Bang the Drum and People will Come

So after a quick turn-around in the UK, switching our best clothes to our worst, and swapping our wedding list-matching suitcases for grubby backpacks, we set off for our next adventure in Zambia.

Although the main focus of this trip is the work for On Call Africa, our first month in Zambia will be spent working with a charity called SAPEP.  They train volunteers from rural villages to empower their own communities to reduce the burden of AIDS.  At first we were sceptical of what they actually did, but the more we learn, the more it makes sense.  As well as providing support for people with HIV, both psychologically and practically, they help them to learn new income-generating skills so that they can improve their quality of life for both themselves and their families.  And because it’s all done via community volunteers, or ‘peer educators’ (the PE in SAPEP), it’s realistic in terms of creating behaviour change, and it’s sustainable.  But any way, if you’d like to know more, they have a UK sister charity, PEPAIDS, which supports them and has a fantastic website – www.pepaids.org

The main thing we’re doing during our stay with SAPEP is helping them put together a grant proposal for a new project and coming up with ways it can be monitored.  Neither of which we have a great deal of experience in I have to say, but we’ll do our best.

We arrived in Zambia’s capital, Lusaka, on Thursday morning and were met by a SAPEP employee, Wilson, who drove us the two hours to the small town of Mazabuka, our home for the next month.  Since we’re not here long enough to rent a house, we’re lodging in a guest house.  We can’t help but compare Mazabuka to our previous home of Gulu, in Uganda.  Although a lot smaller than Gulu and in a different hemisphere, there are lots of similarities.  Whilst the rolex chapatti stands are missing, the smell of charcoal-grilled corn-on-the-cob still fills the air, street sellers price their tomatoes and aubergines ‘per pyramid’ of four, kids constantly shout ‘hi, how are you?’ as you walk down the street, and EVERYWHERE sells mobile phone credit.  After a week of rushing round Manchester in January, the overly-friendly, laid back people of sunny Mazabuka are a welcome relief.  That being said, we’re already dreaming of cereal with fresh milk, and cheese, and tea, and nice toast, and wine, and a toilet with a seat.  We needn’t have worried about ‘cruise ship weight gain’, one month here should sort that, let alone six!

On Friday, we went out to a village with some of the SAPEP guys to watch them do a dance/drama session about HIV and child abuse – heavy topics!   Wilson decided not to drive to the village in his 4x4 because the roads were so bad after the rains the day before. He was afraid we’d get completely stuck and not be able to get home again.  So instead, we crammed into a minibus with the rest of the team.  How we thought that a two-wheel drive bus carrying twice the number of people as it was designed to do was going to make it there and back I don’t know, but I guess you could say it did.  We had to stop literally every five minutes to get out and push it out of a muddy ditch, but we made it.

We arrived at a house in the middle of nowhere.  There was a single family living in the house and no one else.  Given the fact that the team had been due to come the day before but had to cancel because of the rain, and there was no way to communicate this to the villagers, we wondered how on earth anyone was expected to show up.  But, ‘beat the drum, and the people will come’ we were told, and they did.  Within 15 minutes a crowd of well over 50 people had arrived to watch the performance.  Unfortunately for us, it was all in the local language ‘tonga’.  But going by how much the kids enjoyed it and the dynamic Q&A session that that followed, it seemed to have been a great success.  It’s so hard to imagine what life must be like for people living out in the villages.  They are subsistence farmers, and the focus of every day is growing enough food to survive. The rainy season is busy, with crops growing like crazy, while the dry season is slow with not much to do except sit and wait.  Most of them get very little, if any, schooling.  It really does hammer home the need for international aid workers to include local people in the planning when trying to implement any kind of programme requiring behaviour change.  The cultural differences are astounding.

Pictures to follow soon.

John Virgo and a non-alcoholic beer

Following our disappointing and premature return from Kosovo, we looked for another adventure to replace the two months surplus time that had available to us. We opened wide the net and applied for anything and everything. For the first month, we needed some paid work to cover our over-spend in Kosovo and to allow us travel for longer in Zambia.

After a few frantic days of phone calls and e-mails we had two offers on the table. One was for weeks of locum work in the UK. The other was for 4 weeks of locum work on a cruise ship in the Caribbean. Guess where we chose to spend Christmas?!

