Thursday, October 15, 2009
I've been really wanting to write something, but just didn't know how.
I just got an email from a friend in Namibia, a few minutes after opening up one of my bags. My stuff has been stored at my parents' and FINALLY it arrived in Norris Point. We've just moved into a more permanent house (beautifull by the way and PLENTY of guest bedrooms... It's a bit big for 2 people, but it's the off season in Gros Morne, so very very cheap...) Anyway there was ONE bag I was looking forward to unpacking. The bag I packed last before leaving for Namibia, so all those really nice things that didn't make the cut for out 22 kg allowance. Opened it and found some, oh, so wonderfull wonderfull brown corduroys. Mark says that makes me very square, but I don't care.
Well, hey, it's Octover, there is snow on the Tablelands, it was just Thanksgiving. So tho' it's hard to remember the heat of Namibia, here, curled under my wonderfull wonderfull duvet. It's COLD!
Mark and I are well. We're travelling twice to New Brunswick, once to Labrador and once to Gander to check out some job opportunities...
I'll add pictures when I figure out PICASA.
Saturday, July 11, 2009
It's also the day of E.'s funeral. You may recall she was one of our personal patients. She was 12 and had had HIV since birth, and Tb twice. She wandered about the hospital saying very very little. She was discharged a few weeks ago as she was doing well. I saw her in the OPD a few times, and she seemed to be doing ok. But then the other day she was readmitted, very short of breath. The day after that she seemed a bit better (I was in Outjo by then), but I got a text to say she'd died. I didnt' want to believe it and had to phone the ward and to talk to one of the nurses about it. It's one of those things that surprise you, even tho' it shouldn't. She was sick with 2 lethal diseases, and probably got a third infection on top of it... But still very, very sad.
So two very important things to pray about today.
Monday, June 29, 2009
I'd only met him once, casually, outside the grocery store in Outjo. He was from DRC, so we spoke french. Everyone spoke really highly of him.
We had a gathering in Khorixas hospital, prayers and singing, for him, last Monday. And we've been sending releif doctors to Outjo. (There were 3 docs there, so they are 2 down, as his wife is travelling back to Congo for the burial. They have 6 children.)
It's my turn this week, to go to Outjo, but I've been waiting for the transport for 4 hours now, and still nothing...
Saturday, June 20, 2009
I was really upset. I didn't know how many people were going to be there (would it be in front of the whole community? was there going to be anger, threats of violence? I know it sounds melodramatic, but there were stories, from a few years back, of the people of the community lifting a doc's car and preventing him from entering the hospital) Apart from that, there was the difficulty of explaining ourselves. It was a really hard decision to make, and some of the reasons were very much about personal relationships at work making work quite unpleasant, and clinical decisions we were struggling against. We had no intention of making that public.
Mark wrote a fantastic letter. I wish I could reproduce it, but he's away in Spain (at a wedding) with his computer. It was very honest, heartfelt as well as diplomatic. It acknowledged the difficult working relationships without blame, and without making them the main reason for our resignation. It was great.
I managed to get 10 copies made for the meeting, and that is about how many people were there. There was the chief of the #Aodaman tribe, the mayor of Khorixas and a bunch of councillors. What a room full of intelligent and locally powerfull people. And Namibia being so small, they probably can talk to the president easily enough (well, they implied that, and I believe them).
It lasted about 1 hour and was nominally conducted in Damara, through a translator (tho' the translator seemed really powerfull too, and seemed to run the meeting, with the traditional chief's ok). Having things translated was actually really helpfull, to sort of diffuse emotional content, and time to think about answers.
Suffice it to say, it went well. For which I am very gratefull.
Tuesday, June 16, 2009
The goal of VSO is to accomplish sustainable development: sharing skills, changing lives. We felt, since the beginning, that what we are doing is not sustainable. We have been filling a post they could not fill otherwise. That was a bit annoying, but we still felt we had something to offer the hospital and the community here.
We've been stressed, again since we arrived, about licencing. Rather dull stuff, but it takes years to get a license here in Namibia, and we had (have) real concerns that Mark (and maybe me!) might not be able to work in Canada without being properly registered here.
And working with colleagues as a team... Oh dear. There have been storms and storms. We all have our strengths and weaknesses, and 2 of our colleagues aknowlegde, for the most part, their own weaknesses. Mark and I (we hope) know when we are out of our depth and ask for help.
When patient's lives are at stake, it's not the time to be self reliant. It would be different it we were really out in the middle of an untracked jungle, we would have to do the best we could. But here, we are 4 tarmac'd hours from our referral center, where there is an ICU, and actual laboratory investigations can be done regularly, CT scans and everything. Conflict about referral of really sick patients has come up again and again. Conflict about treatments. It's unpleasant.
So we've re-evaluated our priorities. What we came to do is something we believe is not only valid, but also interesting and fascinating. I love caring for patients who are actually sick! (The worried well are few and far between her) But not at the cost of our ability to work together in the same country.
