Tuesday, 24 June 2014

Turning it up to 11.

A scale of 1-10 on the volume control for either a home sound system or for that matter the amplifier for an electric guitar would be normal, from 1 the quietest to full volume at 10. So what would happen if the scale was changed from 1-11?

Its' simple according to Nigel the guitarist in  Spinal Tap "It's one louder"  he  explained to a journalist  'These  (amps) go to eleven'  Is  this  just a bit of stupidity from the 1980's mockumentary of a heavy rock band? It may be but as a phrase It has entered the English language 'Turning it up to 11' has now come to mean taking something to an extreme, perhaps ridiculously so .

In a blog last month we wrote of 10 ways to know its' hot, the last , actually no 11, read 

 11) The cacti in the garden wilt ( I made that one up)

Our rains have yet to begin properly, the hot and dry weather has returned but I haven't had time to water the garden and so look what happened to our young green spiky plant last week, perhaps it isn't a cactus after all. It is supposed to like the heat, but couldn't cope with the temperature cranked up to 11. It has now been restored with a single long watering. Life giving water.

At the hospital we have been busy of late, in March 101 babies were delivered, a new record; and over the first 5 months we have an extra 15%  deliveries on last year. In May we set a new record for the number of cases operated in a month ,70, and again there is an overall increase  so far this year of 8%. In reality the increase in workload for us is much more as last year we had an experienced nurse surgeon from Cameroon who did his own lists and shared operating out of hours. This  year Andrea and I have been covering extra on calls and also doing more surgery by day.

As we sit in the transit area at Addis Ababa airport on our way home to the UK, we can relax, reflect on the year,  and look forward to a break.

However we leave the hospital behind, Dr Isaac will be joined by Dr Mike from the US for the first month and they will have to work hard. There will be no surgery but still plenty to do, and with Malc (administrator) and Sue (nurse) still in the UK for health reasons there will be extra burdens that fall on them and our other BMS colleague Rebecca. In August Dr Isaac will be the only doctor and the hospital will have to offer a reduced service. Please pray for them and for all the staff of the hospital, that they feel that they are not being forced to work at intensity no 11.  

Wednesday, 11 June 2014

Heat of the moment

DUST,    'is it also linked to global warming and heat trapping ?'

This question appeared in the last blog, along with an off the cuff retort.

 Actually I didn't know the answer  and hadn't looked it up, hence the question mark . A friend wrote to me and in fact, although it is an atmospheric pollutant that definitely  does cause human disease,  that appears to be is the limit of its problem. It is more linked with global cooling than warming. The relative balance of  effects  reflection of sunlight  back into space and absorption of sunlight and warming comes down in balance of a small global cooling. Not a dramatic effect but certainly not a villain. The problem lies elsewhere  with greenhouse gasses CO2 etc. and not with atmospheric particles. Sorry for any confusion.

An interesting lesson to me, I'll be more careful not to make less than fully researched remarks, and won't use  question marks  to cover myself any more.

Sunday, 8 June 2014

Dust in the wind

Is it dusty in Kansas, I always supposed it would be because of the words of this song title, a 1970's classic. But I don't know much about the geography ,of the  USA perhaps it is isn't dusty at all.  However I do know that Chad is probably the dustiest country on the planet, or at least the Bodélé depression to the North of us is,. It is in the  southern Sahara and is the lowest point in Chad and represents part of the old Mega lake Chad  ( 20 times bigger than today) that dried up thousands of years ago. It experiences  dust storms 100 days every year, and in season produces  an average 700 000 tonnes of dust a day.

We get dust storms  less often, but each year  before the rains the wind blows down from the north  we have dust storms the like of which you have never seen. You can see it coming as in the picture above, (Guinebor II 2009) a wall of dust hundreds of metre high rolling across the flat earth. A strange  silent vision of the calm before the storm and then the wind arrives blows, gusting snapping hard grown trees, twisting street lights, ripping of roofs making walls fall . We get people injured by flying sheet metal etc and there are sometimes deaths.  After  the strong winds pass  the dust rests in the air, the sky is an eerie orange and a fine silt gets into the houses and coats every surface. 

