Scorchio

Another scorching day in Gizzy.

I haven't been updating very much, sorry about that - and it's not like I'm working a full-time job (har har har) so I don't really have any excuse. We've just been settling in over the last few weeks and things have been ticking along just fine, slightly hampered by the OVERWHELMING HEAT which basically leaves me paralytic as soon as I leave the apartment/switch the air con off/move even slightly. Cycling to work is a sticky, sticky trial. My poor patients.

Another reason for not updating is because I don't have many photos - because Gizzy is such a small town it feels quite intrusive to take a camera with me anywhere. I've been waiting to accumulate some, but I've given up. You'll just have to imagine it for now.

So, ophthalmology.

This has been an extremely steep learning curve, and I am extremely grateful that I've got such an easy ride - plopped into a department used to juniors with no experience and with a consultant for direct one-on-one teaching all the time. The only bad thing is that there are no other juniors, of course, so from a morale point of view it's distinctly depressing being the person who knows least and with no one else to commiserate with. Still, I am now no longer trembling with terror at any procedure (tremor: not a Good Thing for an ophthalmologist. True story) and I am sailing through my sub-tenons blocks in theatre now (warning to non-medics: links may suddenly catapult you into a world of gory eye pain) and did my first Avastin injection today. I was also forced into being the scrub nurse for a morning of cataracts and it left me with a deep, deep gratitude for everything those angels in blue do for surgeons. And with a renewed appreciation of exactly how messy doctors are and how much time other people spend cleaning up after them. I don't think it's a coincidence that so many nurses who work closely with doctors (i.e. scrub nurse, clinic nurse etc) are mumsy or dadsy types. Doctors need parental supervision when they play with their pointy toys.

And aside from work, it's all been lovely. We're sort of in-between socially - we're both a bit separate from the house officers, and there are no other registrars in Gizzy - so we've been sort of promoted up the social age ladder to socialising with all the consultants and their families. This means basically that we are fair game for their 1000000 children and Tim got quite fairly tackled when he got into the pool at the theatre party by 2 small girls who decided he was perfect to ride on. Tim emerged with a certain amount of bruising and a fair amount of PTSD but I think he loved it.

That's the other thing here - everyone has ridiculous houses, ridiculous grounds, surrounded by orchards or vineyards, everyone has a pool, and why not a tennis court while you're at it? Land is cheap here because it's so far out - when Tim and I went to the local cinema (we were watching the National theatre's 50th anniversary documentary and were 2 of 4 people in the whole cinema) the lady in charge said, "you're doctors, aren't you? I knew you were doctors. People your age don't want to move to Gisborne, usually. It is so quiet." The local cinema, by the way, is bloody incredible - they serve pizza and beer in the intermission and you sit on enormous, incredibly comfortable bean bags to watch the film.

Not that we're going to be spending much time indoors. Right outside our apartment is the river, and last week Tim and I jumped in and swam from our front door right to the sea- about 1km, but easily carried by the current. Just in front of the beach are tennis courts with a pretty heavenly view, and we've also been paddleboarding and snorkelling so far. We've also joined up to the Arboretum - which is a huge tree park just north of Gizzy - which we went to last time we were here. It is wonderful - shady and beautiful and, like so much of New Zealand, very, very quiet - hardly anyone else there at all. It's like having your own private wood, filled with birdsong. And also, very loud, amorous frogs.

So things are going well. I've started having nightmares about specialty applications, but it seems so far away from this distant, sunny corner of the globe...................................................

First kite-surfing lesson of the summer

And I got completely pulled off my feet head first into the beach. I now have a new appreciation for helmets.

Today we also went wine tasting and to the farmers' market, where we got about 1kg of free peaches. I have no idea what to do with them. Peach cobbler?

On Friday I walked around town and introduced myself to all the optometrists in town. There are three. They were all excited to see me. I explained gently that I knew nothing about anything and therefore could not help them in any way, ever. They were all very nice about it. We parted with mutual affection.

On Thursday I saw my first eye patient and dictated my first eye letter. Hurrah!

On Wednesday I scrubbed in and helped repair a globe laceration (someone who got punched in the eye on Friday, ruptured his globe but thought he'd try and sleep it off through the weekend. New Zealand men are tough. And perhaps insane.)

On Tuesday I realised just quite how little ophthalmology I know.

And that takes us back to Monday.

I leave you with the view from our apartment. So far it's been an edifying week.