So we handed in our resignation last week (we'll work till Aug 15th). This, or something like this, we would like to do again. But we'll look into our placement with different priorities next time.
Saturday, June 6, 2009
I thought I would try and describe a typical day, now that there are typical days…
Well, we wake up in separate beds (2 single camp beds tied together by the legs), and crawl out from under the mosquito net. Actually for the last week we have forgone the mosquito net as it is bloody cold- I’m not sure what temperature it is in the middle of the night, but less than 20 C at 7 AM. I’m wrapped up in a blanket inside my down sleeping bag, and am nice and toasty. So we’ve separate beds and separate sleeping bags. Then Mark has a freezing shower (I only shower every 2 days, and I turn the hot water on for about 45 minutes before I get in.) We have breakfast, usually porridge these days, and coffee from our fantastic Bodum-type cafetiere, that Anne and Andy gave us when they visited. Then go to work, walking 15 minutes to the hospital.
At work we each do ward rounds. Currently I am on Paediatrics, Male and Tb wards, Mark does Maternity and Female ward. We start around 8.20. Tb ward only is done 2ce a week: Monday and Thursday. These are confirmed cases of Tb who are in the initial intensive phase of treatment. In other hospitals they are only kept as inpatients for 2 weeks, then followed weekly, but here we tend to keep them for the full 2 month intensive phase.
After that, I’m now on “CDC” as in “Centre for disease control”. Tho’ the only disease we control is HIV (well, we’re working on Tb prophylaxis too…) and Mark is in the out patient department. I’m seeing all and sundry who have HIV in the Khorixas area. Everything is very much about following guidelines, which are, on the whole, very sensible. It requires so much concentration!! I’m prescribing nearly the same thing to every one: 3 drugs for the HIV, 1 to prevent Pneumocystic jirovecii pneumonia, 1 to prevent Tb and 1 to reduce the side effects of the Tb drugs and multivitamins. But then, not all are on the same 3 drugs for HIV, not all need the PCP or Tb prophylaxis, do the have anaemia? Is their liver ok? Do they have Hep. B? All makes minor variations, and luckily, I’ve the guidelines to tell me what to do!!! I just have to remember to read the guidelines.
At 1 PM it’s lunch time, till 2. If we’ve walked to work we have lunch there. Sometimes I’ve remembered to bring leftovers, but often we eat fat cakes: balls of dough that have been deep fried. Don’t knock it till you’ve tried it.
We knock off at 5 PM and walk home. Evenings aren’t very exciting: sometimes we visit the rest camp a few km out of town, and use their pool, having a beer or cider afterwards. Rarely we eat there (the food is basically alright, but not more than that). The exercise is nice, but it is getting colder now. No problem for Mark, but I’m a bit wimpy… otherwise the sun is setting at 5.15 these days, so we are eating, watching movies or shows (friends have given us electronic versions of all sorts: the first 3 seasons of Seinfeld, How I Met Your Mother, and movies galore… ) and bed is quite early: 9 PM, often enough.
Friday, May 22, 2009
On the way back up, we spent another night in Windhoek, in Anne and Andy’s apartment. We had met these Canadians in Ottawa, and are ecstatic they are in Namibia too. Oh, my, though, was I loving their apartment! Unfortunately they were mugged a few weeks ago, in broad daylight in an ordinary part of town. They are absolutely fine, but it does show that there are some benefits to living in the sticks. Khorixas does have minor violence (stab wounds with broken bottles, usually) but very little targeted at white/tourists. Mostly because there are so few!
Back to work on Monday was very difficult. But this week was a 4 day week (Thursday off) as is next week. Some people are enjoying a 5 day weekend, but we’re on call…. Still had Thursday off (went to a low key campground, v. cheap) and will have Monday too, so can’t complain!
Hullo! I got a couple of comments that I haven’t posted anything, and it’s true! Just noticed: May 1st was when I put on the pictures.
But then, of course, you’ve not commented on my blog!
Well, you have, some of you, in emails.
But there is something weird about just putting this stuff out there…
I’d love to share more of the medical stuff: but hopefully won’t put the non-medics off their lunch…
Assisted a C-section today, and we’re hoping to transfer skills: that is, our PMO knows surgery, and I and another Nigerian are interested in learning how to do a CS (not 100% sure I want to be able to do them, but it might turn out to be usefull). So I just closed the last few layers today (there are about 6 layers to close after a CS).
M. who had Tb and has HIV went home last week. She is one of our miracles, from just lying there like a stick insect to walking up and down the halls and smiling!! She gained 6 kg (up from 20 to 26… age 18). She actually spoke to me in English 2 weeks ago: I didn’t even know she could speak it. On ward rounds for the first 2 months she would just stare at us. The nurses would speak Damara, and she would nod, sometimes. It barely seemed she was awake. But I guess as she got better, her brain started functioning better. (She had meningitis during this admission, too). Anyway, she was moved into a ward with some other women, and I needed to ask a patient something, and she translated for us! It was really neat.