Occasionally you get Sahara dust in the UK with spectacular sunsets and a faint dusting on your car, other places get it harder, it made BBC news when a dust storm disrupted the Dubai air show it  and another  unusual storm  killed 4 people in Tehran earlier this month. Here  it doesn't  make the news its part of life.

All this dust can't be good for health, last year the BMJ informed me that arrival of Saharan dust has been linked to hospital admissions  in Italy due to respiratory disease, heart attacks and strokes, the first makes a lot of sense  to me, and you do see people riding motorbikes with surgical masks in Ndjamena, the other two  I don't fully understand the mechanism  but it is clear dust can't be good  for you. Is it also linked to global warming and heat trapping ?  Really something needs to be done!
NASA: Bodélé depression dust storm from space
Ndjamena is  just below Lake Chad
But life is never that simple, the dust from the Bodélé depression is swept up into the atmosphere and it travels extraordinary distances. Each year 50 million tonnes of mineral rich dried diatoms  from the old lake bed are deposited on the Amazon  acting  as  fertiliser . This meets half of the Amazons annual requirement. The world's biggest rain forest is supported by the world's biggest dust bowl. Dust from the depression also fertilises the Atlantic ocean causing blooms of phytoplankton at the bottom of the food chain. An amazing interdependence and  something that at first seems to only  be a problem is actually  a vital part of the world ecosystem.

Back to the hauntingly sad song,
I closed my eyes,
Only for a moment ,and the moments gone,
All my dreams, pass before my eyes a curiosity,
Dust in the wind, all we are is dust in the wind.

Same old song
Just a drop of water in an endless sea,
All we do crumbles to the ground though we refuse to see
Dust in the wind, all we are is dust in the wind.
Don't hang on,

Nothing lasts forever but  the earth and sky
It slips away,

All your money won't another minute buy
Dust in the wind, all we are is dust in the wind
 Dust in the wind, all we are is dust in the wind
 ( lyrics  from  Dust in the wind, Kansas)
Life can be hard, at times we could all give up in despair.  'It's all meaningless', says the writer of Ecclesiastes,  'a chasing after the wind' . In human terms we are all insignificant on the world stage of 7 billion people , but perhaps with God's help our grain of dust can be of  some significance and benefit to someone , somewhere on this planet.

                                               A nearly perfect dust print of a paper cut
                                                    Valentines card in Chadian dust

Come and hear about our grains of dust making a difference at Guinebor II as we return to the UK this summer on the following dates 
              Wakefield Baptist, (6 July 10:30 and 6:30)      
                St Leonards East Sussex(13 July 10:30)
          Hull, Cottingham Road (20 July 10:30)
          Louth, Eastgate Union (20 July pm)
          Macclesfield, All Saints  C of E  (27 July 9:30)
          Forest Gate, Woodgrange London(10 August 11:00)
Possibly Penzance Chapel Street Methodist(17 August) TBC 
              and Kettering Fuller  (24 August)  (TBC)




Sunday, 1 June 2014

10 ways to know it's hot

So right now it's the hot season in Chad , temperatures reach a peak at about 2pm, 45C  in the shade is common,  50 C happen on exceptional days each year. Our human bodies are normally at 37C, if you are very unwell with a fever you may reach 40C and we cope relatively easily with such temperatures. Once it gets hotter than this things get more difficult and strange things happen.

What's like living at these temperatures ?

Here are 10 ways to tell should it ever happen in England! An exceptional  heat wave with you peaks at about 32C so you have some way to go.
1)Your candles start to become spontaneous  works of art.

2).Your clothes from the drawers have that freshly ironed warmth. Plates from the cupboard are heated ready  for soup .   
3) The kittens stop moving and lie flat on the floor making you wish you could slow down too.

