Swansea Gambia Link

Tales from West Africa, one week in

2009-12-12T05:40:00.000-08:00

Hello again,

It is now Saturday, marking one week since our arrival in the Gambia. It has been quite a week. Just to reiterate what the others have said in the previous posting, we have been made to feel so welcome and are really settling in.

The clinical exposure we have had here has been very different to that which you would experience on the wards in the UK. Whilst many of the diseases remain the same, (especially the non-communicable diseases, such as diabetes and hypertension), the presentation is so late that the complications are particularly severe. I saw a diabetic foot which you could see through as it had undergone so much necrosis. The learning curve has been steep.

We also spent yesterday afternoon / evening in the A and E department, which is split into medical and surgical sides. Those in the surgical side saw a 'one doctor and one nurse' display of how to manage lots and lots of patients (mostly RTAs), where as us in the medical side got to see some 'classic' presentations. I did feel a little out of my depth however when the one doctor was called over to ICU and left the scene, leaving myself in a room with increasing numbers of patients, with whom the best I could do was take a history (if they spoke English) or do an examination.

Aside from the medicine, we have seen and done lots. Aliki, Claire and myself even saw the President the other day, as he was overseeing the large commissioning celebrations in the town centre. A big party is planned for tonight also to celebrate the graduation of the recent batch of docs, the entry of the pre-meds and our little visit. The Chief Medical Director has also announced that he would like to come, so it really will be a big do.

We're off now to a presentation on HIV and antiretrovirals.

Before I dash, I thought I should let you all know that Rob, Robby, Woody and myself played for the clinicals football team and we won!! Beating the pre-meds 3-1. We are now in the final against the nurses on Wednesday. The backdrop to the football is spectacular.

Anyway got to go. Thanks for reading.

Alex.

...first few days

2009-12-09T08:01:00.000-08:00

Nanga Deff! Hello from sunny Gambia.

We have been in Gambia for 5 days already. CRAZY. And can't believe how much we've already seen - many weird and wonderful things. And how many friends we've made. They are a fantastic bunch over here, who feed us ridiculously well, defend us from man-eating spiders, and introduce us to football Gambia-style.

We arrived on Saturday following a pretty interesting night in Manchester Airport to a greeting from half the country and 34°C! Nice. After massive introductions, a quick meeting, a dip in the pool was definitely necessary. We can also heartily recommend Julbrew, an award-winning Gambian beer.

Sunday is a day of rest, and so we were treated to a trip to the Abuko nature reserve, where we saw lots of birds, monkeys, crocodiles and some hyena (rather scary).

On Monday we were introduced to the hospital for the first time, and had the privilege of meeting most of the chaps in charge. Pretty awesome experience to be honest.

Since then we've been spending time on the wards and theatres in the mornings, going to lectures and enjoying Gambian past-times in the afternoons (especially football). The wards have been very interesting, and Woody has managed to snap a few clinical pics too.

Sadly, time is short, and we need to go eat again! So, much love everyone here; we are having a fantastic time, and we cannot speak too highly of our hosts, hostesses, and this top, top country.

Fosoma,

Anna, Gemma and Rob

P.S. good luck to the first years with their exams.

2009-07-27T12:00:00.000-07:00

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

2009-07-24T12:00:00.000-07:00

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

2009-07-21T12:00:00.000-07:00

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

The final 3 days...

