Snow

I awoke this morning to find that it had snowed overnight. I shouldn't have been surprised as the weather forecasters have been predicting this for the last few days. However, over the last couple of weeks there have been definite signs of spring - daffodils appearing, lambs in the fields and slightly warmer temperatures -   so it does seem like a dramatic turnaround.

The view from my kitchen this morning.

There is something quite magical about snow and the fact that we get a relatively small amount of snow in the UK each year means we tend to overreact as soon as the flakes start to fall. People will stay home from work, the trains will stop running, roads will be impassable, schools will be closed and those who venture out will do so in order to start panic buying. Sales of sledges will increase dramatically and snowmen will appear in many gardens. 

People who live in countries that get a lot of snow every year watch the British response to it with wry amusement, whilst those who live in countries who never get snow cannot comprehend what it is like. In March 2009, after an unusually long period of cold weather where the snow had lain on the ground for many weeks, I went to work in South Sudan. I still had the photos I had taken of the snow on my digital camera and I showed them to some of my South Sudanese colleagues. It was clear that they could not imagine what this very different weather must be like - it was totally outside their sphere of reference, as to them it is 'cold' when the temperature drops to around 25C.

Today in Juba, the capital of South Sudan, it is 37C (and the forecast is that it will be over 40C by the end of the week), whereas in Carlisle it is currently -1C. As much as I enjoy the snow I have no doubt about which of those temperatures I prefer...

...and emerging on the other side

It is just over 5 weeks since my operation and in that time my 'world' has been confined largely to the four walls of my house. After what was described by the surgeon as 'successful' surgery and three days in hospital, I was discharged home and have been gradually recovering.

It has been a slow process and I still have some way to go. I have occupied my time by resting, watching DVDs (I've successfully resisted the lure of daytime TV!), reading (although the effort of concentration required is surprisingly tiring...) and idly surfing the internet. I am starting to consciously have times in the day when I feel normal again, which reminds me just how 'abnormal' I have been feeling these last few weeks.

Today is a crisp, clear, sunny, winter's day and for the first time in weeks I felt like I just had to be outside for a while. I walked the short distance down the lane from my house and stood in the sunshine, leaning against a gate. I looked across the fields to the northern Pennine hills, listened to the birds sing, felt the warmth of the sun on my face and thought of Africa.

Into the unknown...

Today I am going into hospital for an operation. As instructed by the hospital I was up early this morning for my last meal - a light breakfast of toast and a cup of tea - and now I can't stop thinking about how nice it would be to have a cup of coffee!

I've never been in hospital before so in many ways I don't know what to expect. Like going to live and work in a new country my knowledge and understanding is based on what I have been told by those who I will be 'working' with, other people's experiences in the same situation and the information I can gather from the media.

And like travelling to a new country by this evening my world will seem a very different place. I have woken up in my own bed, feeling 'normal' but tonight I will sleep in a different bed and will have to adjust to the unfamiliar surroundings.

Maybe moving between countries and cultures has prepared me well for the unknown world ahead of me now.

The boot is on the other foot

I seem to have got out of the habit of blogging since being back in the UK. Something about the familiarity of my 'home' country seems to make the day-to-day occurrences of life seem less blog-worthy than the day-to-day occurrences of life when I am in another country. Driving into town or buying the week's groceries just haven't seemed interesting enough to write about.

This week we have been hosting some friends who have just arrived in the UK from South Africa. I have spent quite a bit of time showing them around and trying to explain something of the British culture and lifestyle. Having experienced what it is like to transition to another country I hope I understand a little of what they are now going through as they adjust to a whole different way of life.

Weather, food, driving, public transport, rubbish disposal, personal security, shopping, banking, the postal service, health care (and many other things) all vary from one country to another and are just some of the things we have talked about this week.

They are the things that make up our day-to-day lives and in our home country they are so familiar that we barely give them a second thought. Having had to explain them to someone from another country I am starting to see that maybe some of these things could be worth blogging about after all...

40 Degrees of Separation

Last Tuesday evening I left Chad and returned to the UK. It all happened rather suddenly and was not part of 'the plan'. When I was unwell a couple of weeks ago I was advised that I should return to the UK for further tests, that even the 'good' hospital I was treated at couldn't do - a further reminder of the limited health care available to the majority of Chadians.

The first few days of being back in the UK are always a rather strange experience. Making the transition from Africa to the UK seems to take longer than the journey and so I find myself physically in one country but mentally still in another.

Returning at this time of year there is also the stark contrast in temperature to contend with. Although this is the cooler time of year in Chad daytime temperatures still reach 38C, whereas the temperature in Cumbria on Thursday morning was -2C...