Friday, May 1, 2009
Monday, April 27, 2009
But when we got to Bersig there was no nurse, she'd gone to Khorixas for the weekend! It was really annoying, what were we to do? Drop him, to wait for the nurse (and the wound to get septic?) Take him with us (there is a clinic in Terrace Bay, about 100 km further on) but what if that nurse was away as well? How would he get back? Would he be waiting for us? while we were sightseeing? UUURGH! How did it become our problem! Well, it became our problem when we picked them up... Soooooo we drove them back to Khorixas, at the hospital gates, and started again. 4 hours later...
We spent the night at Springbokwasser gate, at a campsite, for free. This is the Gate for the Skeleton coast national park. It was incredibly remote. A small group of buildings for managing the access to the park, surrounded by nothingness. We explored the river bed, took loads of pictures of Welwitchia (the miracle plant that grows in the desert... About 1 cm per year). Baked potatoes on the fire, slept, woke at sunrise. Wow, what an amazing sunrise. I don't see many sunrises, just not that kind of person, but I've seen more in Namibia than anywhere else. Mark took some amazing pics (we'll upload them later).
The seaside was cool, you could feel the air changing as we approached it. The seasonal campsite (only open Dec and Jan) was eerie with cormorants. Just beautifull. The water was too cold for me. (And I'd been looking forward to swimming in it.) Mark immersed himself, and I paddled.
We stayed for a few hours, and there was an enormous dune just back from the ocean which we climed. Very desert, very Laurence of Arabia.
Who knows? Was our good deed punished? We had a fantastic weekend, no matter if it was because or despite giving a lift to that child...
Sunday, April 19, 2009
On Wednesday I treated 2 girls who had taken their grandmothers' diabetic treatment. They live about 80 km away on a farm. I'm not sure why, but they had to wait till the morning to even start the trek to the hospital. First a donkey cart to the road, then wait for a lift from a passing car (of which there are not many!) So I fear it was just too late for one of them. She has spent too long without sugar for her brain. She was very unwell and unstable in hospital. We were able to stablise her, but transport to Windhoek was very difficult, as both our ambulances and drivers were out, and would be too tired by the time they returned. Mark and I and a nurse and the aunty and the sister who was ok went in our car to the next town where an ambulance took all of them (without me, I was exhausted, Mark went) to Windhoek. She needed oxygen and monitoring. The oxygen ran out half way to Okahanja, and the monitor's battery died...so the hospital in Okanhanja gave them both and she made it to Windhoek in much the same state as she left Khorixas, which is all we could have asked for. The hospitals in Outjo and Okahanja were fantastically helpfull. We don't know how she is doing, yet.
I think the stress of that day took about 3 days to pass.
It's a bit strange what we can and can't offer here. In some ways, if we were more "in the middle of the bush" and couldn't even think of transfering her, we could cope with that. And certaintly patient expectations aren't high, people are quite fatalistic, used to not knowing what caused an illness or a death. I struggle with that. Many doctors do struggle with uncertainty.
Monday, April 13, 2009
Frustratingly, Easter is a 4 day weekend, and we are working 3 out of 4 days of it. It is the life of a doctor, and we should be used to it, but somehow, being a volunteer, I find it a bit more annoying. But we did have Friday off together, which was nice.
Last week we met a Spaniard who is cycling in Namibia, scouting it to see if it's suitable for guiding a cycling holiday. I ran into him again Friday morning in the shop and he came by for a chat, some water and to use the internet. He's tired of cycling and taking a few days off, to do more typical safari type stuff, so we're storing his bike for him. I showed him Margo and Chris' blog. He cycles about 100km a day, carrying 8 liters of water with him. That's to last 2 days, in case he doesn't get to a campsite that night. It is so hot and dusty here and the roads are so straight, I can't imagine doing what he's doing. I don't think he's planning on taking tourists here either, as he keeps saying that the scenery is so "boring". Daniel, be warned. By the way, for potential visitors, I think the scenery is only boring if you're travelling slowly...
Otherwise we were very quiet. Mark worked very hard on Sunday, tho' we did have time for supper, with another visitor, Pratap. Pratap is also VSO and he travels about 2 weeks every month, helping set up campsites, coordinating conservancies and generally knows everyone. When he visits it's like the outside world is coming in for a while. We had chicken, potatoes, cauliflower cheese, some Indian vegetable Dr Reddy's wife had given us, a green salad. And Chocolate cake. It was reminiscent of any Sunday dinner we've hosted in the past, and completely lovely.
And now I'm on today, and it's been really tough. I'm not sure I can write about it, but it is part of the things I anticipated might be hard, coming here. A few days ago I identified a few things that make the hard things more bearable. It's completely corny, but completely true. There are a couple of young girls who are struggling with HIV and Tb, and both are doing
well. The older one, M, I've been taking care of almost every day for 6 weeks, and she was always just flat, recumbent, apathetic. Our boss, Nkire, got the rehab person to come and see her, and I think he gave her (and the nurses) confidence to use the walking frame! What a difference. Big smiles and applause at her first jaunts up and down the ward, and now big smiles on my ward rounds. She's not out of the woods, maybe never will be. The younger one, E, was picked up by her aunt to be taken home for the long weekend. She usually wanders the hospital, with a serious face, rarely a smile, up and down and around. Her too, I saw today, smiling and waving at me.
