From Ghana to Gang Riots in London.

Smile for the camera

It is with deep sadness that I left the shores of Ghana:  The vibrancy and happy nature of the people there and the slow and calming pace of life.  Throughout my stay in Ghana one song in particular was played repeatedly.  It would hover from porridge stalls and sooty tro tro’s, shop windows and mobile phones.  The title of the song is “I love my life”.  The Ghanaians really do love life.  They laugh a lot and in fact the word for smile means laugh so that the Ghanaians see themselves as laughing quite a lot of the time.  I took the photo of this wonderful lady during my outreach work in her village. I asked her to smile for the camera.

Coming back to the UK was a shock to the system.  The pace of life meant I had little time to stop and catch my breath. Two nights ago at work our department was closed down for security purposes in response to a stabbing in the waiting room.  On the same night an eight year old boy was chased by 4 other youth past the resuscitation rooms and when a nurse tried to protect the boy he kicked her and ran off .  Riots in London are common but the scale of these has surprised even the most experienced of staff that thought they had seen it all.  A shaken registrar turned up to work last night having had his car jumped on by 8 men in black hoods and face masks. His story was tweeted by an eyewitness on the online BBC news live page.   The majority of those treated at the department are for riot related injuries are young, under 20.  An elderly Jamaican patient stated “It was coming.  There is too much tension and nothing for these youth to do.  It is a consequence of the government’s cuts: their neglect.”  With my heart in my mouth I drove home from work at 2am avoiding police swat teams chasing white vans and youths in hoodies.   Arriving home I got out of my car anxiously as 3 young people stood at the end of the street with rollerblades on.  They were laughing and joking with each other.   It was the summer holidays after all and they had nothing else to do.

Today is another day.  On my way here 4 grey police swat team vehicles drove up and down the same round in a haphazard manner.  A fellow driver pulled over to the side to let them past looked at me with raised eybrows in a “what the heck are they upto” manner – I could only agree.  As I sit here typing this sirens are wailing and I wonder what havoc awaits me out on the streets.  London is burning, burning with fiery pent up frustration that is spilling onto the streets.  Young people can’t get jobs.  The young of the ethnic minority communities of south London have been particularly affected as they are the ones less likely to receive a good education and in turn good jobs.  Youth centres are being closed down.  This is the recession translated into reality.  The library man has just announced that “due  to civil unrest this library is closing”.  I better round off.

Africa is often viewed by us in the west as an impoverished continent rampant with gang violence and corruption.  The events in London show that this is possible anywhere where there is inequality and a polarising social make-up.  To solve this problem is undoubtedly complicated.  Perhaps however, the answers lie in Africa itself and I can only emphasise what the Ghanaians have taught me.  To laugh at things that get you down, to be dedicated to family and friends, to enjoy the free things in life and to love life.   Here concludes my year of being “under new skies”.  I’ll leave you with a link to the song that will always bring a smile to my face.  The Ghanaians did another version of this called “I love my wife” – also worth listening too.

http://www.youtube.com/watch?v=d93w_tuorrE

Ghana and the Slave Trade

  It has been some time since my last blog – 4 weeks I think!  Ghana continues to open my eyes to new things; however she is reluctant to give me good internet access.  Life at the clinic has become so routine that Sena and I wonder how we will adapt to life back home.  I had a brief visit home to attend a wedding and the experience was somewhat surreal.  Everything was just as I had left it so that I felt I had never been away.  My life in Ghana was in another dimension completely separate from life in the UK.  I was unable to build synapses to connect the two lives and so I slotted into life in the UK without much deliberation but with a niggling feeling that I was in a dream and reality was out there in Africa.  I was surrounded by supermarkets stocked high with food that was without season.  In Ghana I have seen the watermelon and yellow mango season come and go. In the UK running water, electricity, transport and fuel are available at the touch of a button.   In Ghana I carry my water from a well and have gained the patience to wait hours for transportation that takes hours to reach its destination but in turn have met and conversed with many wonderful people.  In the UK people rush about everywhere, connected to electronic contraptions and avoiding eye contact.  In Ghana I can barely walk a few yards without someone calling out “Good morning!” and “How are you?!”