4) Whilst helping with homework Ruth and Rebecca object to the sweat running of my forearms and making their school books wet. The rest of the school has air conditioning! Operating gloves are wet inside when you take them off.

5)You drink at least 3 litres of water at work and more when you get in. You even want to add salt to your drinks and tea tastes better than coffee.

6) Proper evening ward rounds become impossible, everyone's sleeping outside, including us on the  veranda.

7) Your house walls radiate heat at night  and the fridge needs wet towels draped over it  to evaporate heat and keep it at 15 degrees.
8) Chocolate fondue arrives in the post.
9) It's hard to know which patients have a fever at 2pm is it the patient temperature or the air temperature that has been measured. The babies especially take on the temperature of their surroundings, which ones are really sick?

10) Plastic and rubber things crack up spontaneously  or become very bendy.

11) The cacti in the garden wilt ( I made that one up)

Hope this guide helps!!  When we wrote this we were  just back from enjoying a break from these delights in the swamp cooled guest rooms of a mission in  town and were excited by some unusual cooling rain fall .Its hot and sticky again now so we are counting the days just another few  weeks  we hope   before temperatures drop to more manageable levels and we stop counting every breath of wind. What's needed is a nice day at the swimming pool, like we had to celebrate Ruth's 18th birthday last month, ( the flowers are very beautiful but guess what they wilt quickly, I wonder why?)






Wednesday, 19 March 2014

Little by Little

Sometimes when you get caught up in the day to day business of consultations and complicated deliveries and operating it’s hard to see all the changes that are happening around the hospital .

A few weeks ago I was showing a visitor around and I realised that instead of saying we hope to do this and that, I was able to say this is being done or even that has been done.

So what are these ‘small’ changes. Some you might not notice like having the documents available all the time to keep the notes up to date and keep the out patients running smoothly. Having a steady stock of drugs in the wards, maternity, operating block and emergency room even with a degree of control when the nurses remember to fill in the forms .Getting the paint touched up when it’s peeling and other small repairs. You wouldn’t notice too unless you had been before that there’s no longer chaos at the cash desk as the patient form an orderly queue on the benches after they are let in the gate.

Other things are more obvious like having curtains on the ward to give patients much needed privacy. A new desk instead of a plastic table in the maternity. Having solar lights in the single rooms as well as the wards and also plumbing that works. Painting of the wall between outpatients and inpatients looks good and we soon we will be adding pictures for health education and evangelism. We have boxes next to the beds too with bibles in Arabic and French and a place for the notes.

Our recent bigger change has been offering vaccinations. Finally the solar fridge is working the vaccines have come and we have mastered the paper work. It’s great to see the new born babies and pregnant women vaccinated and the children coming as now it’s not too far away. So far we’ve seen over 100 women and the same number of babies in just over a month.

Most of these changes have happened as we have become a bigger team with a pharmacist and administrator and two nurses. It’s great that we can all work together to improve things. Malc and Sue are having a well earned rest and home assignment in the UK at present and Claire will leave next week so I hope we can keep things up now with our reduced team.

We continue as well to improve the medical care we offer in other ways and little by little the midwives and nurses take on more responsibility. One doing her first D and C for a miscarriage last week and our anaesthetist now confidently doing spinal anaesthesia. A few weeks ago we managed to save the life of a patient by giving her a blood transfusion in record time and then later attaching her to both oxygen concentrators to get enough oxygen into her blood after her lungs filled with fluid when her kidneys stopped working. She went home well 10 days later.

 It’s a good job God is with us turning our little by little into something bigger for him.

Saturday, 15 March 2014

Man is but a drop of dirty water

So began out first ever physiology lecture at medical school and Marks recent teaching o
n fluid balance and dehydration. Thursday mornings at 8 o’clock is teaching time so far we have had courses on diabetes and malnutrition Malaria Hypertension and diarrhoea all things we see a lot of. This time it was back to basics and calculations on the blackboard borrowed from one of our staff who is having French lessons to help him be a more effective administrative aid.