These are the things that will sustain us.
Wednesday, April 8, 2009
Sunday, April 5, 2009
Anyhoo, we went with Sue to Brandberg this weekend. Sue kindly took pictures of us stuck in a sandy river bed- which will follow.
Sue is ex-VSO (her placement was in Nepal), a vet and has worked in the Shetlands, the Falklands, New Zealand, the Dominican Republic and now Windhoek. Oh and she's Canadian-British, super fit and enthusiastic. She joined us Friday night and we had a little goat (one of the nurses gave me the front quarter of a goat. The kitchen staff kindly cut it up into small peices, and I roasted it with thyme.) We set off Saturday morning and got to the campsite before noon. Then set off to the "river" which sounded like a nice place to have lunch, paddle, maybe walk up or down it... The staff repeatedly told us not to drive in the river. Which we interpreted to mean don't drive up or down the river. When we got there, the river was dry and baking. There were tracks across the river and Mark (usually the most risk-averse) thougth it was good for crossing in our 2WD condor. It wasn't, unfortunatly. Oh my word it was hot. Digging out our tires, putting brush and our firewood under the tires, reversing, repeating the same thing. Trying to get Sue's Rav4 (a small 4x4) to tow our car out, breaking the tow rope twice. Stopping and having lunch... Trying again. I was near heat exhaustion, I think. I was just too hot to do anything after a while. That's when Sue and I went back to the lodge and got a worker with a 6 liter ancient Nissan and a big peice of nylon rope, and hauled it out... Thank goodness.
It was a perfect place to "try out" our limitations, close to civilisation, with Sue and her car to help us. But it was 4 hours in the heat, really trying to get ourselves out.
Wednesday, April 1, 2009
I just love these pictures. I bought Mark this camera about 3 years ago, it's ONLY 6 megapixels and the pics are massively reduced to go on the blog. But ANYWAY, the top one is a giraffe with Etosha pan in the background. Then that tree one: behind the tree, all in a row, are hundreds of springbok. It's amazing. Then the lilac breasted roller, which flashes blue in flight. Lovely. Then an Oryx (or Gemsbok) then an elephant. Did you know they walk silently?
Monday, March 30, 2009
We tried to leave work promptly at 5, but is somehow just didn’t happen. The Gates of Etosha close at sundown (7 pm) so we camped at a lodge about 9 km from the park gates. We got up at 6 (yes, 6 on a Saturday) and drove. We saw thousands of springbok, oryx and zebras. A lot of them. A lot. And wildebeest, quite a few of them. Celia and Siew Wee were really keen to see something else, but Mark and I were just amazed by these prolific animals. They were just loving it; the grass, the water.
It’s not the best time of year to see game, because it’s rained so much. Etosha pan is usually an enormous flat bed of sandy whiteness. But we saw it full of water, stretching away. About 100 km by 40 km. Immense, shallow. In 6 months (or less?) it’ll be dry again.
Later in the afternoon we did see some giraffe, but the whole scene was quite beautiful. We spent the night in another campsite (fantastic hot showers, better than home). And Braii both nights (It means barbeque, but you can cook anything: we had a veggy stew and roast potatoes (or roast sweet potatoes)).
On Sunday (again getting up at 6) we explored north. We’ve decided all this driving is not the way to go. You just find a waterhole you like and sit there for a while…. Like 10 minutes… and the elephant just walks up to you! And drinks. And blows bubbles with it’s trunk. It was by itself, really quiet, and really cool.
There was also this amazing bird, a purple breasted roller. And eagles. And busterds. (Pics soon.)
Etosha is a weird place in a way. It’s so expensive, and the tourists are mostly white, the staff mostly these grinning black people. It’s beautiful, but completely artificial in a way. (I mean, the animals are wild enough, but still contained)
So we came back, and Monday morning waking at 6 am, (the joy of going back to sleep and sleeping in till 7!) going into work. Oh what a change! CD4 counts, difficult patients, patients who won’t talk to you, patients who talk too much, patients who just don’t get it: (when your CD4 count is 50 (normal >500) and haemoglobin is 3 (!) (Normal 12) you’ve something more to worry about than constipation- or potency, for that matter)
Thursday, March 26, 2009
We wanted something reliable, powerful enough for the dirt roads of Namibia, but not necessarily a 4x4, we didn’t want something too flashy, and we were aware that the ability to give lifts was a bonus. Based on the difficulty we had with a VW in Western Newfoundland, we wanted something easy to find parts! Well, pretty much everyone agreed that Toyota was the most widespread car in Namibia. So one of the VSO staff scouted for one for us. He found a Toyota Condor. It’s a 7 seater, 2.4 l engine, a bit higher off the ground, (better for clearance, and seeing the animals) and our contact assured us the engine was fantastic. Of course the seatbelts, fuel cap, radio, window winders, back seat security, tires, spare tire restrainer could all be fixed… Well, they have been fixed now, but it took a while, and a lot of Mark’s patience. I would lose it every time I spoke to the guy. The tires really were bald, and we were planning on buying new ones, but didn’t before one of them exploded. Really. I’ve never seen anything like it. It tested our jack and pump, and found both wanting. However Namibian helpfulness was not wanting, and all was well. We now have 5 new tires, and I’m a lot happier about it. Oh, the radio isn’t fixed, tho’. And the starter motor packed it in the day after we bought it. But again, we learnt how to get things done, and it’s all fixed now.
