Sponsorship Reports
Report of my time learning about tropical veterinary medicine in Kenya - Summer 2008
By Catherine Wilson (Bellairs and Bayshill 1997-2004)
I travelled to Kenya for five weeks during the summer of 2008 with the help of a travel grant, and joined a team linked to the non-govern
mental organization VETAID, a charity which aims to assist African livestock farmers to improve the welfare and productivity of their stock. The project involved working with the people of the Maasai tribe who are world-renowned for their unique farming methods and the pride and respect they have for their animals.
We were to be working on the field based part of the trials for a new vaccination against Contagious Bovine Pleuro Pneumonia (CBPP). This disease has been eradicated from Europe but is rife in Southern Kenya and causes a huge loss of productivity for the farmers. The immunity produced by the current vaccine lasts for less than a year and there is a high chance of the cattle suffering from the severe side effects, which include abscesses forming in the gluteal muscles and sloughing of the tail from below where the vaccine was injected. We were testing to see whether the new vaccine is an improvement in these respects from the original. This would be based on results from pre and post vaccination blood tests and observation of the cattle to determine the level of immunity that is developed as well a
s the side effects seen.
I was part of a four man itinerant team taking blood samples. The other members of the team were two vets and a diver/cook/all round useful guy! These three are all men of the Maasai tribe so are able to speak to the Maasai farmers in their mother-tongue language which is useful as some of the uneducated farmers speak neither Swahili or English (all the team were also fluent in English, luckily!).
Our first stop was camping for ten days in a small remote village one kilometre from the Tanzanian border, to collect pre-vaccination blood samples. Our day involved waking up between 5am and 6am and driving out through the bush whilst the stars were still out to the homestead (Boma) we were to be taking samples from that day. By the time we arrived at the Boma the sun would have risen and the ladies would be out milking the cows, which they do at the same time as the calf is suckling. After they had finished we would begin working, with the Maasai farmers restraining the cattle with a rope tw
isted round a stick and lassoed around the leg of the cow as it was running past - that took some skill! We then took a blood sample from the Jugular vein and measured the diameter of the tail, to see if there was any change due to swelling, pre and post vaccination. After our work was done we would relax with a cup of tea (very, very sweet and very milky, made of course with fresh milk and only occasionally with the added protein of an unlucky fly!). We drank this inside the Bomas, which the women build with sticks and cow dung, with separate sleeping areas for the man, women and children and also calves and goat kids. Often when sitting in the smoky black interior you would put your hand down and find something soft and furry- a newborn goat kid too young to join its mother walking to find pastures all day, and instead was happily keeping warm by the fire.
After tea we would head out to see any clinical cases. The most common was East Coast Fever, a tick borne disease which strikes c
alves. By the end of my stay I was able to be pointed in the right direction and told to examine and treat the animal which was great - my first independent bit of “proper” vetting! We even saw a case of Foot and Mouth Disease which is fairly common in East Africa and not considered significant, but would cause full alert in England so I must have disinfected my clothes at least five times in paranoia of bringing it back home! Once we had finished the farmers would let their cattle out of the Boma area for the day so they can go and graze, usually guided to the best areas or watering holes by young boys, to return home at night just before dark.
We had the rest of the day free, either for a game drive during the time when we were staying on the edge of the Maasai Mara Game Reserve, a walk through the bush, visiting friends and chatting or discussing about any veterinary issues we could think of. We also vaccinated some sheep and goats against “Blackquarter” (Clostridial Enterotoxaemia) and Sheep and Goat Pox, which are also not present in this country but in Kenya have high fatality rates.
One day I joined the vaccination team. The farmers had walked their cows down to the crush either very early in the morning or the night before and were waiting patiently for us to arrive. The vaccination takes place in the tail and for experience learnt that it was a good idea to vaccinate the tail and not any fingers!
During my stay I had the privilege to become part of and learn so much about the Maasai culture and way of life. The farmers are now sending their children to school to be educated (in English) so the old traditions are 
slowly shrinking, but it was still common to see the blue cloaks worn by the newly circumcised children, both boys and girls, polygamy (one man we met had seven wives, one living over the border in Tanzania!), wizards, drinking of a mixture of fresh cows blood and milk is still a common remedy to increase strength and cure illness. It was common to see a girl the same age as me already having given birth to two or three children, as frequent childbirth is very much respected among the Maasai and very necessary for the tribe's survival, especially in days of yore before the acceptance of some parts of Western medicine. I was often asked how many children I had and when the answer none was given was offered a hand in marriage for 40 cattle (which I sadly declined as I don't think my father would much appreciate then in the back garden!).
The whole experience was really incredible and I gained so much, both from the willingness to teach of the vets Saitoti and Lemain and the welcome I received into the community form the Maasai people themselves - I hope our efforts manage to produce them useful results for the community in the future.