So each day I now:

• Take a hot shower, rather than a cold one
• Put on more layers of warm clothes, rather than wearing as few thin cotton clothes as possible
• Wear two pairs of socks, rather than none at all
• Switch the heater on in the car, rather than the air-conditioning
• Keep the central heating on, rather than the ceiling fan
• Sleep under a warm duvet, rather than on top of a single sheet

I am definitely a person who prefers hot weather to cold weather but there are two things I love about a cold climate - you can spend the evening in front of a roaring log fire and you see views like this:



Blencathra

The Pilgrims Return

A few weeks ago I blogged about the chaos around the airport as people prepared and departed for the Hajj. I speculated as to whether there would be an equal amount of chaos when the travellers returned and this week I found out. The answer is 'yes'...

I obviously need to find out more about what the Hajj involves as I thought it lasted for 5 days, whereas it is about a month since most of the pilgrims left N'Djamena. I wonder what they have been doing all this time?

This week the metal barriers that were left behind a month ago have been put up again and the area all around has been full of randomly parked vehicles. There have been a lot of the orange Peugeot 504 taxis, that are as common in N'Djamena as matatus are in Nairobi or Kampala, as well as a number of new looking 4x4s. I guess the different modes of transport represent the relative wealth of those being picked up.

Inevitably there is the accompanying entourage of people awaiting the return of their family member and so every morning and afternoon I've had to negotiate my way through this crowd of cars and people. Each returning pilgrim seems to bring a large sack-like bundle with them, in stark contrast to their departure when I don't recall seeing any luggage. Those who take the taxi transport option load their luggage into the boot of the car. There are often several travellers sharing the same taxi so it isn't possible to close the boot. The suspension sags under the weight but the pilgrims are on the final leg of their journey home.

N'Djamena taxi

Health Care

I saw a statistic recently that Chad has the equivalent of one doctor for every 28,000 people. With the exception of South Sudan (which is the country that embodies the word 'exception') my impression of Chad is that the standard of health care generally available to the average person is the worst of all the African countries I have lived in.

One of the benefits we provide for our Chadian staff is to pay a percentage of their medical bills. As the person who authorises these payments I get to see the details of what they have been treated for and the medication they have been prescribed. Almost without exception and regardless of the true nature of the illness each person seems to be routinely prescribed high doses of pain killers, antibiotics and anti-malaria drugs. It is not uncommon for all these drugs plus the consultation and related tests to cost what would be a significant proportion of an individual's monthly salary. So not only are they being wrongly diagnosed and treated they are also being charged exorbitantly.

This week I have been unwell and when, after two days, I was feeling worse rather than better I decided the time had come to see a doctor. This enabled me to see first hand a hospital on the outskirts of N'Djamena that is trying to improve the health care that at least some Chadians can receive. The hospital at Guinebor II is funded, managed and run by a small team of expatriates, working alongside Chadian staff. Their primary goal is to provide health care services to the local population but as a 'sideline' they make themselves available to treat anyone from the international community who otherwise doesn't have access to 'quality' health care.

I arrived in the middle of the morning and there were maybe 100 people sitting on the ground, trying to stay in the limited shade that was available. It was difficult to know how many of these people were patients and how many were their accompanying family members. I first had to go to triage to be weighed and have my temperature, heart-rate and blood-pressure taken. Afia, the triage nurse, seemed highly amused by the 'narsara' (the generic Chadian word for 'white person') in her treatment room and smiled broadly throughout the whole process. When she had finished her initial assessment of me I was officially 'registered' as patient number 86 (presumably the 86th patient of the day) and handed my patient record book - half an exercise book with a picture of a footballer (who I think is Didier Drogba) on the cover...



My Chadian medical record - everything handwritten (in French) and mine to keep!

I then went to the cashier and paid 5,000 CFA (about £6) for my consultation with the doctor. This was the maximum amount a consultation would cost, with the lower amounts presumably for seeing less well-qualified staff. I'm somewhat embarrassed (but also very grateful as I was feeling pretty rough by this point) that Dr. Mark saw me ahead of some of his other patients who had been waiting longer than I had. He prescribed me a course of antibiotics, that cost another 1,500 CFA (about £1.80), and already today I am feeling a lot better.

I was impressed by the calm and order of the hospital, by how they are trying to develop the skills and responsibilities of their Chadian staff and by their commitment to improve the health care given to the local community at a more affordable price. You can read an account of a day at the hospital here.

Unfortunately for most of the residents of N'Djamena, including our staff, this hospital is too far out of the city for it to be a viable option for their treatment. However, it is encouraging to know that on Thursday of this week (as on every other day of the week) it provided a high level of health care to at least 86 people, in a country where such facilities are sadly in very short supply.