The 2010 World Wealth Report (conducted by Merrill Lynch) estimates that a mere 103,000 people of the nearly seven billion people on the planet control 36.1% of the worlds wealth.  Also, less than 5% of the world’s population live as we do in the UK.  We are privileged but my experiences here remind  me that there is much about life in less developed nations that we can learn from.  In particular: appreciating the small things.

15th Century Mud Stick Mosque Larabanga

I had the opportunity to travel north to the border with Burkina Faso.  The North of Ghana feels like a completely different country.  It is geographically more similar to the Sahel region of West Africa and takes much of its cultural influence from there.  The land is Savannah like with Baobab and Acacia trees and the people farm cattle more than crops.  The predominantly Muslim population dress more conservatively with women in floating scarves and dresses and men in long shirts.  Travellers from around West Africa are also apparent:  Men in pointed straw hats from Burkina and others in big white turbans from Mali. 

The most interesting aspect of this trip was being able to piece together another part of the puzzle that was the Trans Atlantic slave trade.   I had started this journey in Liverpool, witnessing at the slavery  museum how from the 1600’s (when American plantation owners increased demand for slaves to satisfy the increasing demand for sugar in Europe)  till its abolition in 1807 the British had set sail with ships such as the ‘Liverpool Merchant’  bound for the West Coast of Africa.  They traded alcohol and weapons for slaves and then set sail for the Americas where they traded slaves for cotton, sugar and tobacco – products of slave labour – before returning to Europe and completing the ‘Triangle’ of the Trans Atlantic slave trade.  By 1795 Liverpool controlled over 80% of the British and over 40% of the entire European slave trade. 

Cape Coast Castle

On arrival in Ghana the British docked at the infamous Cape Coast castle or in the case of the Dutch, the Elmina Castle.  Here they collected slaves that had been bought from African traders.  Elmina castle is a stark reminder of the brutality of this trade, a white wash building with a network of dark dungeons and an exit facing the sea titled “Door of no return”.  It is estimated that European ships transported some 12 million people to the Americas on a journey in which on average 13% of the captives died (though in some ships the figure was much higher).  Further North in the little town of Paga by the Burkina border I visited the Pikworo slave camp.  An African man from outside the region set up the camp that was for many locals the first step of the brutal journey.  Captured villagers were first bound to trees and women were chosen to cook.  At meal times the food was served into holes dug into rocks by the captives.  Captives were intentionally starved so as to weaken them; preventing them from rebelling.  Any that tried to escape were tied to a boulder and forced to face the sun with open eyes until they went blind and died.  Those that survived this initial torture were bought by African traders, shackled and walked bare foot the 500miles to the Ghana coast where they were traded with the Europeans. 

Bowls carved into rock at Pikworo slave camp

The impact of the slave trade on Africa was manifold.  The weapons traded at the castles further destabilised the African nations often supporting internal conflict.  The economic impact of depopulation (particularly of the young male working population) is thought to have contributed significantly to the poverty of the African continent today.  

 The organisation and planning of the trade is sickening. Worse still is the fact that it went on for so long – commenced in 1502 by the Portuguese and Spanish who wanted labour for the newly discovered colonies and only officially abolished globally in 1831.  The trade is a reminder of the puzzling aspect of ‘Man’s inhumanity to Man’.

Homes with low doors designed to protect villagers against slave raiders.

Bad medicine

“Next patient”, Ma Vic called.  A seven year old girl walked in with a rotten bamboo splint wrapped around her upper arm.  She had apparently fractured the arm 5 days ago.  I looked worriedly at the swollen hand several times the size of her unaffected arm and the pus exudating blisters spreading from under the splint.  She had very little movement and sensation in her fingers indicating that the nerve and blood supply were in jeopardy.  With reluctance the mother let us remove the splint and dirty cloth from around the arm.  The traditional ‘healer’ that had put the splint on had warned against removing his handiwork.   Despite the painkillers the girl screamed with pain as we peeled back the material.  Her skin had reacted badly to the burnt herbs and was blistering all over.  She squeezed Sena’s hand as we washed and redressed her skin.  Without proper plastering and facilities it was essential for the girl to take the 1 hour journey to Agogo hospital.  Later, on calling Dr Ashura at the paediatric unit at Agogo, it was evident the mother had not taken our advice despite warning her that her daughter might loose her arm.  I expect she had gone back to the healer.