Gizzy fizzy

Hello hello from Gisborne (motto: "the New Zealand of New Zealand.")

We've been here for 2 days and I love it so much. SO MUCH.

Much has occurred. I will be brief. In summary:

1) I arrived back in the UK from Ghana
2) I took many, many hot showers
3) There were no cockroaches
4) I was generally happy and ate a lot of food not involving fufu
5) I sorted out my NZ visa, which involved a very happy Kiwi called Dave in Immigration who was cheerful as, in stark contrast to the Brit manning the reception desk at New Zealand House.
6) We flew to NZ in the midst of unrelenting hail and misery in London
7) We got to NZ in 30 degree blazing sunshine

The first leg of our flight was on Virgin. Now, those of you who know me know my unrelenting hatred and general bias against Virgin for reasons too long to enumerate so I shall restrict myself to saying I was unbearably smug at just quite how bad the Virgin leg was. The sound system didn't work so it varied between unbearably loud and crackly to inaudible on any given announcement. The TV screens were epileptically flickery. The listings for the movie channel was wrong (devastating Tim, whose only joy in life at that moment was to watch the Alan Partridge movie - listed but not in fact shown), and the comedy channel had no sound. The food was really, really bad. In their defence, their staff were very, very lovely and I could hear them apologising mellifluously to passengers continuously through the flight for everything that was going wrong, something at which they seemed practised.

The Air NZ flight, on the other hand, was bliss in a bucket. And they had a new safety video out! It wasn't very funny but they tried hard, the sweet loves.

In conclusion: I love Air NZ and feel you all ought to fly with them, everywhere, ever.
The end.

So we arrived in Palmy on Friday and it was so nice seeing old friends, and also popping into see Penny, the amazing admin who helped us so much when we were organising jobs in NZ. I'd bought her a hunky firemen calendar (which took a lot of searching for, believe me, plus unwilling Tim in tow "I don't want to be here while you're buying that. Do I have to be here while you're buying that? I'm leaving.") which she and the other two admins absolutely loved ("this is exactly the kind of thing we need in this office.")

Saturday was the long drive up to Gisborne on a very beautiful windy road. The funny thing is that we've had a lot of mixed messages about Gisborne - Tim and I absolutely loved it when we visited (and are loving it now) and have heard from a lot of people who think it's the best thing since sliced baked goods, more or less, but have also encountered quite a few people who think it's the utter pits. Their complaints more or less centre on "there's nothing to do there, and it's so far away from everything."

At this point I always say, "What about the beaches?"
And they always respond,
"Oh yeah, I suppose it's got nice beaches."
"What about the vineyards?"
"Oh yeah I suppose it's surrounded by vineyards."
"And I hear it's very sunny."
"Oh yeah I suppose the weather is good."
"And it's famous for its surf, right?"
"Oh...yeah if you like surfing then it's ok."
"And it's surrounded by beautiful countryside, coastline, loads of walks and cycle trails?"
"Yeah yeah it's right in the country."
"Sounds brilliant."
"No, you see...it's just...well it's....it's just..."

And they can never quite finish the sentence.

Gizzy is far away from everything and it is a tiny town where everyone knows each other and it takes hours on windy windy roads to get anywhere and to be fair to the detractors if you were born here you'd probably be just about desperate to leave once you hit 18. There are also lots of issues - it's an incredibly poor area of NZ, being hugely reliant on the timber industry and farming, which have taken lots of hits, unemployment is high, and there are numerous social issues with the Maori who live here and make up 50% of the population (highest in NZ). On the other hand, it is a place of stunning, unbelievable natural beauty, people are incredibly friendly and welcoming, the Maori presence gives it a really wonderful, grounded, different feel to other areas of NZ (and I wish people wouldn't forget the Maori were here first. It's really their land, by all rights, which they're rather graciously letting us live on, mainly because of the sneaky dealings of the British, and now they're suffering all sorts of social ills related to colonialism which is too complex to go into here), and the lifestyle is pretty amazing. It's more or less exactly what I expected and I am delighted to have the privilege of living here for 7 months.