Medical Elective in Cusco, Peru
By Lucy Simmonds (St Clare and Bayshill 1995-2002)
The elective experience offered by Birmingham Medical School is a fantastic opportunity to broaden medical, cultural and sociolo
gical knowledge and awareness. I had always been interested in visiting South America and as a conversational Spanish speaker I managed to get a placement in the emergency department of the Clinica Pardo in Cusco. Cusco has a population of around 300,000 and is situated at 3400m above sea level, a fact that caused some shortness of breath and palpitations during my first few days! The name means ‘navel of the world’ because Cusco was at the centre of the incredible Inca Empire, which I became fascinated by, particularly during my four day trek to the awe-inspiring site of Machu Picchu.
I observed and assisted in examining patients and in minor procedures whenever possible. During these activities I noticed some major differences between practice in the UK and Cusco. I instantly noted a lack of privacy in the department - the interconnecting doors between the two consultation 
rooms were sliding glass doors and offered very little visual shield between the rooms. Furthermore, patients would frequently walk freely into the consultation rooms while another patient was being attended to. In the UK we are lucky enough to have curtains between all cubicles and private consultation rooms and new interventions to retain patient confidentiality are continually arriving in our daily practice. The experience of working in a busy urban clinic in Peru really helped me to appreciate how well the NHS actually does in so many facets of its care. Another glaring difference that I observed was in the are
a of hygiene. The attention to infection control was so low that it was a real shock to me, trained in a country where we have almost unlimited access to hand-washing facilities. There was no alcohol hand rub, and though I left some of my own supplies, alcohol was evidently an expensive luxury that was saved for the cleaning of open wounds and not to be wasted on hand cleansing.
During the consultation of a Dutch traveler presenting with Giardia and salmonella gastroenteritis I was able to assist in translation. The doctor had only very basic English and the traveler was unable to describe her symptoms. Having a decent level of conversational Spanish from my AS days with Mrs Palmer and Miss Diaz at college, and having poured over a medical Spanish-English textbook (which I later left at the clinic), I was able to translate the woman’s symptoms and the doctor’s questions and advice. I was very happy to be of assist
ance and it was also enjoyable to feel like a valuable part of the team.
The elective was a very enlightening and humbling experience for me. I witnessed practice so different to that which I will begin working in next year, but in many ways, there were key similarities. The compassion and conscientiousness of the doctors there was something I am keen to emulate and am so grateful to them for allowing me this insight. I would like to thank the Guild once again for contributing towards this fantastic experience.
Malawi Update – December 2007
By Hazel Mowbray (Glengar and Bayshill 1995-2001)
Waiting for rain is a torturous business. It is officially late this year and sky-watching has become the latest past-time; every morning on the way to work the driver looks up and makes the day’s prognosis: too little cloud, too much sun, not enough shadow, too much brightness. The only thing that makes the rain probable is the heat. Was it really this hot last year?
Now, we are told, the rains will arrive this week. They said the same thing last week, and the week before. In October and November the fake mango rains tricked the mangos into ripening. The real rains will push the mangos from the trees so that you can’t walk without stepping on fallen fruit. This is the season when a sturdy umbrella becomes the latest accessory, when the windows get closed straight after the rains end to prevent vile flying insects from swarming inside and dying on the floor and the entire country starts to look like a jungle. It’s also the season when flooding destroys livelihoods and homes, and when hunger becomes a real problem – we call this rainy period the lean season. Crime goes up, nutrition rehab. unit (NRU) admissions go up, food prices in the markets go up. This is because as soon as the real rains come everyone plants maize, but this maize won’t be harvested until March, so between now and then there is no food apart from that stored from the previous harvest or from winter cropping. Of course if the diet here wasn’t 97% nsima based – the staple made from maize flour containing 1 of 46 essential nutrients – this problem wouldn’t happen, and if winter cropping (between April and October) was intensified with the use of irrigation, there would be enough maize in reserve to get through the lean season, or if diets were diversified, as they are more so in the Northern region, it wouldn’t be a problem. As it is this is the busy time for us, waiting to see what the rains will bring: good harvest, bad harvest, no harvest.
For the last week I have been in Mangochi, and its good example not just of what I’ve been doing for the last three months, but also of the Ministry of Health working at district level. Mangochi has 36 health centres which operate a programme called OTP – Outpatient Therapeutic-care Programme. This is a nutrition programme targeting those with severe acute malnutrition. OTP is part of a bigger programme, CTC – Community Therapeutic Care, which has three programmes operating under it, all complementary.
WFP already provides the food for the Nutrition Rehab Units (NRUs), and at every NRU there is also supplementary feeding, which we also provide the food for. We recently agreed to support the CTC programme by providing food for supplementary feeding at everything OTP site. About half these sites already have SFP, but the rest needed to be assessed before they could start the programme.
So last week in Mangochi I turned up to do the assessments. Each health centre has a nurse/midwife or medical assistant and about 4-12 health surveillance assistants, the main implementers of health programmes. So what did we find? Well, at one health centre the medical assistant was drunk at 11.30am, at another all staff were out buying fertilizer coupons (at 10am), at another a very delightful nun and her two health surveillance assistants had absolutely no idea about the Supplementary Feeding Programme despite being trained in September, then another one had lost all their patient records of the OTP programme as they’d had an accident with some gas cylinder, and didn’t have a register, at another they were using syringes to pin notices to a board!
