It’s week two now – it’s been a long day, so it’s lucky we had a restful Sunday. The end of last week was very productive, and on Saturday we decided that extra-curricular adventures should be had. Saturday morning we met Dr. Levine and Essa, a security advisor from RVTH, and ventured inland to Lamin Lodge. There we took a boat up-river to the mangroves, hoping to catch a glimpse of some of the hundreds of bird species found in the Gambian skies. Oysters are harvested by the local women from the roots of mangroves. Evidently, a delicacy, but we also discovered that the shells are used to make a variety of things – lyme, paint, to mix with cement, even chicken feed. The things you learn...

We visited Essa’s mother’s compound near Lamin, where we had domoda with bongo fish and plenty of mango. Mangoes are sold on every street corner and the trees are found in most gardens, and so you are always welcomed as a guest with a plate of sweet, fresh mango. Delicious. Here, you eat from a large shared bowl – your share is the slice of bowl nearest to you and you eat with your fingers (importantly, those of your right hand). Strangely, us toubabs (white people) are provided with spoons – they’ve probably noticed how much of a mess we make. Essa has been crucial to almost every visit to the hospital. He’s a good man, always looking out for us and getting us places that, without him, would be out-of-bounds for us. He’s made sure we’ve met the right people at the right time – and it’s only recently that Nia’s got used to hearing her name being called across the courtyard of a Gambian hospital... by Essa.

We attract children like there’s no tomorrow, and we can’t usually move for them. No school on Saturday, so both us and the children thoroughly enjoyed spending the afternoon outside the compound learning new names and generally giggling at how “Keith” turns into “Key” or “Cake”, Gambian-style. We’d brought pencils to share out before we left for Kachikali, where the crocodiles live...

At Kachikali there is a museum of Gambian culture and history... and a crocodile pool. Two things we wouldn’t have put together, but it worked! There, we stroked crocodiles while they basked in the sun and took care of not disturbing the “Big Mamas”, who were heavily pregnant and thus a danger. After scaring ourselves silly, we made our way home.

Today has been really positive. We spent some hours at a gynae outpatients clinic and a short time on Labour Ward with Dr. Juan, a Cuban gynaecologist. Each day is an eye-opener for us, especially today where we saw exactly how different the clinic set-up is here compared to the UK. We arrived faced with dozens of patients lined up on benches outside the outpatients department; some with babies, some recently post-partum, some elderly, some even as young as 7 or 8 years old. The rest of the day was spent at the market (looking for cool clothes and water – a running theme) and the labs. We are waiting for the all-clear to take clinical photos of patients at RVTH. Hopefully, we’ll hear from the placement administrators tomorrow morning before our first ward round. Fingers crossed.

Nia and Keith

Celebration of office, twice

Travelling's been much easier since we moved into our little office at the Public Health Labs, as they're half way between Kerr Serigne and Banjul. Banjul and all roads leading to it have been very busy recently due to the July 22nd celebrations – the 15th anniversary of when the current Gambian president came into power.

We spent Wednesday celebrating in Banjul, where we visited family compounds and watched the parade. Dr. Levine, the U.S. doctor, has taught us a great deal about the Gambia – he has invited all of us to his adopted village next weekend. We really can’t wait.

We’ve organised to spend time at A&E, O&G, and on the internal medicine wards at RVTH – with the help of a Gambian medical student, Momodou Tekanyi. We've met Dr. Ousman Lee (an F1 with an interest in pathology) who will teach us on his ward rounds next week. The Cuban doctors have been supportive and the departmental matron of A&E (Lamin Jai) has been a great help too. Momodou Lamin Jammeh ("Dux") from histopathology has been particularly good to us and is very enthusiastic. He was impressed with our learning package examples and is looking forward to Dr. Raz Ali’s arrival as he has a few cases he'd like to discuss with him. Dr. Ali is a UK pathologist travelling with us as part of the pathology programme team – he arrives a week today with our audit team: Ceri, Cathy, and Wendy. We’re really looking forward to seeing them – they might bring us more insect repellent...

Nia and Keith

Settling in

Asalaam-aleikum!

We’re here... it felt like we’d been awake and travelling for days, but it was only some 24 hours from Swansea to Kerr Serigne via Llantrisant/Newport/Gatwick. We spent the weekend settling in and finding our way around, and set off for Banjul on Monday morning for meetings with directors and development officers at the Royal Victoria Teaching Hospital (RVTH). We had a fascinating guided tour of the hospital and met with Momodou Lamin Jammeh - a histopathologist based at both RVTH and the Gambian National Public Health Labs. He has kindly provided us with an office to work from at the NPHL (which is only a stone's throw away from Kerr Serigne) – here we have wi-fi and air-con, together with bottled water we have found them to be indispensible! We are very grateful to him and his team for all their assistance. Clinicians and directors from both bases have been amenable and seem supportive of our pathology programme – one project we are running is based on pathological procedures in the form of learning packages that can be used by Gambian medical students during their studies.

The Gambian summer is incredibly hot – each morning we prepare for the intense heat and downpours, arming ourselves with long-sleeves, light clothing, and plenty of mosquito repellent (as Nia has ended up being a meals-on-wheels for the local mozzies). To date, we have made social visits to the monkeys and explored Senegambia and its beach. It’s out of season, so all is quiet.

We are off to meet a Dr. David Levine this afternoon - he is a retired American doctor who has spent several years in the Gambia and has settled near Kerr Serigne. Tomorrow is a public holiday and so we hope to be back at RVTH on Thursday, gearing up for next week, when we’ll meet patients recruited by the pathologists and take our clinical photos. That’s if we survive the heat. And rain. And did we mention the heat?

Nia and Keith