On Saturday we moved in. Our flat overlooks the harbourside and is costing us a ridiculous £500 a month to rent. It comes with its own outdoor pool (shared, of course), sauna and gym, and is in a pretty wonderful location. We watched the sunset from our balcony, which sees all the way out to sea. So that's the good part. The bad part is that it has clearly been terribly managed. Though the build is in great quality, the furnishings are pretty haphazard, and when we arrived (despite having signed the contract 6 weeks ago and paid rent for 2 weeks beforehand), there was no power (the letting agents having decided it would be superfluous to let us know beforehand), there was damp in the flat, there was mould all over the inside of the fridge, which was really disgusting, and there was almost no furniture in the bedroom - no wardrobe or drawers. We only had one set of keys (without which you cannot even get into the building), and the response to a request for a second set was "oh we're not obliged to give you any you know." Charming.

Luckily we have an incredible building manager who has an undying grudge against the owner of the flats (who he has described to us as an unbelievably tight millionaire) who gave us candles, is knocking up some furniture for us, and gave us access to one of the other flats for hot water and use of their fridge.  So we had a very peaceful candlelit evening watching the sunset, and really it could have been worse.

The next day we managed to get the power turned on and were also greeted with a bottle of 'gizzy fizzy' by a GP who works at the practice Tim is starting in. It turns out our apartment block is literally riddled with doctors.

On Sunday we were invited to a BBQ by my new consultant at his, again, ridiculous house. It was a really lovely evening - he'd invited a few other docs, who all appeared to be south africans who'd moved to new zealand 'temporarily, just for a couple of months' about 10 years ago and had produced about a million children between them. We got the grand tour, complete with constant toppings up of champagne, of his chicken coop (with slidey out chicken poop remover), veg garden (and a taste of the asparagus and broad beans), plum trees, swimming pool, billiards room, etc. After the biggest meal I have ever eaten (true story), we were then hustled into playing football with the kids, who were hilarious - there were 2 little boys, 4 and 6, who looked pretty much identical and seemed to think they were playing rugby. It was impossible to take the ball off them because they would fall over it and then the other one would jump on top and make a scrum.

So that was a great introduction to Gizzy. And today I had a very gentle orientation, together with a work badge that says 'registrar' (though it also says 'opthalmologist'....a spelling I didn't have the heart to correct). We finished the day by going to the beach for our first after-work swim of the year, and a dip in our pool as the sun went down again.

In case this is all too idyllic, as I'm typing this, Tim is writing an extremely long complaint letter to the letting agency (there is much, much more stuff wrong with the flat than I have described)...but much like the issues with Gizzy, the bad can't hold a light to the good. It's beautiful here. I love the job. I am going to learn to kitesurf.....

Back in the UK!

And my first hot shower for 3 weeks. Life just keeps getting better and better.

Pineapple pineapple

The end is in sight! On Thursday I went in to surgery, which again finished around 9pm. All cataracts this time, apart from 2 eviscerations for florid endophthalmitis (a devastating infection of the whole eye) – one was really quite painful to watch as the eye was so inflamed that the local couldn’t penetrate very well (local anaesthetics are usually slightly basic, and so in inflammatory conditions, which produces acidic environments, they tend to precipitate and do bugger all). Dr Clarke, the incredible surgeon, injected another huge bolus of anaesthetic into the eye but the poor patient kept up a persistent low-grade whimpering underneath the cloth and you could see his hands clenched for a long time under the gown – not pleasant. That eye must have been paining him for a long long time because it was absolutely awful – completely blind, proptosed, angry red, ulcerated, and the anterior chamber, the iris, lens and the aqueous humour, was completely black with degeneration. Anyhow, after all the gunk has been scooped out things settled down a lot and he endured the rest of the cleaning and sewing up with no discomfort.

We also did a lot of kids with terrible bilateral cataracts and probably very poor prognosis as a lot of them had horizontal oscillatory nystagmus and astoundingly bad vision – probably due to intrauterine infection with something like rubella. If you could see these children then I think anyone against vaccination for rubella who can maintain their views should be absolutely ashamed of themselves. Even after cataract removal most of them will probably be almost blind, with no hope of a cure, but you have to do something and it may be that some of them will benefit from the surgery. Their cataracts were very interesting to see – liquid, unlike a senile cataract, which usually just pops out like a little button.

