‘You don’t want it to rain in the desert’

Well actually we do want it to rain in the desert after the drought of the last few years, but it makes all the travel around here much more difficult. November has been a rather busier month for me out in the desert. Sarah, the doctor I’ve been working with since June, has finished after 16 months here and I’m on my own until January. Running a rural clinic in Africa is rather more work than I realised as Sarah had previously made the admin side look so easy.

Outreach set up in a village pre-school.

Activities at the end of last week included: pushing one of my translators around the village in a wheelbarrow as she had hurt her knee the previous evening and couldn’t walk to work, arranging for a company in Windhoek to renew the license on our out of date fire extinguishers, turning the water off at the mains as there was a giant flood coming from a rusted flexi pipe in one of the clinic toilets, transferring a baby to hospital that was breathing at a rate of over 100 breaths per minute, and finding a second-hand phone to give to my star football player to contact him before a big match.

It sounds strange writing it or even consciously acknowledging it, but every single one my San patients goes hungry. The average BMI for our clinic patients is around 15 (expected to be 18.5-25) and we adjust drug dosing due to the average weight of a woman being 35kg and a man 40kg. This hunger is ‘normal’ for me now but at the start of November I experienced water insecurity in Namibia for the first time. As an upper middle income country, 6 times as wealthy as Kenya, I am sometimes surprised at the issues I come across. This is perhaps due to its GINI index ranking as the second most unequal country in the world. (Recommended reading: The Spirit Level by Kate Pickett + Richard Wilkinson, and The Price of Inequality by Joseph Stiglitz). Despite my reservations about its high level of inequality, Namibia along with Botswana is a shining beacon of democracy and stable economic growth in Africa.

The water problems I saw were when we were providing our outreach clinic at Donkebos. This is a San resettlement village deep in the Kalahari, where we found they were having huge problems with their boreholes. At least half of the patients had medical problems directly related to lack of water. Children with headaches, older males with low blood pressure, younger women fainting. I asked one woman how much she had to drink the previous day and she replied with ‘one plateful of water in the morning, and one plateful in the evening’. Measuring water consumption in ‘platefuls’ when the temperature is 40 degrees during the day is madness.

Other patients were unwell indirectly from the lack of water. Diarrhoea was common as there was no spare water to wash their hands after defecating. I enjoyed the aftereffects of this after sharing my water bottles with the patients, spending the weekend on the toilet or feverish in bed as punishment. My friend working for a San NGO and I are still looking for a solution to the broken borehole problem so if anyone has a spare $15 000, then we’d love to hear from you.

Girl + bow the size of her head.

The football team has given me more enjoyment this month. We’re on a 3 match winning streak now, but the highlight was playing against Skoonheid a couple of weeks ago. Skoonheid is possibly the best San team in the area and was the team that had beaten us 7-1 last time. I’d collected all my best San football players from around the village and set off for a Sunday afternoon match. I started off as the glamorous linesman again but swiftly had to become referee when a giant thunderstorm caused the original referee to run off seeking shelter.

The pitch had gone from a dry sandy dustbowl one minute to a boggy pitch covered in puddles the next.  My team, mostly made up of schoolboys compared to the adults of Skoonheid, played amazingly and won 5-3 (I’m pretty sure two of their goals and at least one of ours were offside but there were no linesmen who would help me). The San are very understated and don’t show much emotion, but this time my team’s enthusiasm at winning showed through.

This is our stormy football match as seen from the shelter.

I sometimes feel guilty that the volunteers that are with me while I’m working with the San edge towards poverty tourism when taking photographs. I don’t think it is necessarily deliberate but the San often don’t get much back for the photos that are taken. To change this I try to encourage our volunteers that are here longer to print off photos when we’re in the local town and give them out to the San who are in them. The photos that the San families do have are treasured. A family that lives on a farm near us proudly show us their photo scrapbook from around 15 years ago when we visit.

Recently the father of Sara, the girl I was sad about when she died last month, came to me in the village to thank me for trying to help her. One of our volunteers had taken photos of Sara with her family when she was still well and had printed some of them out. When I gave them to him he was overjoyed, showing the photos to the friend he was with before his San stoicism and reserved nature returned. He thanked me again and walked slowly away to catch his hitchhike back to the farm.

The matriarch of Otjizombaka

I have terrible trouble with patient names while working here, often when trying to find patients that are sputum positive for TB (confirmed, infectious TB). My patients always have a San name which usually involves a click, and then an English name given to them. Patients will sometimes be known by their San name or sometimes just by their English name. There can be different spellings of the same name so a common surname such as Khao, can also be spelt Kao, Xhao, Xao all pronounced the same and used interchangeably by the same patient. One of my translator’s surnames is Kashe on her ID card (her father’s surname) but she always writes her surname as Kleinbooi which is her mother’s surname. Many patients don’t have ID cards as they are only necessary for admin tasks such as collecting pension money.

A regular occurrence of being stuck in a village with a flat tyre, being helped by the villagers.

Another complication is patients having absolutely no idea how old they are. I guess if you were born on the floor of a shack on a remote farm 50+ years ago, why does it matter how old you are or when your birthday is? I often have to guesstimate ages and write down their birthday as the 1st of January on forms. A regular occurrence would be a patient coming to the clinic without an ID card, with a first name of San clicks that we struggle to translate, unsure how to spell their surname, unsure how old they are and unable to say where they live as they move around to different farms so often. Extra challenges in the desert.

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