Category Archives: Medicine

Camp A…

There are two IDP camps near the hospital. We went to the one a little further away, found a tree (a difficult job in itself) and set up our mobile clinic. 

Women and children first was the request, but men would still try to sneak to the fromt of the line. Most complaints were simple to sort out, and worsened by chronic dehydration. It feels awful to tell people they should try to drink more water when the country faces drought. Most children have small round scars or fresh burns made by traditional healers. Diarrhoea, constipation, headache and fever are common. Plus the chronic diseases plaguing all societies. The double burden of disease is truly manifested here. 

We work through each patient via the translators, treating as necessary, giving public health advice and any medicine we can. Follow up is arranged for those who need it. A few very sick patients are taken in the truck back to the hospital. 

And by 11am the sun is so strong we have to leave, apologising to those still waiting and promising to try return in few days..


Setting the base…

At 7am, after steaming hot somali tea and a bowl of oats, one team headed to the hospital and one to the closest IDP (internally displaced persons) camp. I was part of the hospital team. Our job: to set up the hospital. Piece of cake…

We started by organising the space. Choice was limited, but we found two desks and put them in the rooms with least sun, in the hope of not melting whilst seeing patients. Creating a physiological systems-based system the cupboards were stacked with medicine. One shelf cardiac, one shelf Gastro. Three shelves antibiotics and rehydration solution. Etc. 

We called the engineer to fix the lack of running water in the toilets. The lab, full of never used analysers and a capable technician has no reagents, these go on the list to be ordered. In the female ward we find babies with measles. The males is a mix. Later on we open a third ward for mother and child to prevent measles cross-infection.

A few hours after we started, we were ready to see patients. Just as soon as the interpretors arrived…

What (not) to wear, in Somaliland…

Whilst waiting for the aforementioned permission to work I decided I should find some Somaliland-appropriate clothes. The fashion rules are pretty simple here, expose nothing higher than mid upper arm or ankle and cover the head. Women dont wear trousers so long skirts or dresses are the mainstay. If you think this leaves no room for individuality or glamour you’d be wrong. Headscarves can be worn in a number of ways, wrists are often adorned with gold, eyes may be heavily kohled, colours are bright and in the evening the dresses are embroidered or beaded and quite beautiful. 

I asked Fahima, the lovely operations manager at The Institute of Public Health to help me in my quest. Somaliland born but European raised she moved back recently to expose her children to her culture and help develop the country. So, along with friends we got a driver to take us to the local market after early breakfast. But not before she made me change from my UK clothes in to a traditional dress she had bought from home. ‘Its a traditional area’ she said. Translation: even thought you arent showing skin you still look too foreign.

The first task was negotiating entrance to the market. A labyrinth of sellers and stands and woman on the floor fanning flies away from wonderfully scented morsels of food, all piled under canvases slung between buildings. The matt of sellers spilled  into the street and we picked our way carefully to the shady market core. Once inside we had to choose materials, based on colour, pattern and textile. When all you wear is a large sack and a headscarf these details gain heightened importance. Cloth procured, we headed to the seamtress to get the dress, aka dirac, made up. Finally, the finishing touches – headscarves in complementing colours. 

And then came the fun bit, as we sat on plastic chairs the girls asked for the household items they needed. One by one, items were brought by young men eager to make a sale. A lady came round and we picked through her handmade jewellery. An old man wandered past with hot cups of somali tea. After deciding on the purchases to be made a man arrived, piled them into a wheelbarrow and off we went. Navigating our way out the shadowy market and in to the singing sunlight.

That should’ve been the end of the trip, but as we bumped our way down the chaotic streets towards home one of the girls spotted a fan she wanted. Immediately, the driver stopped, on a roundabout I should add, and shouted at the shopkeeper to bring it over. Hanging out the window, holding up a hooting line of traffic behind (with not an eyelid batted) the fan was examined and plugged in to demonstrate its power. It was paid for by saad, a kind of text payment sent phone to phone. And off we went, allowing the roundabout to function once again..


This is the view from my hotel room in Hargeisa. A hotel room I hadnt really expected to be in, since the plan for this trip was to go to ‘the area of most need’ which is unlikely to be the capital city. But there have been issues getting started, in order to travel we need permission from the government, and permission is slow to gain. Whilst we wait we sort our supplies, procure medicines and analyse maps and security reports, read research papers on Somaliland, drank copious amounts of tea and had many formal and informal meetings.

This evening we met the Minister for Education, State Minister and some other important looking people. We explained our case, our plan, what we needed (essentialy just permission) and still we need more meetings. 
Luckily though, Ole, the german social worker working closely with us, is a man with a plan. He identified a second possible location and is waiting permission from the sultan of that area and security confirmation that we can go. The plan is to set up a hospital as a referral centre, and then to undertake mobile clinics in the most affected areas, IDP camps etc. But for now, we wait…

The inverse care law…

”The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.

The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources.”

Trawling through medical and economical literature on health inequality/inequity this afternoon….  This quote by Julian Hart from The Lancet in 1971 seems even more relevant today as it probably was then.  And it strikes me that perhaps some of the UK policy makers *cough Jeremy Hunt *cough* should review the knowledge base linking economics, health and inequality and rethink some of the recent movements that seem to be aimed at dismantling the NHS.

Just a thought.

Distinctive deaths…

The most distinctive causes of death by state, 2001-2010.

This incredible map shows the ‘distinctive’ causes of death in each US state.  That is, the cause of death that is substantially higher (in these statistics at least double the standard national rate) than in other states.  An outlier in terms of dying.  Some states, apparently, have more than one outlier, some are shocking, but I dont think many are completely inexplicable.  Its a nice (can we say nice when discussing death statistics?) way of showing the impact that socio-economic and cultural factors have on our health and wellbeing, right up to the way we die.

Someone I was discussing this with stated they’d like to see the map in relation to distinctive deaths divided by English counties.  I just cant imagine there would be many outliers, not to the extent we see here.  There are certainly areas of depravity and areas of wealth, but on the whole I think we are a much more integrated society with less cultural differences than observed in the US.  I could be wrong of course, so I’d also like to see that map…

(you can read the original article here)

How not to paraglide…

What do you get if you cross a paraglider with an intoxicated 20-something year old?

3 fractured thoracic vertebrae, 2 fractured lumbar vertebrae, 6 fractured ribs, a remarkably stable pelvic fracture, a haemopneumothorax, and a partridge in a pear tree… 🎶 (sorry)

Now, call me old fashioned but if I were to hurl myself off a cliff attached to what seems to be nothing more than a large kite, I would want to be sober and securely strapped in, at a minimum.

(For those with curious minds, the person in question made a remarkable recovery and continues to enjoy flinging himself away from solid ground towards midair, albeit likely with less booze on board)