strikes: this is certainly public information in Juba so I’m sure stating a few of my observations will be ok. I know there’s been some rumours, circular emails and anxieties back home about the current situation, so I thought I’d comment:

Since Monday last week (our first day!) a number of the house officers and medical officers (F1/HO and SHO equivalent in the UK) have been on strike in protest to not having been paid their incentives by the MoH for the past few months (a sum of several thousand US dollars each). In the very early stages there was apparently some nurse participation but this seems to have resolved. This has lead to the hospital being run by skeleton staff which is not ideal for patient care, but it’s still generally functioning. However, news/rumours of the situation have permeated Juba and is generally leading to fewer admissions as patients aren’t bothering to present to the hospital at all. I was looking at some admissions figures from the Emergency Medical Ward (EMW) today and a couple of weeks ago admissions were 30-50 per day, whereas for the past few days it’s been only a handful, and the chronic wards are virtually empty.

Some nice weaver birds in the hospital (to break up all that text).

There have been several negotiations between the Ministry and the Junior Docs but as yet I still don’t believe the situation to be fully resolved. This was further complicated by an unfortunate one-off episode last Thursday afternoon when some policemen turned up at the Doctor’s Mess (where we live although we weren’t there) and allegedly beat some of the doctors that weren’t working. Now I haven’t actually met any eye witnesses/victims so I don’t know the full details, but it seems to have been a relatively minor affair, although all the doctors clearly felt the threat of any violence completely unacceptable, which didn’t generally help matters in general. There have been more negotiations since and it’s unclear where the edict to the police came from, but everyone seems to condemn the actions and there’s certainly been no more trouble of that nature on the ground that we’ve been aware of. In general the senior directors in JTH are doing exceptionally well at holding the hospital together and still managing to provide emergency care to patients under these difficult circumstances.

Matt enjoying a fine lunch at the Sister’s excellent (cheap) restaurant.

A separate issue that’s been registering more on the NGO radar over last week but has less implications for us was a GoSS curfew (one day only) and military operation searching households and compounds seizing illegal firearms from civilians in Juba. Most of the hospital staff approve of the operation and it seems to have been conducted professionally.

From one report:

"Thousands of illegally and privately owned weapons including RPGs, PKMs, Kalashnikovs and pistols were retrieved in the town’s residential areas. Among them also included 12.7 anti-aircraft weapons privately owned by individuals.

The minister of Internal Affairs, Gier chuang Aluong, said the operation was aimed at freeing the town from armed criminal activities. Speaking to Sudan Tribune by phone, Majak Kuol, a resident of Juba in Atlabara B, said they started a cordon and search operation in the town early this morning. He added the joint operation by the SSPS and SPLA was a peaceful exercise acknowledging having been restricted movement."

Also anecdotally it seems to have worked. Chatting with some of the surgeons they tell me that they haven’t admitted a single gun-shot wound so far since the operation, so it seems to have been effective, which can be no bad thing. (Last year I was certainly seeing a few gun-shots per week.)

So on the lighter side of things, we’re making the most of the place. Our accommodation basically backs onto the Tearfund compound (with whom Dave and I made many friends last year) so we’ve been hanging out there a bit in the evenings playing badminton with a couple of their guys. Also they’ve kindly agreed to provide our evening meals which is just a real blessing, as the hospital is willing to pay and it’s good value all round. Recently we also tried our hand at some vetinary medicine...

Jasper the friendly dog.

So they have a puppy (rescued from marauding monkeys apparently) who’s a lovely little dog. Anyway, he needed an urgent blood test doing for quarantine regulations one day, and the vet couldn’t come (due to the aforementioned curfew.) Not afraid to try new things, we agreed to have a stab at it, so to speak. We didn’t have any knowledge of how best to go about it, so consulted the AQA text service, which astoundingly works here in Southern Sudan. They recommended the jugular approach, but we rejected this on the grounds of a) complete ignorance of the relevant anatomy and b) proximity of his teeth. A bit of exploration revealed a decent looking leg vein and with two assistance on restraining duties (which Jasper thought was a great game) I manned up and got 10mls without too much trouble at all. So there’s a first for us, but I always like learning new skills.

The tempting veins...

I generally like animals but I had a bit of a shock the other night when bedding down I felt something exceedingly strange scurry up my leg. Turned out a lizard had crept up there into my sleeping bag earlier and was probably just as indignant as I was at having it’s sleep disturbed. Anyway, we chased that out and now I’m more careful about tucking my mossie-net in firmly in the day time as well as night.

That darn lizard.

That’ll do for now. This week’s going pretty well and we’ve achieved most of our planned objectives for the week already, and some ideas and strategies are germinating so we’re feeling pretty good. More to come soon...

James & Matt