It is cases like the above that make me wonder at people’s reliance on traditional healers?  During our village outreach we were informed that for most cases apart from malaria (malaria having been drummed into them), people would consult a healer first, “especially for cases of Epilepsy or abnormal behaviour”.   As if in answer to my question I was approached by a young Ghanaian man on Saturday night whilst sipping my Malt drink on the beach at Cape Coast.  He rejoiced at us being in the same profession.  He was also a doctor, a traditional doctor or traditional scientist as he also liked to put it.  He was twenty five and was so confident regarding his knowledge on how to treat people I could see how people could be convinced.  “We use the plants and the trees, not the rubbish stuff you get at the pharmacy”-  I explained we also use plant derivatives in many medications that are now thoroughly trialled.  “I have never had a patient not get better with my treatment” –  I expect this is because they don’t come back to him if they get worse. “I never take money for my treatment” – but patients are required to leave the equivalent of £3 at the shrine where he blesses the treatment.  This is substantially more than the cost of a course of malarial treatment and much more than the amount those with national health insurance would pay, which allows people to get treatment for next to nothing.  He ended the conversation with, “The Black people are sick, I will cure them.” 

It would be unfair to dismiss the work of all traditional healers.  Many of them have knowledge of local herbs that have been passed on for many generations and that may have a role to play in medical treatment.  The appeal of traditional and faith healers is multifold including cultural perceptions of diseases such as  mental disorders, the psychosocial support afforded by healers, as well as their availability, accessibility and affordability and scepticism around the effectiveness of ‘conventional’ treatments,.   It will take establishment of good, accessible health care that can rival the availability of traditional healers, and collaboration with traditional healers in order to encourage people to start making a change in their consulting habits.  Our health centre is one such unit that is promoting primary health care in a developing country setting.

Clinic life

We have now fully settled into village and clinic life. In the mornings we do consultations with the lead nurse Ma Vic who translates for us. The majority of cases are malaria. Children commonly present with fever and diarrhoea and a fair number of children present with severe malaria, drowsy and pale. After seeing the kids we take their blood and examine it under a microscope where invariably the ring shapes of the plasmodium parasite can be seen inside the invaded red blood cells. A haemoglobin check is done and then the children are started on intramuscular quinine and observed in the ward. The most severe consequence of malaria in children is cerebral malaria. This occurs when the parasites clog up vessels supplying the brain leading to seizures and coma. Thanks to the clinic and it’s accessibility to the 32 or so villages that would otherwise be miles from a health care centre, many of these severe cases are prevented.

Last week we were invited to attend a national malaria training course run over two days and sponsored by the big cats: USAIDS, WHO, CDC. It was an excellent course covering all practicalities on the subject. We were surprised to receive the equivalent of £30 for ‘travel expenses’ at the end of the course, more an incentive to get doctors to leave their busy wards and attend the courses. If only we were paid to do medical courses back home!

On Tuesdays we teach the health volunteers under a leafy tree. Being a farming community, many patients present with “Waist pain”. I enjoyed teaching them back exercises which they initially found hilarious (see photo). The volunteers are excellent. This week we visited one of the villages to do outreach work. The village still practices the old pagan religion of the Ashanti tribes and a fetish priest temple stood sentinel at the entrance to the village. Vasco one of the volunteers sung a very jazzy song about Malaria while Moses did a beatbox and all the villagers clapped in time. If only health education was this fun back home! After teaching, Sena and I did a clinic in one of the mud hut houses with grass roofs, prime mosquito hiding territory, before heading home to find out about how to supply the villagers with cheap bed nets.

Evil Ulcers

This gallery contains 1 photo.

I spent last week at Agogo Hospital that is linked to our clinic.  I apologise for the gruesome descriptions below but the experience was very fresh in my mind at the time of writing! There is little other way to … Continue reading →

Obruni in Ghana

 

“Obruni! Obruni!”  (White person, White person!)

By the time Sena (who is also volunteering at the clinic) and I had made our way from the village along the red dirt track road to the clinic we had an entourage of children in our midst  skipping and singing.  I felt like the Pied Piper of Hamelin.  In response to their singing we sang “Step we gaily on we go, heel for heel and toe for toe” to the delight of the kids who danced to the Scottish folk song with African rhythm.  “I am in Africa!” I thought ecstatically to myself.