The supplementary feeding programme is essential as it targets women and children in the moderate malnutrition stage, preventing them from reaching the stage of severe acute malnutrition, which is much harder to treat. Only three weeks ago I was in the most northern district of Malawi, Chitipa, at the district hospital. Sitting in the NRU, being assessed for admission, was what looked like a long-legged baby being carried in its mother’s arms. The “baby” weighed 12kg, and was 5 years old. If supplementary feeding and anti-retroviral treatment were reaching all those who needed it children like this one wouldn’t exist.
In the last couple of months our house was broken into. The petrol for the police to come to our house and make an inspection had to be paid for by us. A statement was handwritten by us, agreed by the police, then we had to type it up, print it onto the one sheet of paper the police provided, make four copies, return to the police station and pay 500kw (about £2) to have it stamped. I can see why many people never bother with a police report. Then another colleague died, this time from malaria, reminding that this highly treatable illness is a killer in sub-Saharan Africa even amongst the highly educated and well off. For Ennelles the illness was compounded by HIV, and at 26 years old she leaves behind her HIV negative son and a rather large gap on the eighth floor of our building. She makes the third colleague to die in the 15 months I’ve been here. Then, after nearly 8 months of waiting the Italian Government have agreed to fund my proposal for 28 nutrition demonstration gardens based on the Low Input Model of permaculture, one per district, based at the nutrition rehabilitation units at the District Hospitals. This is without doubt the most positive thing achieved to date.
Half the time I still think more harm is done than good by this aid game – the aid mentality, the dependence on lunch and travel allowances, the craving for the material uselessness of the West, the attempts to change a country where crime is low and the family unit rules, and where the saying goes that the only reason there has never been a civil war is because the population is so apathetic. The other half, I wonder why it seems such an effort and begging process to rectify such a blatant and palpable wrong: that half the world is incredibly rich and half the world is incredibly poor, and that it was only by chance that we were born into the rich half. Even then we still seem able to abuse all that’s on offer, destroy our bodies, turn blindly from those that need help, and feel hard done by when something doesn’t go exactly as we want.
Easter Island and The Galapagos Islands
By Georgina Leechman (St Helen’s and Bayshill 2001-2006)
Certain that I wanted to take a gap year, I had to narrow down the places I wished to visit. My passion for geography led me to work in the Galapagos and Easter Islands.
I was not interested in simply being a tourist in these unique islads, so I became involved in a conservation project on the Galapagos Islands and an archaeological project on Easter Island.
Easter Island, famous for its Moai statues, was the first place to be visited, in early November 2007. Easter Island is supposed to be the most isolated place on earth even more so than the Antarctic. It is 2,300 miles off the coast of Chile to whom it belongs, in the middle of the Pacific Ocean. The project that I participated in was called 'Easter Island Cultures', run by a professor of archaeology from the University of Richmond, Virginia. The volunteers like myself helped survey an area of one square kilometre. The task was to record archaeological features left by the early native Polynesian inhabitants, the Rapa Nui. It is believed they arrived on Easter Island as early as 300-400 AD. Their descendants still live on the land. My contribution was working with a GPS Navigation system to locate sites and items such as caves, chicken houses, rock gardens, bones, shells, carbon, house pavements, cooking ovens and petroglyphs (inscribing on rock faces). We also had to make sure there was photographic evidence of the sites.
The recording of these sites and their location
can assist in the making of land management plans designed to minimise future impact on the ancient landscape of the island. This impact will happen as the population grows and land is distributed to the local people for agriculture. The results that were compiled will also contribute to the records of the National Park Service of Chile.
The main research objectives were to understand the forms of Rapa Nui agriculture and building structures, as well as to use carbon dating to date more precisely the settlement, rise and final decline of Rapa Nui. The final objective was to obtain greater understanding of why Rapa Nui society was nearly wiped out between 1800-1900 AD, the result either of over-intensified agriculture destroying the land, the arrival of the Dutch bringing diseases and introducing slavery, or climatic change. A combination of all these factors as the probable cause still needs further research.
My Easter Island experience stood out in a fabul
ous gap year owing to the participation in first-hand archaeological research in the field - a truly unusual experience. Easter Island and its people are unique in their culture, ecology and history. I had the opportunity to watch a tribal dance performed by the villagers, and taste the local food of raw fish with onion and spices. Native children and adults were very interested in our work and usually thanked us by throwing parties or offering to do our laundry. As in any similar situation there were some who objected to our work but that was usually through lack of understanding of our research as they thought, mistakenly, that we were ruining their heritage.
My next stop was the Galapagos Islands, 600 miles off the coast of Ecuador in the Pacific Ocean. The project I joined was called 'Galapagos Invasion'. We volunteers mapped 25 hectares of invaded Scalesia Forest in Los Gemelos on the Island of Santa Cruz.
The Scalesia Forest is indigenous to the Galapagos Islands, however with the increase of tourism and population, invasive species from
mainland South America have begun to overtake the native vegetation. The main invaders are sauco, guava, passion fruit and cedar, all of which spread quickly and are hard to exterminate. With the use of GPS Navigation and herbicides we were able to give 24 hectares back to the Scalesia Forest. There will be an on-going project to retain what is left of the endemic ecosystem. Climbing the mountain each day and then labouring for hour after hour with a machete fighting 'the invasion' was exhausting!
