Tag Archives: global health

Daily frustrations…


If there is one word to describe this trip so far it is frustrating.

Things that frustrate me (disclaimer: this is potentially a moany venting post):

  • The slow pace of negotiating something that should be straight forward.
  • The failure of leaders to overcome their differences
  • The inability to see how dragging of feet means more suffering for the people
  • The total waste of resources that should be used to help not hinder
  • Flies
  • The truths, half-truths and outright lies that people tell (and trying to figure out which is which)
  • ‘Somali time’ aka if we say we leave at 4am we might leave anytime between 4 and 10. But be ready, just in case
  • The constant reminder of the worlds inequities
  • The fact that my ‘shower’ (rusty pipe dripping cold water hanging precariously from the wall) doesn’t work
  • Having to wear a headscarf all the time but not knowing how to prevent it blowing into my face and having to totally rearrange it following a gust of wind

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…

The narrative analysis…

This is why in every succeeding remembering moment, the story will likely be revised as the present becomes the past anticipating a certain future that bestows a meaning on the whole.

Sometimes you get given a paper to read for research methods class that is so stale and devoid of colour that no will in the world could allow you to reach the reference section. And then you get Brigitta, the women I wish was my adopted grandmother. A retired childrens nurse who continues academic work “for fun” a bespectacled, grey haired and humorous lady who, due to her extensive experience both in the field and home, seems to knows anyone who is anyone in global health. And Brigitta gives you a paper that makes you cry, one that makes you think and one that makes you question everything.

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)

Cinterandes mobile surgery unit goes to Palmar

Palmar, the sleepiest fishing village

At sparrow fart one sunny Monday morning we made our collective ways, bleary eyed, to somewhere I cant remember now in order to board the Cinterandes minibus to Palmar.   I sensed this journey was going to be a bit dry so the first action I took, to inject a little fun into the looong journey, was to set up a sweepstake on the time it would take to arrive at our destination. By the time we hit Parque National de Cajas the responses had been recorded in a completely fair and impartial manner and we settled in for the ride.  The journey took a total of 6 hours 47 minutes, which meant I lost, although I’d like it to be known that if we hadn’t stopped for a (delicious) seafood lunch at a random sand-side ship restaurant then I would’ve won.  I hate losing.

The beach came complete with roaming cows!

The beach came complete with roaming cows!

As soon as we were dropped off at the centro de salud, run by a south Korean nun and a German nurse/midwife (I think), we were confronted with the task of sifting through the patients they had identified as being suitable for surgery.  Because of the transient nature of our visit to this sleepy fishing village the patient selection was meticulous.  Patients need to be able to withstand the anaesthetic and operation well, as they are only kept overnight at the centro de salud and follow up is by telephone.  Therefore, if patients have health problems such as untreated hypertension (high blood pressure), heart problems or current infection the risks of surgery outweigh the benefits.  This selection process meant that of the 30 or more patients who needed surgery only around half were suitable.  We worked late into the night taking histories and pre-op-ing the patients, the operating list was drawn up, we ate, we slept.


Breakfast was at 7.30 and operations started at 8am.  A circular system developed whereby students took it in turns to scrub in on cases either acting as scrub nurse or assisting, then looking after their patient in recovery before returning to the truck for another case when their patients’ observation period was up.  We worked in pairs and mainly stayed with patients we had met the previous day, this meant my cases included a laparoscopic cholecystectomy (keyhole gallbladder removal), a small child with an inguinal hernia and a young man with an epididymal cyst.  That evening the lovely ladies at the centro de salud cooked us a huge dinner but before we could retire, exhausted to our beds we were whisked into the minibus, still attired in scrubs to take a post dinner wander around crazy Montanita, the nearby surf town known all over Ecuador and South America for its incredible parties and great waves.  As we wandered past the hippies, the travellers and the people who looked like they really had a story to tell I noticed that everyone was looking at this motley crew dressed in blue pyjamas wandering aimlessly through the sandy streets and I realised that if the folk of Montanita are looking at you funny then you really are in trouble…

The crew hit up Montanita

The crew hit up Montanita

Wednesday was our last day of operating, it was more of the same but the cases were perhaps slightly simpler as we were leaving the next day so wouldn’t be around should unexpected complications arise.  Anyway, after we had wrapped up at the clinic the big boss people took the decision that we should go for a fancy dinner to celebrate.  Of course, a fancy dinner in one of the small villages on the Pacific coast of Ecuador is not the same as a fancy dinner in say, London or New York.  So we sat on uncomfortable chairs and chose our treats from sticky laminated menus while every member of staff watched the on-going football match on a tv the size of a greeting card.  We were told, with no hint of irony, that the food would take a while, because of the aforementioned, very important, football match.  Luckily a random Swedish guy someone seemed to know turned up with a bottle of whisky which was passed around without mixer, much to the dismay of my taste buds.  I could tell you about the rest of the evening, but I will spare you the details, because it involved a trip to Montanita, cocktails, a bottle of the local lethal liquor Zhumir on the beach and a lot of dancing.. besides, what happens in Montanita, stays in Montanita…


Getting to work in the truck


p.s. you can read the official details about our trip on the Cinterandes website here 🙂