Another interesting thing was the way the anaesthetic was administered. I say interesting – I really mean a bit horrifying since there was no IV access, the kids all had LMAs of various sizes – and I am not an anaesthetist but frankly the sizing of those LMAs was way off, the anaesthetist just seemed to be shoving whatever she felt like into those tiny little throats – one I thought would probably do for a 100kg man and she was just shoving it into this tiny 9 year old, who looked the size of a 6 year old, with gleeful abandon. He obviously wasn’t having any of it and was coughing and choking up a lot of increasingly bloody sputum. It really made my toes curl to think of all the trauma his poor airway was undergoing – and the anaesthetist just kept on trying and trying, and the tube kept on rising up (well of course it would, it’s not the right size you idiot, is what I thought). I didn’t really know what to do – no one else seemed concerned, and I am clearly not an anaesthetist, and I didn’t want to offend, but at the same time I felt this was really wrong. In the end, I said, pathetically, “that seems like a big tube for such a small boy.”

Anaesthetist: “the little tubes are not good for him.”

Me: “I don’t think this one is very good for him.”

Anaesthetist: (quite surprised that I was talking to her) *ignores me with expression that clearly says “as if you know anything”*

Anyway, after 20 minutes of messing about with his airway (she tried every tube on her trolley 3 times. 3 times!) she eventually got the LMA in and then halfway through the op he started waking up. This seemed to happen with every child on the list – she always seemed to be talking on her phone or not paying attention and then the little body would start coughing and the surgeon would have to call her attention back. Then agonisingly slowly she would check the valves and the tube and all the plumbing – and usually something would have fallen off somewhere and be leaking gas into somewhere and she would put it back on, and then something else would fall off...

It was absolutely a shambles and quite depressing to watch, but I suppose none of the children came to much harm in the sense that they were all alive at the end and had their ops done, and they clearly don’t have the resources for anything more. This was happening to the private patients just as much to the Unite for Sight patients. I did feel though that this whole place was one long adverse incident waiting to happen.

Anyway, depressing rant over. Friday was my last outreach and was also slightly depressing. We had a new volunteer (a local Ghanian) who was a highly efficient woman and who enjoyed summoning me and patients by clicking her fingers and looking very disapproving, something which I really did not enjoy. I’d never really understood before why waiters always complained about people summoning them by snapping their fingers. I’d never done it to anyone and I’d also never seen anyone do it so I couldn’t imagine how offensive it was. Well after having it done to me repeatedly I can quite see how a few days of it would drive me into a murderous rage.

An amusing thing happened though during the day. I needed to use the loo and this is always a big deal in outreach because you have to get a translator and then someone has to speak to the local people and then they have to find a loo for you and often it's locked up and it's no end of palava. Anyway, when I returned, before I could sit down, the local woman seized my wrist in a vice-like grip and asked me a series of questions in Twi. Our volunteer translated for her –

Volunteer: “She says, are you quite empty?”

Me: “Er – yes! Thanks! I’m feeling much better.”

Volunteer: (raising eyes to heaven piously) Thank God for that.  Bless him.

Local woman: (also raising eyes and hands to heaven expressively)

Tickled. 

So I'm just killing time now before I go home and today I had a bit of a walk around and explore and also ate another huge pineapple. Pineapple is one of my favouritest fruits ever and I can never get enough of it, much like strawberries and raspberries and blueberries in season. I remember reading an article (in the Guardian, naturally) about how the author got sick of berries in season (they were naturally doing the Guardian thing of trying to eat only local and British and therefore in summer ate essentially nothing but berries because of the glut), and plums, and all the rest, and I couldn't sympathise because I could eat my favourite fruits every day and not get sick of them. Lucky me, because pineapple here is so super cheap - you can buy a really huge one for £1 - and I mean huge, bigger than you've ever seen - and the nice lady with a machete waves it around and asks shyly, "shall I peel?" and of course you say "yes please" and then she does this amazing thing with the machete - peels it all and chops it with minimum of mess and then puts it all into a bag for you and you're happy for ever, until you run out and have to buy another pineapple.

So I've been stuffing my face with pineapple (no surprise for any of you that know me, I'm sure, since I'm perpetually stuffing my face - when the US folk were here, they were all too hot and bothered to eat at any time but I was always very keen to eat because I never knew when I was going to eat next - as on the outreaches, a whole day could go by without food of any sort, apart from a lukewarm can of Fanta Orange - , and whenever I looked up from having a meal they'd all be sitting watching me with this disbelief on their faces, sweating profusely, and eating hardly anything. One of them eventually said, in a very considered voice, "you're an amazing eater, Connie" and then after a thoughtful pause, "I like that about you."To which I couldn't respond with any dignity because my mouth was full of rice.) which has been absolutely lovely, and wandering about reading James Herriott. I love that man. And then eating more pineapple. I estimate in the last week I've eaten approximately 6 pineapples, to say nothing about how much pineapple juice I've drunk. It's all a bit blissful, really. And also vanilla ice cream. I think I am now built up entirely of vanilla ice cream and pineapple juice.  