It is hoped that the success of this project may become a model for other conservation projects on the Galapagos and international forest types. The project has also inspired the first collaboration between the Charles Darwin Research Station and the Galapagos National Park Service, two important governing bodies controlling the Galapagos conservation effort. The difference between the conservation project and being a tourist meant that I was able to contribute to preserving the ecological balance of the fragile archipelago of the islands, so famous for its plants and wildlife described by Darwin in his 'Orig
ins of the Species'. The work that has been done in the Scalesia Forest has also deepened the understanding of the impact of economic activity (tourism, trade, migration) on the ecosystem, an important global topic at present.
Medical Elective in Uganda
By Rosanna Chinn (St Helen’s and Elizabeth 1994-2001)
At the end of the fourth year of study, Birmingham medical students have the opportunity to organise and carry out a period of stud
y anywhere in the world. After much deliberation and planning I arrived with a fellow Birmingham student at Kitovu Hospital, a missionary hospital in Masaka, Uganda.
Uganda is a land-locked country in East Africa with a population of 28 million people. It has a high incidence of HIV and AIDs, although it has been heralded as something of a success story owing to a rapid reduction in the spread of infection during the 1990s. The country has rebounded from civil war during the rule of Idi Amin, and is now relatively peaceful and stable, apart from the ongoing civil war in the north dominated by the Lord’s Resistance Army.
Kitovu Hospital has 200 beds in five wards: medical, surgical, paediatric, obstetrics and gynaecology and a special “vesico-vaginal fistula” unit. Most patients pay a small amount for treatment and many prefer this to the “free” government hospitals, which often run out of basic equipment and treatments. The hospital is well-staffed with six fully-qualified doctors, two junior doctors and three clinical assistants, as well as nurses, midwives, health workers and an HIV counsellor. The wards are extremely basic by UK standards, not much more than a system of sheds with concrete floors and rows of rickety iron be
ds with thin plastic mattresses. The beds are arranged in various bays but have no mosquito nets or curtains around the beds for privacy. Every inpatient requires an attendant, normally a family member, who stays at the hospital and is responsible for washing and feeding. Basic tests available at the hospital are x-ray, ultrasound and some blood tests; for any other tests patients are referred to the large government hospital in Kampala, the capital, a difficult and expensive journey for many. The electricity supply in Uganda is sporadic, so the hospital generator was essential and often had to be fired up halfway through operations or in the middle of the night!
The vast majority of patients we saw had malaria, HIV-related illnesses or tuberculosis, the big three diseases in sub-Saharan African. We also saw patients with snakebites, terrible burns, horrific road traffic accident injuries, advanced cancers and much more. Outpatient clinics brought a surprising number of patients with high blood pressure, not a problem we were expecting to see in Africa, but perhaps inevitable considering the amount of salt in the Ugandan diet! We were continuously impressed with the clinical skills of the doctors, who made sound diagnostic and treatment decisions using clinical judgement alone, without the help of many tests considered routine in the UK.
Our stay at Kitovu coincided with the vesico-vaginal fistula (VVF) clinic. Visiting surgeons from England, Ireland and Italy had come to carry out surgery on women suffering from this terrible condition, which results from obstructed labour and leads to the affected women (usually in her teens or 20s) suffering with urinary incontinence and being ostracised by her community. The wonderful work and training of local doctors being carried out was certainly a motivation for our own work and studies.
Our visit also included some day-trips with various teams based at Kitovu. We spent a day with Community Based Health Care, who carry out childhood immunisation programmes, distribute free mosquito nets and give health promotion talks. Another day was spent with Palliative Care, who visit terminally ill patients at home, managing pain and distributing m
edicines and food. We also went out with the hospital blood bank on a collection day, and donated our own blood too! These various trips into the surrounding rural area were eye opening, and helped us to appreciate the living conditions of the patients we were treating at the hospital. The sound of many little children shouting “Bye Mzungu” (white person) will stay with me forever!
The greatest impression I have gained from my work in Uganda is how much is possible with so little. I am greatly indebted to the doctors at Kitovu who spent so much time teaching and guiding us, and also to the Guild for their generous financial help.
Research, Conservation and Exploration in Patagonia
By Jess Hartley (Bellairs and St Hilda’s 1999-2006)
As part of my Gap Year and thanks to a Guild sponsorship, I spent three months in Argentine and Chilean Patagonia on a Research, Conservation and Exploration expedition. I left for Buenos Aires on the 1st January, definitely not a travelling date to be recommended if you are someone who likes to c
elebrate New Year’s Eve-just water for me on the plane. And just to make me regret having had that last glass of champagne even more, once in Buenos Aires, I embarked on a 19-hour bus journey south, to Bariloche. Lucky for me, northern Argentina is simply flat, so having slept for the entire journey, I didn’t miss out on any spectacular scenery. The group that I was to spend the next three months with couldn’t have been a better mix: four gappies, some new graduates, some people on career breaks and even a granddad-to-be, bringing the grand total to over thirty people, all from every stage and walk of life.