I didn’t really know much about cruise ship medicine. P&O assured me that there was no such thing as typical passenger; and that the sometimes quoted ‘newly-weds’ and ‘nearly-deads’ stereotype was un-true. With over 4,300 people on board, it’s fair to say, there is a mixture. I was delighted to hear that most of the ‘nearly-deads’ don’t survive the flight to Barbados, so my cruise ship was healthier than most! My job was to mainly look after the crew, a much younger and multi-cultural bunch. I was advised to brush up on the treatment if STI’s!

I was quickly fitted for my uniform and presented with a crate of clothes ready for departure. As a three stripe officer, I’m apparently quite highly ranked. I think I’m something like 12^th in charge of steering the ship if the Captain and everyone else keels over. Considering, I was unable to put my uniform on correctly without substantial help, this should be quite worrying for the passengers and P&O as an organisation!

Now two weeks in, I have settled in and am enjoying work. Between 8-10am and 4-5.50pm, I am a G.P. The rest of the time I’m an Emergency department doctor without a department. The facilities are actually excellent. We have most of the top-of-the-range kit and a small but quality team of doctors and nurses. We’d like to think that we can cope with most things, but it is still slightly scary that there is no hospital nearby to help out if things get complicated

The crew are a varied bunch. 1,200 of them. 10% Brits, 50% Indians, 25% Filipino and 5% representatives from all the corners of the globe. Some well paid professionals enjoying the luxuries of the ship, but most are manual jobs, a life below deck and working long hours. A perk for everyone is that they get to come and talk to me for free! No healthcare costs plus no local chemist equals a queue of people with not much wrong with them. In the UK, it’d be pretty mundane stuff, but taken out of its usual environment, it’s actually quite interesting. Any sign of gastro-enteritis or Bird flu and the ship goes into lock down. If anyone sneezes and I’m in a bad mood, I can get them locked in their cabin for as long as I deem necessary. Most people are quite polite and escape with some paracetamol and cough sweets.

The passengers are not so lucky. Outside of the NHS, we are effectively a private clinic. Like a plumber, electrician or lawyer – you have to pay if you’d like to see a doctor or a nurse. After years of being spoilt with free and high quality healthcare in the NHS, Brits are often stunned to learn this. Half of them disappear when informed of this (which does raise the question of whether they needed to be there or not). Some of the other half becomes hostile and un-grateful. Their (slightly extortionate) bill appears to replace manners and good will which does make the job more taxing.

Most of my day is spent worrying about ‘what if’. Watching the old folk’s drunken dancing and the kids playing by the pool(s) makes me extremely nervous, and it’s only when I’m hidden away in my cabin that I really relax. We have been fortunate in that we have had only a handful of serious cases but it could all change any minute. One serious accident or one tragic illness and everything will change. We’ll all be flat out until we can get to a port with a decent hospital. We are lucky in that we haven’t had that scenario yet, and I wouldn’t wish is on anyone – but it would be quite exciting…

The evenings are fun but quite repetitive. I am on-call most evenings, which makes having a few drinks quite difficult. Similarly, there is a chance that I’ll be up working all night and then all day, so early nights are always quite appealing. About 1 in 3 nights, are formal nights and we have to dress up. Mattea has become an expert in tying my bowtie and I have had the odd experience of attending to an elderly lady, with blood pouring from her head whilst wearing my tuxedo! The entertainment programme is a mixed bag. The theatre company put on fantastic west end quality performances, whilst the celebrity guest speaker (big break legend) John Virgo was made even more painful by having to drink non-alcoholic beer.

Matty, is now a lady of leisure – not something she is very good at. She has a running battle with our cabin steward about who gets to make the bed. There’s something odd about being surrounded by holiday makers on the trip of a lifetime, trying to enjoy it alone while I work, and not really feeling like she’s earned a holiday. Thankfully she’s been able to take on a voluntary post working for On Call Africa as their development assistant. We are heading out to work for OCA at the end of February and Mattea is working to help with the planning and organisation of the project. She is also press secretary, fundraiser and anything else she can think of to get involved in. All of that with an abysmal internet connection has been quite frustrating, but slowly but surely it is coming together.

At the end of January, we are heading to Zambia. We have 4-5 weeks prior to linking up with OCA and we have been accepted by a charity to help with healthcare and health education for a short term project. The culture shock of going from black tie balls to rural Zambia will be a massive challenge, but I am eating as much as I can in preparation, and I am trying to convince our cabin steward to come with us!

Happy New Year to all of you. 2011 has been very kind to us and we are truly excited about what 2012 holds. We hope you are all well, please do keep in touch.

Dave & Matty xx