Water has been in our thoughts these last few weeks as the dry and hot season is upon us. The water bottle taken to the hospital is now coming back empty and often more is needed We took a lot, about 80 litres with us on our recent holiday as we travelled   850 km to Zakouma Chads safari park.

On the road we passed many camels and lots of cattle and sheep and goats. What was most impressive though were the collections of animals and people around the water holes and wells outside the villages .Most of the countryside is dry and parched and it’s hard to see where they get enough for the animals to eat but the water sources are all too clear.

The dry season means it’s the best time to go to the park as the animals are looking for water and we had a great time seeing all sorts of animals including 100’s of giraffes on our early morning safaris and huge collections of cranes pelicans and Maribou storks gathering at the waters edge in the evening. At night we passed a leopard in the bush and several hyenas out hunting.

Our trip back passed through Bitkine where the water for the town comes from the Ouadi dry at this time of year but filling intermittently in the wet season. Time to consider how much water you use when it’s all brought up the hill by a heavily laden donkey.

Time too to consider where does our real source of life giving water come from as we sat on the hill overlooking the town and watched the sun go down.
We may be a drop of dirty water in physiological terms but we are also fearfully and wonderfully made. 






Saturday, 18 January 2014

So what makes a Chadian Christmas different?

Well of course to start with we think its cooler but actually its rather like a summers day in England around 17 at night and 30 in the day.

Apart from  the temperature then:

Well there's the tree Sunday the 16th had us scouring the compound for a suitable branch to paint gold and silver and  make glittery, a bit different from a green fir tree but perhaps more suitable here and certainly easier to find apart from the plastic ones for sale by the hawkers outside the supermarket with lights already attached. It looks good once we've decorated and there are no needles to clear up.
Then the films we watched two different Nativities the first with the staff and the second with patients and their relatives not snuggled up in the warm by the fire but projected onto the perimeter wall, sitting on wooden benches under the stars. 

Christmas eve shopping almost felt similar to England  in that it was so busy. It too was outside, the market having doubled in size as it spread up the surrounding roads. Women sat behind  piles of locally grown vegetables on mats on the floor, frozen chickens (from Brazil) were defrosting in the sun , live ones were squawking and amongst all this  motorbikes were weaving in and out  threatening to knock  us over. We enjoyed the buzz of anticipation as we bought our vegetables for the next day.

What about the food....                                             well  on the 25th we did manage a  traditional Christmas safari dinner with a slight twist of a watermelon nativity it would still have been excellent in England However the nibbles after the Christmas presentation earlier in the week  were prawn crackers, chunks of roasted  beef and a type of donut.
Donuts were also on offer along with sweet and strong  tea during a pause in  the Christmas eve service and we had a gift of sweets prawn crackers and biscuits from one of the midwives. One or 2 mince pies were also eaten thanks to supplies from England and our retired guard who came to greet us loved the Christmas cake eating two  slices and taking a third home for his wife

I wonder what time your Christmas eve service started ours was at 6pm and got going about 2 hours later lasting till 7 am! We only managed until 11pm as we were on call the next day but did enjoy the Bible quiz even if Mark, representing the hospital  got his question wrong.

Christmas day was spent part at home but also we managed a Caesarean and a chest drain amongst other patients needing our attention. It did stay quiet for our Christmas meal though and it was not all work, we enjoyed handing out gifts to the patients: sweets, balloons, more biscuits, oranges, knitted hats and booties, balls, crayons and outfits for the little babies and  no Father Christmas  in sight .

Our Boxing day walk was where we really knew we were in Chad we decided to go and book our New Year camel ride but we were in for a surprise. We arrived at the golf course, which is where the camel rides take place don't worry about the greens, there are only browns and were asked if we had come to see the Hippos. Half and hour later we were watching a group of 15 hippos in the water just down from N'djamena's main bridge one chomping the greenery making a terrible noise.
So that was our  Christmas was it really so different what made it good was sharing with others and having fun celebrating the wonderful news that Christmas is and that doesn't need any special food or place or weather does it?