So my last greetings from Ghana, and I'll see you guys on the other side when I return

love

Connie

Apologies for the length of this post

but it is the accumulations of all my nonsensical musings to myself over the last week, and now I've obtained some internet to post it, well, I can't spare you from it, that's all. 

***

Sunday 27th Oct - Currently watching ‘Ghana’s Most Beautiful’ on the one channel this hotel has, having just enjoyed a shower in a ridiculously clean bathroom, with air conditioning that works, and a ridiculously soft bed – I am literally in heaven.

I have just arrived in Elobu – on the east coast of Ghana, near the border with the Ivory Coast – for some overnight outreaches, after a very rambunctious car ride with all the Crystal crew, and a brief stop for dinner where we had the biggest serving of schwarma ever seen, and watched a bit of football – Chelsea vs Man City, Chelsea being vociferously supported by all the Ghanians as there is a  Ghanian on the team (you learn something new…). John, one of the drivers, spent most of the drive trying to speak Chinese to me, and balancing the fire extinguisher on his head in response to a challenge (I just wanted to know if everyone in Ghana can balance anything on their heads, as this seems to be the primary way of carrying stuff about. The answer is yes, it seems).

The rest of the crew are staying in a different part of the guesthouse – I guess the rooms with ceiling fan only. I had considered it, but decided I was going to splash out – it costs 5 cedis more a night (around $2) to have a room with air conditioning – and I have decided I am officially too old and too boring to rough it any more, ever.

The air conditioned rooms, it turns out, are in a separate, luxurious, ridiculously clean block of their own.  “Connie is in the VIP suite” announced Ernest, one of the optometrists. I told him that I would usually never ever be in the VIP suite and would always go for a cheaper room but this time I decided – damn it, I’m a doctor now and I’m going to have air conditioning if I want to!  This to loud cheering and applause from the whole car suddenly (“yeah, Dr Connie!”)

Speaking of Dr Connie, the team are now introducing me as Dr Comfort to everyone now for ease (since Comfort such a common name in Ghana, and usually shortened to Connie – see earlier). Find this hilarious, also, disconcertingly innuendoish.

No internet in the guesthouse though, despite the luxury (soft bed! Clean sheets! Clean everything! No cockroaches!) so will be updating all in one go again at the end. Here goes.

Monday – wake up at 6:30am very, very reluctantly – this is the best night’s sleep I’ve had for a week, since the air conditioning works and you can actually decide the temperature, not just ‘on’ or ‘off’ – which means I don’t keep on waking up alternately freezing or boiling. Today, we go to a rural outreach – the first of four – in which 400-600 patietns are expected per day. 400-600!!!!! To be seen by 2 optrometrists! HOLY. Moly.

We work all the way through the day – after breakfast at 7:30am, we literally do not eat again until 9pm, a state of affairs which has made me very vexed indeed. One of the volunteers very kindly came round and bought Fanta Oranges for everyone – I think Fanta Orange may be associated in my mind forever as the official Drink of Ghana, as it seems to give infinite energy to whoever drinks it. I spent the day doing data entry which is both mind numbingly dull and extremely important (for funding purposes, surgical referrals, medicine stocks etc) and is quite nice, actually, because 1) at least I get to sit down and 2) last week I got to shadow and see lots of interesting cases, and this week I’m glad at last I’m giving something back, and helping to relieve some of the burden for the optometrists, who otherwise would have to go home and do data entry after their ridiculously long day (!) How they are not burnt out and exhausted is beyond me. I am genuinely humbled and in awe of their dedication. Ernest has been doing this for 4 years – “I’m pretty tired now,” he said, “I used to be young and strong. Now I am old and tired. And you don’t get to see your family. It is a very hard life. Always travelling and working. But, you know, it is very motivating to see people and really make a difference to them. So I can keep on doing it for a while longer.”

Tuesday -  I was on data entry again but whenever the computer was charging, I took some time out to do some ophthalmoscope examinations – I am getting much slicker at them though still hopeless. I keep on forgetting how little ophthalmology I know – I guess because I think I want to go into it, I must know SOMETHING about it – but I’m pretty hopeless actually, since I’ve hardly ever actually done any apart from as a medical student. I saw a gentleman with a very prominent corneal ulcer, a lot of cataract, some patients with implanted lenses and all the rest of it, and some very nice cupped discs. So that was my learning done for the day.

