‘When God made Namibia he was angry.’ was how a Namibian once described the scenery of his country to me. Barring my atheism I agree. The majority of the country is stunning and desolate – world famous sand dunes, empty deserts, towering rocky outcrops and wild coastline.
Unfortunately, my area of the Omaheke region is less glamorous. It if flat, dry, sandy and populated by scrubby short trees and thorn bushes. I’ve already had to spend many hours driving the dirt roads in this landscape. On one of my first journeys I was confused by the tracks in the freshly graded dirt road. The tyre tracks were much closer together than usual and were weaving all over the road. I was expecting to turn a corner and see a drunk man in a tiny, tiny car. It was actually a cart pulled by a donkey with a family of 6 in the back, on the way to see us in clinic.
One evening last week I had to drive the 3 hour round trip to the nearest hospital in the dark (less than ideal with the accident rate at night on the dirt roads). Late afternoon a parent brought in their 5 year old child quite unwell. He weighed 10kg (average 20kg), had a haemoglobin of 3.2 (average 12.5) and a horrible chest infection. After leaving him attached to antibiotics, a blood transfusion, being kept warm and getting fed, I was less worried that he would die overnight.
5 days later I was in hospital again and checked in on him. He’d been diagnosed with severe acute malnutrition and tuberculosis but the change was incredible. He looked like a totally different child. He smiled at me instead of constantly either coughing or crying, showed off his dancing skills and gave me a hug when I was leaving. I have no idea whether he knew who I was, but seeing his improvement was one of my favourite moments I’ve had as a doctor.
On a slightly less upbeat note, alcohol is an awful influence in our area. Our regular daily visitors are the kids from the shabeen. They are children aged between 3 (age of independence) and 6 (age they start school) that are like a heartbreaking version of Fagan’s gang from Oliver Twist. They hang out together, play together and look after each other. Their parents live at the local shabeen, which are unlicensed drinking establishments selling home brewed alcohol very cheaply. The parents spend all their time and money on the cheap alcohol and neglect the children.
The kids come to us for food, entertainment and for some of them, tuberculosis medication. It is a difficult situation though as hunger is widespread amongst the San in our village. It is unfair that we only feed the children with parents that make the worst choices. The effect is rewarding the parents, who then have more money to spend on alcohol or their own food. Even sadder though is when we don’t feed them and the parents give the child the thick alcohol from the shabeen to try and satisfy their hunger. This leaves us looking after drunk and vomiting preschoolers.
I’ve recently been in the process of setting up a football team for the San guys in my village. The gardener of our clinic has taught me which brands of football to buy to withstand the thorn bushes encircling the football pitch. The San aren’t explicitly excluded from the football played with the rest of the village but they don’t feel comfortable playing. Now they have a supply of footballs, the San play most days and I join them a few times a week. My parents are kindly bringing out donated football boots for the team when they visit soon, as they all play barefeet currently. Hopefully we are playing the local tourist lodge that has a San team in the next few weeks. I would like to have enough players so they can play and I coach, though I can’t speak the Ju/’hoansi San click language so maybe I can just be supporter in chief.
Again some smaller situations this month have been different to my life in Manchester. Yesterday, my translator and I were searching the countryside for the owner of a goat that I had accidentally run over while driving over the crest of a hill. When we found him we negotiated a deal of 2 packets of ibuprofen for the owner’s aging grandmother, and that we would take the dead goat in the back of our car back to his house. I had unfortunately forced them into a family party to eat the goat that night.
Recently I opened one of the fridges in the clinic and found a large chunk of meat in it. After asking around, it turned out to be half a dead warthog that one of the translators had been given as a present by a potential male suitor. A romantic gesture I’ll bear in mind if I’m ever starting to get desperate for a wife.
This San lady above had travelled with me on a journey . She was in the back in this picture but when some of my patients vacated the front, she joined me there. She was constantly smiling an amazing toothless grin at me, and was clearly excited to be in the front of a new car. The seatbelt alarm was going off as she didn’t know to put her seatbelt on. I tried to explain about seatbelts but our languages were far from compatible. I then reached over to grab her seatbelt and brought it half way across her. She grinned widely, poked her head enthusiastically through the seatbelt loop and hung on to the loose end as if her life depended on it. She looked so pleased with herself that I barely had the heart to untangle her from it and clip it into position.
Finally, as proof that tuberculosis is taking over my life… I had a bad dream the other day that all my sputum samples were inadequate. Tests for tuberculosis have to be sputum coughed up from the lungs rather than saliva from the mouth. I have a constant battle with my patients to collect useful sputum samples, rather than saliva. This now apparently haunts my dreams.