The nurse led clinic consists of two consultation rooms and a maternity block.  It provides primary health care and basic maternity care to a population of 8000 villagers most of whom are farmers.  It is part of an NGO called Foundation Human Nature.  Our role as volunteers here is primarily that of health promotion and training.

The clinic is the closest I have come to a ‘retreat’:  Surrounded by lush greenery and with only the most basic of amenities there is much time to reflect.  We collect our water from a bore hole where we also wash our clothes.  We rarely have to pump or carry our water as the children scramble to do things for us.  I have never come across such respectful and well behaved children.  They are a credit to Ghana which itself is a delight. 

Ghana gained independence in 1957.  It was a pioneer for independence in Africa and led by Kwame Nkrumah who is hugely respected here.  Nkrumah held meetings with leaders of other African nations and encouraged and supported their efforts for freedom from colonial rule.   Ghana is a lush equatorial country with plenty of resources that many international agencies (including the ever more dominant China that builds roads here too) are wanting shares of.  Perhaps because of its natural wealth and reasonably peaceful past, the people of Ghana are amongst the gentlest and honest I have met.

There is of course the darker past involving the slave trade.  Having spent three months studying in Liverpool, a hub of the trade in Britain, the pieces of the nasty puzzle begin to fit together.  We will visit the coastal forts in the coming weeks after which I expect to have more to write on the subject.

We have so far had several meetings with staff including one on benches around an Acacia tree. Many patients present with malaria related problems.  I expect bed nets will be on our list of health promotion topics.  As I write this on a grass matt under a tree the sound of bird song and the laughter of children fills the air.  It is Good to be in Ghana!

After working hours the clinic is alive with children playing and adults chatting.

Pakistan to Ghana

Girl at Afghan refugee camp Rawalpindi

Pakistan has changed much since my visit as a medical student in 2006 when I worked/shadowed doctors in a hospital in Abbottabad and Muzaffarabad Kashmir.  I enjoyed the freedom of climbing the Swat Valley mountains and drinking tea with purdah-less women in their mud huts.  I could never dream of doing this now.  Children here tell stories of how their friends have been taken for ransom.  This method of making money is run by a big faction of drug barons in Peshawar.  As a French NGO worker stated, going out “is like Russian roulette here, you just never know”.

Pakistan has lived a crisis laden existence. Without sweeping changes to the political makeup this country is undoubtedly at the cross roads of disaster.  It is already on its knees.  A journalist reports on the need for “sanitisation and purification” of the present political system.  He suggests setting up an independent election commission in which all candidates would be scrutinised.  I can’t help but feel it is caught up in the middle of a global play ground fight for power.  China, India, US and the West all vying for its submission.  The large China-Pakistan Friendship centre here in Islamabad is proof of this.  In return for cooperation China has built fancy roads and military bases.  India is tapping into Central Asia’s resources via Pakistan.  The politicians here are mere pawns.

Debt keeps this country on its knees.  Pakistan has an IMF loan of $11.3 billion and is requesting a further $3.5 billion.  This equates to over $1 billion in interest!  To repay the IMF, Pakistan may need to deplete its foreign exchange reserves which would devalue the Pakistani Rupee leading to an increased cost of imports and a rise in inflation that already sits at over 16%.

I am sad to say I am leaving Pakistan.  I can’t deny the security issues have played a part but also my lack of strength to continue under the present circumstances.  Unlike Africa where large campaigns by the likes of Bill and Malinda Gates draw attention to issues, Pakistan’s problems have been drowned out by the big T’s “Terrorism” and “Taliban”.  A prime example of this was the lack of funding from the international community during the flooding because of Pakistan’s “bad rep”.  There is no doubt there is massive corruption but Pakistan needs more constructive media attention.

I have learned much from being here and I hope to return soon.  My next blog will come from Ghana where I will be working with an NGO called Foundation Human Nature.  I am sure these will be much more light hearted!