My first month was spent on the Condor project in Argentina. This involved collecting data on the activity of condors, the largest bird of prey in the world, with a wingspan of up to three metres. They came perilously close to extinction mainly as a result of aggressive hunting. Monitoring took place from three locations, Fragua Valley, La Buitrera and Chaquenita. 
Fragua was the project base, where we were housed in a small disused school-house with glassless windows and no doors, but at least it wasn’t a tent. My time here consisted of daily hikes to monitor the birds’ activity at specific distances related to the “road”. This involved long walks, sometimes 26km in a day, in some of the most beautiful hills and valleys of the region and in blistering heat, allowing me really to develop my shorts and t-shirt tan marks.
My next stop was Chaquenita, the most remote of all the monitoring points. We were driven off-track for an hour to the edge of a canyon and after walking/sliding/falling down the side of the canyon, we set up camp right at the bottom. The condor monitoring this time would consist of counting the number of birds at the top of the canyon from the first light of the day to the last light, every hour. I was here for six days with three guys but had a tent all to myself, a luxury that was sadly not to repeat itself.
My last monitoring point was at La Buitrera, a tiny shack at the edge of a private estancia. It had a table and a wood burning stove and ridiculously large holes in the walls, not so amusing when the winds start to blow, and in Patagonia, they really do blow. Again, no girls here either and
I started to find myself carrying a shovel on my shoulder, embracing my dirty hair and building tables, but it was very clear that I was still very much the female as all cooking and washing up was generously left for me to do.
My second month was spent on trek, with tents as home, the great outdoors as the toilet and no washing, plucking, shaving, moisturising or change of clothes. This, coupled with eating porridge, raisins, peanuts and pasta every day and carrying over half my bodyweight in my backpack, made for the most incredible experience of my life. The first few days were spent on the Exploradores Glacier, whe
re we became accustomed to walking with crampons on as well as learning to ice-climb, rescue each other from a crevasse and abseil. Being the smallest person by a long way in my group, it quickly became apparent that if anyone were to fall down a crevasse, I would be the last person they would chose to rescue them, which I chose not to take as an insult, especially as it also became apparent that as my backpack was almost as big as I was, it would probably be me that would be at the bottom of the crevasse!
The real trekking began after these lessons. A day normally consisted of walking for 8 hours in a lot of rain. Apart from this, no two days were the same. We had days walking across the most beautiful glaciers and hour after hour trying to get over moraine walls, trying not to concentrate on the bottomless holes surrounding us. There were days navigating through dense alpine forest, being catapulted to the ground by stray branches that became attached to 
backpacks; glacial river crossings ensured that we had wet boots and feet for the entire trek as well as nicely numbed toes. The nights were just as eventful as the days. Our tent was pitched somewhere different every night, which involved varying tactics to ensure it stayed there all night. Sleeping on moraines meant hours preparing a rock platform to get as smooth a base as possible; sleeping in alpine forest meant trying to find a spot big enough between all the trees; other nights we just had to make sure we weren’t too close to the edge. The most special nights were the ones spent opposite mountains where we could hear roaring avalanches falling all through the night. I feel extremely fortunate to have spent time in places that have absolutely no trace of human existence apart from our own.
During my last month, I worked in a provincial park near the tiny town of Copahue, in the north of Argentina on the border to Chile. Here, I was in a group with nine guys and not one girl for the entire month. I can safely say it was the closest I’ve ever been to growing a beard. The park receives little or no funding from the government and has only three Guardaparques (wardens) to maintain it. The Guardaparques, Ariel, Tati and Segundo, spoke
only Castellano, Argentine Spanish, so we had no option but to ditch our English, which made for some very amusing and also frustrating days. We were totally immersed into the Gaucho lifestyle and culture and when word spread of the help we were giving to the park, we were invited to Mapuche and Gaucho festivals and were treated to several impromptu asados - the Argentine version of a barbeque, involving enormous pieces of meat (normally entire goats) cooked over hot coals, and a lot of red wine. During our time in Copahue, we were able to complete the same amount of work that would have taken the Guardaparques a year. The vital maintanence and conservation work that the park needs can take place only in the summer months because the park becomes totally covered in snow in the winter. In the short while we were there we managed to put them well ahead of schedule and what little funds they have could be spent more effectively as they did not have to contribute to more manpower.
I did not achieve an enviable tan on my Gap Year but I did achieve certain things that will last much longer: scientific knowledge of one of the biggest flying birds in the world, learning Spanish from Gauchos and living for a month where no other humans have set foot.
Malawi Report – April 2007
By Hazel Mowbray (Glengar and Bayshill 1995-2001)
Legend has it that God intended Malawians to live on the plateau of Malawi, but to work and harvest from the rich soils of the Lower Shire valley (pronounced Shir-ee). Of course, fast-forward a few thousand years and things haven’t quite worked out as God intended: a large number of unfortunate souls live in a basin well below the rest of Malawi, in intense humidity and horrendous average daily temperatures of 42 degrees. Oh yes, God was certainly right about one thing – the soil is incredibly fertile, as the sugar plantation owners know, but there’s always a catch – in this case the humidity, floods and drought. Welcome to Nsanje and Chikwawa Districts which make up the Lower Shire. It’s a little cruel, in my opinion, that from the bottom of the basin the soaring ridge of the plateau is visible so that every time you look up you are reminded that not everywhere is already 36 degrees at 7am.