Today was a difficult day as a lot of refugees turned up from the Cote d’Ivoire rather unexpectedly, and had to be seen with a translator in tow while I tried to dredge up all my secondary school French. It was doubly bad because Dennis felt unwell later on in the day and dropped out, leaving poor Ernest – one optometrist! – to refract another 400 or so patients. And then it started blowing up a storm so we had to abandon the outside. All in all, a very wearying day, though made up for it by the number of pygmy goats around. I love pygmy goats. One of them ate my orange with a hilarious sucking noise, with made everything better. Also a lady came and told me in very firm tones that I was definitely going to have twins, and THEN three more, which made me laugh.

I am looking forward to the weekend though.

Me: Bismarck, what are you doing on the weekend?

Bibi: I am fixing up my car. I just bought a car from London. So I am going to transfer the steering wheel to the left hand side.

That made my day.

Wednesday – a much better day. We set off at 8:30am today and when I woke, despite having slept for around 10 hours, I still felt like I could soak up yet more sleep. Someone had donated eggs yesterday and so I was greeted with an egg in a sandwich for breakfast, delivered to my room – which was a lovely waking. After the egg, I really did not feel like eating anything else (having consumed a goodly amount of chocolate milk and the egg already). Ernest was concerned

‘Obruni,’ he said, ‘you have not eaten solid food for 2 days.’

Ignoring the fact that I had only not had solid food for 2 meals, including this one, which I didn’t count since I had the egg anyway, and also deciding against telling him that in India I more or less survived an entire month quite happily more or less on mango lassi, I explained that I’d had the egg sandwich.

‘I don’t count that as food,’ said Ernest, before devouring a huge portion of rice and beans, spaghetti and beef.

When we got to the venue, I thought I’d have a little nap while Ernest was doing his usual speech, but very quickly fell completely and utterly asleep. I woke up to find a lot of small children watching me happily, dribbling slightly, and completely alone in the van. I descended to find everyone already set up – not that I had missed anything.

‘I was worried about you. You were so tired,’ said Ernest. ‘No solid food. You needed to sleep.’

I protested, but I think Ernest was right. Shamefully, after that sleep, I felt bloody amazing. Shamefully because I’m sure 1) everyone else needed htat sleep too, but had soldiered bravely on and 2) I had got 10 hours of sleep last night, how was that not enough?? And 3) I’m sure I would have carried on just fine a few years ago. But I am now old and battered and just want comfort in my life.

I was thinking this as well as we went to a chop bar for dinner. I was just not in the mood for Ghanian food tonight – which, at its best, is very tasty though still quite samey – and at its worst is a lot of differently gelatinous carbohydrates in a lot of very similar tasting hot stews, with unidentifiable bits of animal floating in it. Tonight was more or less typical, and I felt like a standard tourist, really – I just wanted a nice, boring bit of dinner that tasted bland and had a texture like a, say, hamburger. Or a bit of spaghetti. Anyway, I had some goat stew and a bit of rice ball and was thankful for it. And I had a cold beer as well. Really, how could I ask for more?

In my guidebook to Ghana, it says something like:

‘it is probably fair to say that, although it would be a great shame not to try fufu and banku when you are in Ghana, after you leave the country you are unlikely to be overcome with a great hankering for Ghanian cuisine again.’

Feeling like a most ungrateful tourist, I had to agree.

Saturday –

Just realised it’s mine and Tim’s 6^th anniversary! How on earth did the time pass this fast? I skyped him to appraise him of this fact (note – I have also just realised that I do not know if this is the correct usage of the word ‘appraise’. Today is a day of revelations!) Anyway, it was lovely. So odd to think that in a little booth in Ghana, I could see right into his room in Bognor Regis. The wonders of technology.   

I got a private booth as well today in the internet café, because they were all out of space in the big room. The private booths, it turned out, were in a separate hot sweaty little room, each with a single use cubicle, all in use apart from one, and with doors that were lockable on the inside. I really didn’t want to close the door, as it was so hot, but the guy showing me to the cubicle was very insistent, so I closed it and locked it, and then felt very dirty and disreputable while checking my emails.