Please follow the link to a song written by a Pakistani folk singer Arif Lohar.  It resonates through homes and streets here and will always transport me back to this amazing country.  The chorus is particularly groovy:

http://www.youtube.com/watch?v=gjaH2iuoYWE

“Alif allah chambay di booti, tey meray murshid mann vich lai hoo
My master has planted the fragrant seed of love in my heart

Ho nafi uss baat da paani dey kay
Which flourished with modesty, piety and acceptance of his existence

Har ragaay harjai hoo
My God is present in every throbbing pulse

Ho joog joog jeevay mera murshid sohna
My spiritual guide is ever-present

Hatay jiss ay booti lai ho
The one who blew life into me”

The HIV/AIDS of Pakistan

“The cleaner is taking a break today, his hepatitis is flaring up”

“My Dad has hepatitis C, he contracted it during a bypass operation.”

“My husband contracted it from the dentist during a scale and polish”

“She caught it from a needle stick injury from a hep C positive baby she was treating.  Fellow doctors told her just to rinse the wound and she would be fine.  She’s now very sick”

Everyone here knows someone with hepatitis C.  I myself was devastated to hear of the death of a family friend at the age of 45 years from liver failure.  She had contracted Hep C from unsterilized needles.  National data on the prevalence of Hep C in Pakistan are lacking but estimates put it at around 10% of people being affected.  The socioeconomic impact of this is massive: productivity due to illness, deaths, and care-giving (at home as well as in hospitals) is worsening the poverty situation, which is already dire with 30—40% of people living on less than US$1 a day.  Equally worrying are the “hepatitis orphans”.

The roots to the problem run deep and wide.  To start with people are not satisfied with their treatment unless they receive a “tikka” or injection of some kind.  My cousin had a painful ear infection so the doctor at the local private clinic offered him an opiate injection which he gladly took.  A professor in Karachi has estimated that 1·5 billion injections (13·6 injections per person), are administered in Pakistan each year, and that 90% of these are unnecessary.  Poorly sterilised surgical instruments, barbers and blood donations all play their part in the epidemic.  Unsafe disposal of needles means that children can easily get hold of them.

The solution?  Better governance and more recognition of the problem: The insidious nature of Hep C means people are very blasé about it.  Working in a hospital where vials of drugs are left open and needles reused and drug addicts lurk around corners so as to sell their blood to poor hospital patients, I fear this problem like the disease itself, will perpetuate insidiously.

Amazing Spiders

These spider infested trees have reduced malaria in flood affected areas.

 Millions of spiders climbed the trees in the Sindh province of Pakistan to escape the rising floodwaters.It has been reported that the areas where the spiders have cocooned the trees have seen far fewer malaria-spreading mosquitoes than might be expected due to the stagnant water.

Education fights terrorism

Our main man Cameron has been here. Pictures of him and Prime Minister Gilani grace the front pages of newspapers here. The UK has pledged £650 million to support education. Many see this as an “expensive apology” for the comments made by Cameron after the bombings in Mumbai last year, accusing Pakistan of supporting terrorism. Cameron reminds us that “education fights terrorism”.

The UK foreign office released statistics that paint a bleak picture of Pakistan during 2010:

• NGO’s report increasing violence to women and poor human rights

• Police salaries have increased

• Criminal justice system is still poor

• Prisons are operating at 194%

• 2/3 of prisoners are detained for months or years without trial. (Many of my patients’ fathers are in prison.)

• Child labour due to poverty is high

• Only 57% of kids are enrolled in schools. (lets hope our £650 million can change that figure at least)

On a positive note, the 35 day doctor’s strike has finally come to an end. It was a relief to see people in white coats whose absence had left the hospital with an uncomfortable air of morbid quite. The government had finally agreed to pay the house officers 12000 Rupees (£110)/month and medical officers 20000 Rupees (£190)/ month. “Even the Daewoo bus drivers get 22000 Rupees per months” stated a dissatisfied doctor.

The strikes were a long time coming and could easily have been prevented if the government had stopped turning a blind eye. 2 years of false promises made by government officials have been endured by the Young Doctors Association representatives who got fed up hearing comments such as “hum apna pait kaat kar doctors ka pait bharan gay” (We will take a cut from our own stomachs to ensure our doctors are well fed).

Many here are still angry at the doctor’s striking. I have come to the conclusion that protest in the form of a strike is most certainly a democratic right but must not abuse and must remain hostage to human rights. Strikes should never result in deaths.