Saturday, March 21, 2009
Etosha: giraffes, lions (they were, umm, post coital, frequently), guinea fowl,
Our view, pretty canopy in Etosha (there should be the outline of a bird in there, but I can't find it again) and some really weird bug in the outpatient department.
Friday, March 20, 2009
In fact, the last few nights have been really really cold (like 20 degrees according to my crap thermometer...) It feels so much colder. Anyway, cold mornings+cold shower are unpleasant, so this morning, getting up at 5 am to use the euphemism, I turned on the hot water heater!! Lovely hot shower.
The last 2 days have been quiet at work, not sure why, maybe because of lack of water, or because it's Namibian independance day on Saturday (21st March). And I must say, Much Appreciated.
Wednesday, March 18, 2009
So I opened a bank account last week: Mark did it in Windhoek, with minimal fuss and bother. It seems to be a bit more difficult in Khorixas, but possible. Anyway, it turns out I have been black listed in Namibia for bad debt! Someone, in 2007 (!) used my name and date of birth (Come on, who is called Alice Bond Jermy Gwyn!) to get store cards, and "racked up" 4000 N$, but didn't pay it off. Strange, eh?
So they asked me to come back in, and photocopied every single page of my passports (I have my last one, going back to 2002, for some nice visas I have). Anyway, should be alright now. Makes one wonder, in what other countries is ABJG a persona non grata. I'll probably never find out.
We've had no water for 2 days. It's stressing me out a lot, but not Mark, and he's probably right. the big pipe getting water to Khorixas has 3 leaks. Rumours abound, I bet no one really knows when it'll be fixed. Some said 40 minutes ago, some say Friday... Mark has just come back with about 35 liters, tho'.
AND we have a roommate: Siow Wee, a pharmacist w. VSO from Singapore, tho' she spent 10 years in Manchester.
Monday, March 9, 2009
I have to admit to considerable ignorance about Africa. I thought that talking about “tribes” was a politically incorrect way of referring to people here. It is certainly incorrect in the sense of tribes, sitting around the tom-toms and so on. But there are tribes here, and can be distinguished by language, dress and to a certain extent features. There are 11 groups of languages in Namibia, but lots more dialects than that I’m assured! In Khorixas you would do well to know 5. : Herero, Damara, Oshivambo, English and Africaans. (And I thought I was fancy knowing 3) Our Nigerian colleague described the importance of tribes: when you are out of Nigeria, everyone is just Nigerian, but if you return to your country, all of a sudden tribal relationships become extremely important.
Damara is a click language (there are 4 groups of clicking languages in Southern Africa). And our dialect is Damara/Nama. If I ever get organised I’ll get a teacher, but I’m picking up words. “Please” and “Thankyou” have no clicks, nor does “cough” or “epilepsy”. “Breathe” does. Typically the Damara have orangey coloured skin, with freckles, almond eyes (shape, not colour), high cheek bones. They are one of the San (used to be known as bushmen) tribes. Despite the mythology that goes with the San, I’ve not been witness to anything mythic yet. I love to listen to the nurses and patients talk, and wonder how my information about things gets translated (is there a word for antibiotic? Peptic ulcer?)
The Herero are traditionally herders: cows and goats. They measure their wealth in cows. 100 years ago they adopted Victorian/German attire and so wear long dresses with petticoats, aprons over the top. You could think of Anne of Green Gables, (even puffed sleeves!). Often it’s made of a patchwork material. And on their heads! I have no idea how it’s made; a sort of twisting of material creating horns on either side of the top of the head. It’s a bit fierce.
Both of these populations are minorities in Namibia, but quite common in Khorixas. The Oshivambo, on the other hand are a majority tribe. They come mostly from the north, and are the tribe that really spearheaded Swapo (the "rebellion" that made Namibia an independent country, and now has a majority rule)
I’ve just watered my herb garden, my seeds have just germinated, and I’m typing under the lovely double mosquito net Doreen gave us. It really could be worse.