To take off my narrative where I left off – on Wednesday, I just sat and did data entry all day since I was so tired – but on Thursday I did some more examinations, and saw some good stuff – some retinal and disc scarring with toxoplasmosis, lots more normal discs, macular scarring, lots of corneal stuff – in between the typing. I left my Auckland book of eye conditions with the clinic, since the guys there were so interested – they were looking through the book and admiring all of the pictures, which were very smart and nice indeed – and they were really pleased with it.  We drove back in the dark. I stopped off to have some chicken schwarma – I didn’t think I was hungry but was surprised to find after about 3 seconds that I had eaten all of it, apparently without noticing – and to be solemnly told by the guy preparing it for me that I needed to leave my fiancé and live with him, and if I couldn’t do that then could I find him another girl who was very similar to me? Since I take all my advice from men who sell me kebabs I am now living in Ghana for the foreseeable future and all wedding plans are off.

Hmm. Just typing that gives me a shudder.

Ghana is really the poorest country, I think, that I have yet visited – the most consistently poor. I met a load of Nigerians in the guesthouse today (they were here for a Masters course), and they all loved it – “Ghana is so peaceful, you know. It’s not very crowded.” By which I’m sure they mean ‘built up, developed’ because even in Accra, there’s hardly a modern building to be seen. Dirt rounds, shanty towns, wherever you look. And Accra is boomingly prosperous compared to the rest of the country – where I was in the central region and west was startlingly poor, people living in shacks, no running water, the church one of the few places with electricity – and that is rich compared to the North. “In the North, the people and the cows, they drink the same water. To see the people in the North, it will make you cry,” one Ghanian told me very solemnly. And it is very, very quietly and constantly awful, so huge the scale of the problem you can only stand there uselessly handwringing and feeling sorry and not doing a damn thing about it.

Bill Bryson, in his book on Kenya, talks about how Kenya is the 6^th most corrupt country in the world, losing $10 billion of public funding in one year, and how it was overtaken by Nigeria, amongst others. Well, Ghana’s debt has rocketed to $47 billion under the last government, and it is ranked, according to a Ghanian radio show I listened to, amongst the top 3 most corrupt countries in the world – ‘we have just beaten Nigeria! How proud can we be of ourselves?’ said the radio host, to derisive cheers. It is left to NGOs to provide the services ‘which any decent government would provide themselves’, and the scale of the problem is so vast that my heart sinks in even contemplating it, and all my admiration goes out to those charity workers who keep on giving, day after day, when there is so much frustration and waste.

Anyway, on Friday I had a day off, so I went off to enjoy Ghana. I went to the National Museum, which was very small and adorable, and full of very correct but slightly archaic English signs, with phrases such as, “music began by percussive rhythms, striking of the hands upon bony and fleshy parts of the body, for anyone listening to a drumbeat must desire to strike the bony and fleshy parts” and also a long passage about a flute which had the words “throbbing” in at least 3 times. The lady at the desk charged me the student price ‘for volunteers, you know’, and I shared the museum with a huge number of students, both tiny and old. It was very enjoyable.

I then went on to the Movenpick hotel, a massive new 5 star edifice in the center, for a swim. This is what I used to do in Cuba a lot – I would go and pay for the privilege of using a hotel’s swimming pool, and while away an entire afternoon there – and this is what I did there. For 30 ghanian cedis (that Is $15 – and remember that 70% of the population live for under $2 a day) I splashed about in the biggest, bluest pool you can possibly imagine, and had for the price of my entrance a bowl of peanuts, a cold beer, and as much sun lounger as I could possibly lounge on. I whiled away an entire afternoon there, and I checked my emails and generally had a wonderful time, and then got lost on the way home and Dorcas had to come out and fetch me.

Saturday was just as relaxing and brainless – I went out shopping and came back with a shopping bag made entirely out of plastic water containers – I think it probably looks hideous, but it was so evocative of my time in Ghana I had to buy it, and it was for such a good cause, you know. Recycling, fair trade, supporting women, community crafts – all the hippyish stuff that delights my heart. And I bought a pair of books – one James Herriott, whom I could read for absolutely ever, he is just perfect – and an economics book about why poor countries are poor and stay poor (since I have absolutely no idea – not a real, actual, arguable idea).  Watch this space.

And I had spaghetti Bolognese and the biggest pour of red wine I have ever seen (they really do big pours in this country – it was literally about half the bottle) and also did a little shop in a foreign supermarket, which reminded me how far I was from home. Everything was ridiculously expensive, and in the end I spent about £18 on a shop that I’m pretty sure I could have done in the UK for about £10. I came out, amazed at how rich I was, yet again, how rich all of us are. Isn’t it incredible? And what have we done to deserve it? Absolutely nothing. Bugger all, except be born lucky.