I am here, working for the United Nations World Food Programme – although usually based in their Country Office in Lilongwe. I’ve been in Malawi for seven months now, and WFP have asked me to stay for another year, so it looks as if I’ll be back in lovely green, cold UK in September 2008.
A rural health centre.
Having heard the legend of the Lower Shire, last week I was fortunate enough to travel to Nsanje and Chikwawa for a week to conduct a flood-impact-assessment as part of the joint WFP-FAO (Food and Agriculture Organisation – another UN body) mission team. Actually, the ‘team’ was made up of me and Chester, an FAO guy and previous Chikwawa District Crops Officer, and the ever-important driver who managed to get us stuck only once. In November some flash floods hit the Lower Shire – quite normal for that time of year, and quite expected. BUT, come January, no one was expecting more floods. At WFP these floods have been disastrous, as transporters carrying food for the March-April distributions have become stuck in an area called the East Bank, along the River Shire.
According to Ministry of Agriculture assessments huge numbers of hectares had been totally destroyed by the January floods. Unfortunately the Ministry of Agriculture have a few ulterior motives when reporting crop damage, so we were there to do our own assessment. Unlike in the health sector, where Malawi’s 28 districts are divided into Traditional Authorities (TAs), in agriculture the districts are divided on geographical, not political, lines which results in about 5 or 6 EPAs (Extention Planning Areas) per district. We spent a lot of time wandering around fields of half flooded maize, and looking at sand covered rice crops. Why oh why, we pleaded, had these people been advised to plant maize after the first rains? Why not cassava, rice or sweet potato, which are much more resistant to flooding? At one spot we cowered under a tiny tree for shade and looked out on a field of maize which now looks like a beach. Gradually the whole village came over to us and explained that floods had never happened before in the area since 1997, and that they were 100% reliant on the maize they had planted for food. Luckily most other areas weren’t so dependent on their summer crop (it’s summer here!) and could get by on winter harvests, thereby saving us a logistical nightmare of giving them food aid. Food aid, in my opinion, can be a highly dangerous thing.
One night I found myself in a snazzy motel in a place called Nchalo, half way between Chikwawa and Nsanje, with ‘you want regret’ under its sign. Nchalo is your typical Malawian town, strung along a main road with a PTC shop, petrol pump and a whole host of little run-down shops selling all manner of things from bicycle tyres to goats (Chester actually bought a whole goat on the way back). There I sat in a bar drinking a ginger ale next to a guy slowly getting drunk on green Calsberg who asked the same question every ten minutes or so. Behind the barman’s head was a novelty item: a television with DSTv disk, flashing scenes of As Time Goes By. It had taken some persuasion and the agreement of the entire bar to change the channel to BBC Prime, but the explanation that it would remind me of home made everyone very agreeable. Of course, there followed a hundred questions: where was home, what was I doing in the Lower Shire, how long had I been here, which football team do I support? They were, for the most part, half drunk, and so ecstatic to oblige a white girl who for some bizarre reason was spending a night down in the Lower Shire. We sat in the bar till 10pm, by which time the temperature had dropped to a sleep-able 30 degrees.
This woman lost her maize crop to the floods.
I wouldn’t want to live in the Lower Shire, although an awful lot of people do. Illovo, the sugar company, has a huge plantation there, and about 30kms of the M1 road runs alongside sugar cane. Of course, those 30km take nearly an hour to drive as the road is so bad as to make you feel that your spine is being compacted on every single bump. According to the sign, Nsanje, the last town on the M1, or the first – depending on your viewpoint – promises the exciting Nsanje Port on the Shire River. Unfortunately this hasn’t been built yet, and some people wonder, “ Why not build a proper road before building a port?” At least the promise of the port has brought a baker to the town.
According to my colleagues, I can now say I have seen Malawi. I have travelled the whole of the M1, from the Southern tip in Nsanje to the most northerly point in Chitipa, covering 24 of the 28 districts. What can I say? Half the time I want to stay for ever in this beautiful, friendly, well-meaning country, and the rest of the time I desperately want to come home.
Here follows a typical problem of my day to day job in the nutrition programme:
Amos, in logistics, called me a few days ago saying that, unfortunately, there wasn’t enough maize meal to fulfil the therapeutic feeding distribution plan for March and April: a shortfall of 30metric tones, and we need 82Mt. This was a bit of a shock as the pipeline doesn’t reveal any such shortage.
In therapeutic feeding (the NRUs) we give maize meal to the caretaker of the child. This means the mother (caretaker) will stay at the NRU until the child is better instead of withdrawing the child early because the mother can’t afford to buy food independently. It’s one of WFP’s really great, well-thought-through schemes. Studies have shown that when the caretaker isn’t given a ration, the abscondee and death rate of children in NRUs increases dramatically.
Step one: try to borrow maize meal from another programme. Whoops…the only other programme using maize meal is for the refugees and for the next two months they’re getting rice.