Monday, March 2, 2009
Well, Mark and I must be settling in a bit. Last week was quite tiring, hot days, working pretty hard, but getting used to what is and is not possible in Khorixas. I got used to it to the extent that on Saturday, when we stopped in Outjo on the way to Etosha, and went into a bakery and saw, oh my such a spread!! There is such a strong German influence: apple strudel, good bread, sausage rolls, ginger cookies... Really a delight, and such a treat. The thing is, one can really live well with out these things, but one appreciates it a lot more if it's hard to come by!
We went to Etosha, which is enormous, and agreed with each other that it was just nice to be out, seeing something different, it didn't matter if we didn't see any animals: Oryx, Springbok, giraffes, zebras, ostriches, squirrels, guinea fowl, lions (mating), gnus, lizards, impala (lots) warthog, meercat, white capped jay and red capped wood pecker. Big bird about ½ the size of ostriches with a peak at the back of head. Looked like a really large heron, with affronted, mincing gait. Other black birds with white flashes on wings, vv large.
People talk about the "big five" and are a bit snobbish about zebras and giraffes, but we found them amazing. A giraffe is just so strange! It was amazing to watch them from the car, just nibbling. I'm ashamed to say that I didn't know ostriches were in Africa (I thought they were Australian)
Lions can be very active: hunting and fighting, but often spend up to 23 hours a day just lazing around, so I guess we were lucky to see them mating! Meercats make me think of Maya, for some reason. I think she told me once that they were her favorite animal.
All in all an expensive way to spend the weekend, but only 3+ hours drive away, and once we have a tent, much cheaper...
lots of love,
Tuesday, February 24, 2009
The medicine is going well. What has really struck us about HIV/AIDS is that you don’t treat it in an emergency. It’s not like getting in antibiotics “stat”. It’s a bit more like treating diabetes: a chronic, long term, ongoing process. The problem is that if you are non-compliant (or worse, partially compliant) with your diabetes treatment, the sugar doesn’t become resistant to the insulin in the same way that viruses become resistant to HAART (Highly active anti-retroviral treatment). Compliance is incredibly important, and your first shot is your best shot at treating it. So patients have to go for adherence councelling 3 times before starting treatment.
What else do we see: Tb. There are about 20 inpatients with TB right now. Most (I think) are HIV positive. Otherwise, in the out patient departement: Diabetes, Hypertension, colds, coughs, arthritis. And also large fungal infections, odd masses and so on.
Final word: there is a cholera outbreak in Opuwo (about 6 hours away), and up to a few hours ago we thought I (Alice) was going to go and help them out for a week from Monday (1st of March) I was pretty anxious about it. Now it seems I’m not going, but there is a lot of uncertainty about it, but I’ll keep you posted!
Saturday, February 21, 2009
The straightforward way is:
Alice Gwyn or Mark Walton
PO Box 261
However, if the thing is precious then please know that the mail is "reliable" to Windhoek, but we're told not completely trustworthy beyond that. So if you're sending something you really don't want pilfered, please send it to
Alice Gwyn or Mark Walton
C/O VSO Namibia
PO Box 11339
They will bring it out whenever someone comes in our direction
And if that weren't enough instructions, apparently the Post office doesn't put a slip in your box to let you know that a package has arrived, so if you are sending one to Khorixas, do let us know!! Then we can ask for it, periodically
Friday, February 20, 2009
I know people want pics, but I can't seem to upload them. The connection is no longer 3.5 G like in the city!
The hospital is about 1 mile from our house, at the east end of the township area. We often walk to work, at 8 am and 5 pm it’s often cloudy, and not too hot. Our car’s starter engine broke the day after we bought it, so we just didn’t use it.
At work, each doctor has a ward for which they take responsibility. There is a female/maternity ward, male ward, paediatrics and Tb wards. We have been allocated the paeds ward, which is really interesting. We’ve rounded in the Tb ward twice already, which is also fascinating.
This week, a typical day has been: rounding from 8 till it’s done (about 30-45 minutes if there is only the kiddies, 2 ½ hours if we do the Tb ward too) then Mark goes to the “CDC” centre for disease control, where the HIV work is being done. And I go to the out patient department/casualty and see patients. See patients till 1, and as Namibia has a strong tradition of a 1-2 pm lunch hour, but it’s awfully hot for walking home, we bring a lunch to work. Then again from 2-5 pm.
We haven’t been overwhelmingly busy. Currently the HIV clinic is only on a Wednesday, and over the next year we hope to expand that to 3 times/week. I am certainly not seeing the most patients in the OPD, 1 or 2 other docs are on with me, and there are certainly some slow times.
Khorixas is divided in to areas, 3 really. As you come from Outjo (or follow the road on Google Earth) to the right of the main road is the “Town”, where the house lots are quite big, the houses are big (to whit: ours), most, maybe all, have servants quarters. This is where, before independence in 1990, whites lived. After 1990, most moved out, apart from 4 families, apparently. I don’t know when the houses were built, but they are pretty uniform.
To the left of the road is what could be called the “township”, I think. Lot sizes are smaller, houses are small: from the outside they look as if they are 2 or 4 rooms, quite symmetrical, metal roofs, plumbing. Lots of satellite dishes outside of them. Apparently they are crowded with furniture inside.