And with that thought, I’m off to enjoy my banana milkshake, purchased today for twice the daily living allowance of more than 70% of the population.

Sunday – another day spent mostly lolling about on my bed reading, swimming, and generally having poor sleep hygiene. How do prisoners ever get to sleep? It’s too hot outside to do much walking in the day, and there are millions of mosquitoes after dark, and also there’s nowhere walkable to just outside my hotel, so I am in my room mostly. I have been reading a bit of Austen and finally have made it all the way through Mansfield Park. I’m Austened out. The Nigerians have finally departed, sadly, since their appearance here was so innately glamorous and exciting. Excited about one last week in Ghana, and then excited about returning to the UK and getting out of limbo once more – applying for training, and rattling on with my life. 

Wednesday

On Tuesday, I visited the Budubaram refugee camp, and outreach again on Monday. Things much the same as usual – looking forward to going home now, definitely. Lots and lots of traumas, more glaucoma, uveitis, scarring, and the lot. Learning lots, and also eating a lot of plaintain.

Came home and while typing up my day, the hotel staff came in to my (locked) room yet again while I was in there (twice! Twice!) despite me yelling, ‘HELLO???’ as they fumbled with my door – ‘oops sorry we forgot you were in here’ was the answer (both times) – they were showing new guests around. How on EARTH do you forget that someone is in a room, when they are literally the only guest staying in your hotel??

Quite grumpy with the hotel today as, added to the list (1 – the 4 cockroaches (also, one dead cockroach in this room which, though disgusting, is at least dead, has never been removed in all the time I’ve been here despite being in what I consider to be quite a prominent position) 2 – the two entrances – though they seem to come in enough, they have never yet emptied the bin or done any cleaning), today I came down to breakfast bringing with me a pot of extremely overpriced jam to add to their really pathetic breakfast (2 slices of toast), and while I was sitting at the table, one of the receptionists came in with some bread of her own, and opened my jam and began spreading her bread quite liberally with it.

Me: *silence*

Receptionist: (after noticing me looking at her) I am using your jam

Me: well yes, I can see that.

Receptionist: where did you buy it?

Me: Koala supermarket.

Receptionist: Hmm. It’s ok. *leaves eating my jam*

Sigh.

My grumpiness extended onto outreach today. We had split up into two groups to do two different outreaches, and we had less than 100 patients in ours – really should have been done very quickly. But I was with Dennis, the optometrist who, sad to say it, I think probably is burned out – he really doesn’t enjoy his job very much. Today was a day of endless faff. See one patient, chat for ages, walk around, phone his friends, have a drink, walk back, chat to someone else, show someone a video on his phone, see a patient…..it took literally at least 2 hours longer than it should have, and I was dying with impatience the whole time. I hate faff. The other outreach, despite having more patients than us, finished 3.5 hours before us. Three and a half hours!!! GOD.

Still, they took the laptop with them so I escaped from data entry today, so all I did was practise my direct ophthalmoscopy, which I am now proud to assure you is amazing. I can perform a tolerable anterior chamber, lens and vitreous exam with it, and no matter what opacities are in my way (more or less), I can do a good fundoscopic exam. Lots of retinopathies today, including a retinopathy of prematurity. Fried yams for dinner, and a cold beer afterwards has restored my good mood (though not of the other outreach, who were waiting for us for a list – “what the hell were you doing??” was the question when we finally got there. Don’t bloody ask me.)

Thursday - surgery today, and then only one more outreach and then HOME! Can't wait to see you all :-) This has been the most incredible experience and perhaps life-changing - it's definitely inspired me to want ot do more work in developing countries - but I am ready to reutrn :-)

Still attractively sweaty

Dear folks,
typing this quickly from an internet caff in Accra, where I have landed back up after an intense week of rural outreach. Having a wonderful time, but given teh state of the internet here I'm not going to be able to update in depth again until I get back to the UK. Suffice to say, it's been incredible, and I am not craving home yet, though I will be glad to get back - and I am very excited this weekend to be back in Accra where there is more food on offer than bankye, fufu and wakye....................now just to find a good spaghetti bolognese.....

love to you all, and see you back in the UK
xxx
Connie