Step two: try to replace the maize meal with something else. Ah ha, there is sorghum, and we have tones of it and are trying to get rid of it. Perfect, especially as in the Southern region sorghum is accepted (it’s not in the North – they’ll burn it), and we have the biggest distribution in the South. Oooh, so perfect, we’ll replace maize meal with sorghum in the South. BUT, the sorghum needs to be ground ready for use. Technically CHAM hospitals (about half of the ones we supply) could grind it themselves, but then they’ll charge the beneficiaries, which isn’t so great (admission will decrease, which in this lean season is BAD news).
Step three: Spend a morning on the phone to millers seeing how much it costs per metric tonne to grind sorghum, and call round the District MCH Coordinators to see if they’ll accept Sorghum this month (as if they have a choice).
Step four: with quote see if we have any money for grinding. We don’t (we’re broke). Help.
Step five: at this point Blessings (National programme officer) suggests that maybe we just don’t send any food. I start pleading. So, in steps the lovely Karla, our Deputy Country Director (who has a lovely house we house-sit for at every opportunity).
Step six: A solution which will cost a lot (but to logistics budget, not ours) and irritate logistics – but it buys us four weeks to find more maize meal Hooray. We continue with 100% distribution of maize meal in the South (a mere 23 Mt) for Jan/Feb, but only do a one month maize meal distribution to the Central and Northern regions (29Mt), thereby giving everyone maize meal and allowing us to hunt some more down before Feb. Logistics now hate us owing to the cost of transporting such small tonnages twice, while all the other commodities for NRUs (likuni phala, sugar, beans) are still being distributed in a two month cycle. So…watch out for health facility misuse and co
nfusion. But, problem solved for now.
Replanted maize in Nsanje.
Of course I found out today that the Blantyre sub-office is doing only partial distributions to NRUs because they had less maize than they reported. So, all that careful calculation down the drain, and no maize meal in the NRUs. Exasperation is an inadequate word to describe the feeling!
My first week on-call in Papua New Guinea
By Sarah Evans (St Margaret’s and Beale 1996-2000)
Papua New Guinea: 13,000 miles away, a developing country, English (and Pidgin) speaking, with a hospital that needs and teaches medical students. Rumginae Hospital is in the Western province and has about 30 beds spread among the special care, Maternity and TB Wards. Arriving with only seven weeks there, a fellow student from Imperial and I launched straight into our new timetable. Work involved daily ward-rounds, theatre and outpatients clinics. Also incorporated was a week staying in a nearby village at an aid post where we were hosted by the Community health worker (the local equivalent of a GP but with two years training!)
Being ‘on-call’ actually was being ‘on-radio’ (walkie talkie to you and me). There were no telephones in the hospital (with the exception of one outside line) and radios were therefore used instead, their battery life was terrible! The generator only ran between 8am and 9pm so finding time to recharge the batteries was a challenge.
There was one other doctor in the hospital, but thankfully the wards were well staffed with nurses who were very skilled and dedicated. With limited resources to do tests (only basic blood tests) and no imaging except an ultrasound scanner, we relied on knowing the patients well for optimum care, not always easy as the patients had a high turn over rate!
Unusually our special care unit had a number of young babies; one seven- week old with jaundice and a huge spleen (extending beyond the usual place of his ribs down to the pelvis), one five-day old with Downs Syndrome and jaundice and one baby which had a severe cleft lip and palate. The latter was staying in to be fed by tube, unable to suck and therefore unable to go back to the bush. These babies didn’t have names; the local custom was to wait until they were strong enough.
These babies hung on my heart, unable to diagnose the cause of the jaundice with the tests available and with none of the western first-line treatments, the week involved panicked calls from the ward staff as one baby went from stable to brain-damaged. The baby with the large spleen just remained stable but very unwell. We suspected he had a blood disorder but the microscope lens was cracked and full of condensation, making it impossible to confirm our diagnosis. My treatment was predominantly comforting and explaining, the mums sat emotionless, waving flies off their babies, the oxygen concentrator going in the background. Medically all we could do was to balance the crude belt and braces concoction of antibiotics we were giving to try and combat their fevers.
On the other side amongst the other patients were a few patients with Death Adder bites. It was strange getting used to the nurses admitting these and other patients without our being informed. Ward-rounds were often full of surprises! Snake bites were treated with bandages and patients were then usually stable. In keeping with trying to empower nurses to be able to run the aid posts they were often left to make big decisions alone. We were informed only if things got critical and anti-venom was needed.
Outpatients had the fairly typical array that week: there were a number of children with high fevers, ‘diagnosis’ locally was always malaria, or malaria plus whatever else you may suspect! Adults with “short wind” (shortness of breath) this due to anaemia, commonly due to hookworm or malaria which were endemic. One three year old girl had such bad anaemia she had gone into heart failure, which she amazingly survived. I saw patients with coughs and weight loss, which were invariably TB symptoms and many people came with infected sores, often precipitated by insect bites, working in the bush or walking without shoes. The smell often entered before the patients!
Fortunately malnutrition wasn’t a problem in this area, but they were extremely generous with what was classed as edible; tree leaves, ferns, snakes, grubs and sago (a starchy gritty staple extracted from the heart of a type of bush plant stem, a combination of stretchy, chewy and tasteless!).