Further to the south of the township is the informal settlement. I haven’t seen it yet, but houses are self built, maybe with corrugated iron. I assume no plumbing, but I don’t really know.
Namibian health care
HIV has so much attention and so much funding and support internationally and this is reflected in Namibia. I would be interested to know who has to pay for the treatment of AIDS in the US, but it’s free here. Namibia is a two tiered system: there is the state system, which we are working in, and a private system. Within the state system, yes, you can’t prescribe any medication: there is a NEDlist (Namibia’s Essential Drug list) and stocks aren’t always high, but when you do prescribe them, they are free. (for the medics out there: PPIs aren’t on the list, but tramadol is!) A patient who needs it can get transport to Windhoek to see a specialist (on Wednesdays), get a CT, have a kidney removed, whatever. I don’t know what the wait times are, of course.
The doctors we work with
There are 3 other docs here: Dr Everest Nkire, the Principal Medical Officer, a Nigerian who has also worked in Zambia, Dr Reddy from Hyerabad (India, I know I spelled it wrong) who has worked in Jamaica, Trinidad, the Seychelles, the Maldives and Goa!, and Dr Michael Ubunama, who is also Nigerian.
Wednesday, February 18, 2009
We took possesion of the car at 1030 am amd left Windhoek a few hours later, having packed, shopped and gassed up. We stopped after a few hours for a snack under a tree. How to describe it? The roads are very straight and flat (having been made for the purposes of the south African army) There are mountains or hills all around us, but we never seem to go through them, just straight! The B roads are very good (there are no A roads). Every once in a while there is a sign announcing a rest stop in 1 km: a table and benches under a tree. It could be anywhere. Except for the signs warning us of warthogs and flying springbok. Substitute a charging moose, and it could be Newfoundland! There is even a couple of suggestive twin hills, like those coming out of Port Aux Basques into the Codroy valley.
We drive to Otjiwarongo where we meet Mary Anne. She is a volunteer from South Africa, nearly finished her 2 years. She envies us going to Khorixas, for she thinks we’re closer to the good stuff. The grass is always greener. Otjiwarongo has Cymot (Canadian Tire on steroids) and SuperSpar (supermarket). I’m not sure if it has a night life, tho’.
Dark start around 730, when we’re about 40 minutes from Khorixas. We’ve seen big birds, that look like peacocks without tails, an eagle sitting on a telephone pole, little duikers (deer about as small as rabbits) and a fox. So we slow down and arrive safely.
At the gas station, we call Dr Micheal to show us the house. He is Nigerian, and looks about 25 (we find out later he’s 32). He tells us we’re going to the hospital for supper.
What we can see of the hospital is clean, spread out, with covered walkways from area to area. The key to the canteen is finally found, and we eat: tough fried meat (oh Mark the vegetarian), fried potatoes, sliced tomatoes, mango juice, an enormous slab of cheese. There is 1 l of UHT milk, but no cups. Dr Michael takes it.
As we leave the hospital he says: you must take your rations and boxes of food are brought out. Apparently they will continue to give us this untill we ask them to stop.
And so we came to the house: me, Mark, the driver (a traditional leader, and enormous) Dr Micheal and a helper.
Opening doors was difficult. Despite necessity, they broke down the garage door. Apparently the front door can be opened, but is very difficult to shut.
I’d had a day dream (which I knew was a dream) of our “three bedroom house”: discovering it, running from room to room. But life as it truly is: Mark went in via the back door and came out with the information that there are cockroaches. I went in, carrying some stuff, not knowing where to put it down!
There are indeed three bedrooms: in a row, leading onto a large hallway/gallery. In the first bedroom were 2 (hospital?) beds, with thin plastic mattresses, hospital linen and a towel. In the second is one bed, and in the third nothing. After that is a “living” area, eating area, kitchen, pantry, alcove and porch/washing area. At the other end is the toilet, shower, sink: all in rough concrete.
I felt like crying. I was frightened, overwhelemd and somehow scared of this derelict house. There is space, but no furniture. Mark took control, and we made the living room more cosy: sweeping it, putting all 3 beds in and rigging the mosquito net over 2 of them (tying them together with our tow rope!). To cheer ourselves up, we switch on a computer and connect to the internet. There is no service. We turn on the fan (sitting on the one chair) and go to bed.
Now, 5 days later, I still find it too big and not quite clean enough (tho’ I think a valiant attempt was made). It has a new fridge, an old stove and kitchen cabinets that are too rusty to put stuff in. The water pressure was too low (the stop cock was turned off) and that has been remedied. The roof leaks in the kitchen, but only when it rains. We have figured out which doors have keys, and which are just too dirty to attempt to open. We’ve fumigated with Raid and some other insect killer. It isn’t home yet. Yet.
Wednesday, February 11, 2009
Many details really remind me of Bolivia: The flowering trees, grand projects next to construction sites, women selling drinks under trees, the heat, the houses being fenced in and surmounted by protective sharp things (tho’ here it is barbed wire and often electric fences, not broken bottles), taxis sounding their horn to get your attention.
But there are differences: we can drink the water, ice, lettuce, salad, apple peels and so on, you don’t need to bribe anyone when you go to the Police station (to get copies of documents certified, more on that later) there are no men with machine guns in the banks or in the post office. What I find most distressing is that the taxis are not reliable here. They are regulated, but it is easy to make a car look like a taxi-and many do.
I referred to the need to do paper work at the police station before, and just a quick note on that. We had sent an application for authorisation to work as doctors here back in November. Unfortunately, it was never submitted. When Mark and I realised this, we became quite anxious, as may be imagined. We really did not want to be working in any way “illegally” here. And although it might be vaguely appropriate to just go to Khorixas and get stuck in, and worry about the paperwork afterwards, that didn’t appeal to us.
We also started thinking about our return to
the Ministry of Health and Social Services: 3 visits
The Medical and Dental council: 2 visits
(witnessing robbery: once)
The police station: queueing 5 times on 2 different days in the sun
(discovered that Namibians line up with discipline and compassion: pregnant women, seniors and people with disabilities don’t have to line up.)
Phone calls: countless
Completed replies, in writing, that Mark and I have submitted applications for authorisations to work and that this is sufficient to start work : 1 (and there was much rejoicing!!
Saturday, February 7, 2009
It is hot and often dusty
It is so hot, that a Namibian VSO who's husband is from Khorixas finds it too hot
It is actually a bit less hot right now because of the "rains", but will be baking in April
It hasn't rained there in 4 weeks
The people are lovely
Our Nigerian supervisor Dr Nkire is really enthousiastic
We will have a 3-bedroom apartment, and hope for lots of visitors
It is a 5.5 hour drive from Windhoek
Groceries are expensive there
So having been successfully picked up at the airport, and taken to our lodgings (very comfortable) we snoozed and then were taken out for supper by some other VSO volunteers: Sonia and Saskia, Dutch, and Dylan, English. We were joined by 3 others from various organisations, a Dutch journalist and 2 Sweedish volunteers.
We went to La Marmite, which is Cameroonian. Delicious food in wooden bowls. And Mopane worms. Fried. I was starving and ate about 3 of them. They had been prepared in some delicious sauce, but were still rather crunchy, and, well, worms.
So we've spent the last 2 days doing that: getting papers certified at the police station, doing declarations (also at the police station, but in a different queue) going to the Ministry and finding out I'd (Alice) had filled out the wrong form. Doing it all again the next day. Going to the Medical and Dental Council and (Mark) filling in forms for them: Mark really planned ahead and brought his original documents, so he was able to do this...
And in the evenings: going out to different restaurants with Joonho, or cooking. there is really good food!!!
And in the evenings: going out to different restaurants with Joonho, or cooking. there is really good food!!!
Tuesday, February 3, 2009
So we've arrived. The trip started Saturday morning, with a flight to Toronto, then a 12 hour wait in TO. It was incredibly cold! Only -10, but somehow, the damp or the wind, something made it challenging. I was glad I hadn't packed my scarf and hat away, and would have loved my long underwear...
Frankfurt was -1 only and we had rented a hotel room for 6 hours, and got some lovely sleep.
In Johannesburg we had to immigrate into the country to get our luggage: the people in Halifax hadn't been able to book us through to Windhoek.
In Windhoek we figured out that another passenger, Joohon (from Texas) was also with VSO. Lucky him he had a visa already. We didn't, but Mark and I played tag team going out of the immigration area. I felt quite overwhelmed even buying a phone card and phoning the VSO office! Actually it was completely straightforward. And about an hour later Paul arrived with our VISAs
We're just going to post this as a recent thunderstorm has made the electricity a bit dubious
Friday, January 30, 2009
Wednesday, January 28, 2009
Sunday, January 25, 2009
Hello! We've been delayed one more day...So that we can arrive in Namibia around the same time as other volunteers.
In the mean time, last weekend was the day we celebrated Daniel's birthday (38... Only 2 more years till 40!) and I'm just uploading a picture of the cake Mummy and I made for him (and Desiree was there too...)
Friday, January 16, 2009
For the moment, I'm in North Hatley, where it is -23, with no windchill at all, and trying to figure out how to pack for 2 weeks (+/-) in Halifax and 2 years in Namibia.
I read the log of a Peace Corps girl in Khorixas, the town we're going to. She lost all her luggage for about 2 weeks at the beginning, and maintains that all you need are a pair of sandals, a multitool, a water bottle, pictures from home and ... I forget the last one. Everything else can be bought.
However, we are bringing an awefull lot of IT stuff, that we hope will work... Because they are lighter than medical textbooks. And we are bringing Post Exposure Prophylaxis. And downloading the WHO's and MSFs texts on obstetrics for remote doctors. And hoping our computers, PDAs and phones work...
If not, my kind mother has agreed to ship us some textbooks I've got piled in the corner.