Working alongside staff who delivered the most dedicated care in the face of such adverse situations has really developed my appreciation of what we have in England. Being able to help these people was humbling and rewarding, but it also enabled me to get to know them and their culture more. A privilege and something that was a huge benefit when being on-call too! But I think the greatest things I’ve been left with is a greater confidence and the insight of how much it is possible to do without leaving a patient’s side, ‘treating’ with a smile, companionship and even with prayer.
Edinburgh Fringe 2006
by Alice Bonifacio (Glenlee 2001-2006)
With only ten days to rehearse and two weeks performing at one of the most famous international festivals coming up, we didn’t know what to expect! And yet, we have been lucky enough to take part in one of the most exciting and exhilarating events in the whole world: an experience that will stay with us forever.
I had previously taken part in CLC’s production of Hiawatha at the Edinburgh Fringe 2005, and instantly fell in love with the vibrant festival a
tmosphere. This is truly Edinburgh at its best. The Royal Mile is always brimming with street performers and thespians alike, thrusting flyers into your hands, desperately trying to promote their show. It feels overwhelming at first, but soon enough, one adapts to the Fringe way of life and learns how to pack as much into the day as possible. The Fringe was particularly busy this year, presenting a staggering 1,500 shows at about 350 venues dotted all around the city. Part of the Fringe’s excellence is its immensely diverse programme, including comedy, physical theatre, dance and music, as well as just straight theatre! We were performing in a theatre space at the Edinburgh College of Art, seating around 40-50 people. Our average audience intake was about seven people a day, which at first seems disheartening. However, we quickly learned that this is indeed the case for many fringe performers, and became familiar with a much more intimate form of theatre. Many venues would consist of a “stage”, sectioned off by a single piece of black tape, barely separating the audience from the performers. Our theatre space was perfect for our play, as we were aiming to operate on a highly emotional and personal level.
Our play was Whale Music, by Anthony Minghella. It tells the story of Caroline who finds herself pregnant by one of her two boyfriends, and retreats to the northern coastline to spend time with her girlfriends. Our theatre group consisted of six CLC leavers, a friend from the National Youth Theatre with a fellow cast member’s mother, Libby Halliday, (professional film director, producer and ex CLC girl) acting as our highly esteemed stage manager. Thus, Stage Presence was born, and we began our exciting journey to stardom…almost!
Edinburgh certainly taught us what it was like to live as professional actors, managing to perform every day whilst also finding time
to see other shows and enjoying the full Fringe experience. However, as energy levels began to deteriorate, it became quite a struggle to maintain the vitality of the play, treating each performance as if it were the first. Like most theatre groups, we had our peaks and troughs (crashing backstage whilst dismounting from my scooter springs to mind!), yet as the saying goes; “the show must go on”. Perseverance and determination are vital in a theatre group, and each member worked with remarkable poise and professionalism.
I should like to take this opportunity to thank everyone who made this production possible, and for all their support and cooperation. I strongly encourage anyone who wishes to get involved in theatre to consider taking a performance to the Fringe. You may not get all of your money back (indeed, it is highly unlikely!), yet you can guarantee that the experience is worth every penny.
Here are our reviews:
- Reviewer - Ritchie Smith.
Whale Music is a briskly-paced student production, carried off well, with Caroline played by an actress who is easy and yet interesting to listen to.
'Whale music' - the music is what you listen to to calm you down when you are pregnant - and Caroline, unmarried but pregnant, and returned in some shame to her small and inward-looking seaside town, has a lot to try to be calm about. Not least that the unknown father is one of two boys - and probably the one she likes least. There's also lesbian interest from her former teacher, and the (somewhat trite) shock of her well-meaning mother. Anthony Mingella's play is a well-written slice of UK life and is carried off well here - admittedly with a slight touch of sixth form girls in a school play. (There are no men.) The cast didn't seem too pleased after curtain, but this is a good go at a very slightly dated play, with a human and affecting performance at its heart.
©Ritchie Smith, 14 August 2006 - Published on EdinburghGuide.com.
Runs to August 28 at 17:25 every day.
Company Stage Presence.
- Reviewer - John Huntingdon
Poignant yet at times funny. 24 Aug 2006
This was a very well constructed performance. Strong performances from a young but obviously talented cast led by Caroline and ably supported by the rest of thees enthusiastic young ladies. Too many cameos to highlight, and yet I feel I must mention Kate.... I was involved right to the end, at which the cast should be prepared to take a well earned ovation - they thoroughly deserved it.
- Reviewer - Louise Hill
Stage Presence give a thoughtful, truthful rendition of Minghella's story about six women whose lives are touched by the unwanted pregnancy of a friend. Again, no programmes (a bit of a problem at the Fringe this year, it seems), but the actress playing the pregnant Caroline showed a maturity and skill well beyond her years and was well supported by the rest of the cast in an ensemble which worked extremely well together. This production shows the Fringe in one of its most valuable roles, giving young performers the opportunity to showcase and develop their skills. Expect to see Stage Presence back in years to come.