2008-12-23T10:05:00.000-08:00

Saturday 20th 2008
The morning started with a visit to a psychiatric hospital down some winding, narrow side streets just outside of Banjul city. We were shown around the hospital by an interesting Cuban doctor (the only psychiatrist in the whole of The Gambia). Conditons although basic were excellent for a hospital of this kind. The hospital houses around 80 psychiatric patients many of whom we met in the court yard whilst they were socialising and exercising. We saw the patients living areas and the kitchen and laundry facilities. The Cuban doctor also discussed the drug regimes and side effects and illustrated his enthusiasm that the patients should have as many family visits as possible. The most common condition in the hospital was reported to be schizophrenia (a condition which seems more prevalent in certain tribes than others) and psychosis.
We then headed off to the Abuko nature reserve- one of the most famous ones in the Gambia. We were able to walk around the nature reserve for a couple of hours and observe some lively monkeys as well as hyenas and baboons. Some of the monkeys were very domesticated and readily approached us looking for food! Then it was back to the hotel for a bit of R&R in preparation for the evening "Welcome/Farewell Party"!
Donned in our tradtional African dress which had been procured for us by one of our Gambian colleagues: think bright long dresses and head scarves and interesting shirts, we headed to the medical school.
The lively party began with some welcome speeches by the executives of UniGamSA bidding us farewell and welcoming the new cohort of premedical students to the university. I made a small speech presenting one of the doctors at the hospital with our donated equipment and also presenting our frame of the hippocratic oath in Welsh and English- kindly made by Professor Julian Hopkin. The Gambians were thrilled with the frame and also presented us with a lovely African carving symbolising their enthusiasm for the link.
Then the competitions started! I was chosen to judge along with a couple of other Gambian medical students and a Cuban Dr. Helena Wilcox sang an excellent rendition of "Stand by Me" and came a very commendable 2nd place. Cathy Malcolm bravely volunteered for the dancing competition and finished superbly in 1st place! Well done! After lots of eating and attempting to dance in our African attire we retired to bed!

Sunday 21st December 2008
Our last full day! After a morning relaxing by the pool our Gambian colleagues arrived and took us to one of the nearby beaches for a picnic. This proved a most relaxing enjoyable way to spend our last day- eating freshly cooked fish, playing a bit of scrabble and when that all proved too much, hopping into the sea for a cool off! We also said the majority of our goodbyes to the students who had come to Swansea on elective.
We then headed out onto the main Senegambia strip by our hotel to celebrate our final evening together donned in our Santa hats- credit going to Sian for buying them!

Monday 22nd December 2008
The final day. A slightly hectic morning of packing! Some of the UniGamSA executives arrived to say goodbye and followed us to the airport for the final and fairly emotional goodbyes, before we boarded the plane for the 6 hour flight back to Manchester (a rainy and wet 9 degrees!).
We have truly had the most amazing and enjoyable trip- and feel we have experienced the full spectrum of activities in the life of a typical Gambian medical students: from religious festivals to nature reserves from diabetic foot surgery to neonatal ward rounds, from dancing competitions to picnics and from primary health care centres to psychiatric hospitals. It has been a truly inspirational insight into life in the Gambia and I would like to take this oppurtunity to thank our Gambian colleagues for all their efforts in being such superb hosts.
We will be making a presentation on our experiences on Tuesday 13th January 2009 at the Institute of Life Sciences Building on Swansea University Campus at 7pm. We hope to show some of the most interesting photos from the trip and hopefully some of the video footage that we shot to make the documentary on the link which will be released later on in 2009.
by
Gemma Peachey

18 - 19 December

2008-12-19T10:19:00.000-08:00

18th Dec
This morning Sian and I interviewed the two Doctors who manage most of the burns patients. We were struck by the large volume of paediatric admissions, and informed that the majority of cases do not even come to hospital. Dr Norma took us on a paediatric ward round where we were able to examine a patient prior to surgery and speak with several parents and children about their problems. We also met a British Paediatrician working for VSO and were shown around the neonatal unit. One particularly poorly baby was quite distressed and showing some very worrying signs, indicating it was unlikely to fare well. When we returned today (19th) to get an update it was really pleasing to see the baby was still fighting and had made a marked improvement.
In the afternoon Domingo arranged a meeting with the Chief Medical Director. It went very well and we have now been given permission to photograph and film in the hospital. This is a huge benefit and will let us tell a more complete story on our return.
Night time activity included Sian and Ellie's Xmas hats, the Santa conger and the Julbrew hat-master challenge. Say no more!

19 Dec
So.... today was the last day of hospital; it has come around so quickly. I have tried to juggle things this morning to maximise the film and photo opportunities. First stop was with Mike in paediatric surgery. Second stop to catch up with the rest of the gang in Neurology Outpatient Clinic. Then on to Neonatal Unit, Obs & Gynae theatre and finally A & E.
This afternoon the second Swansea presentation was given, on Hepatoma. The guys gave a really good talk, which went down a storm. They were supplemented by a Cuban physician adding information directly relevant to the Gambia afterwards.
Tonight we are going to a party organised by Chiquita and the rest of the recent elective students.

2008-12-16T11:57:00.000-08:00

Hello! Today we had the fantastic opportunity to visit two primary health centres. These are the first port of call for anyone with any health problems and then more serious cases are referred to the hospital. The first one was in Serrekunda which was a bit of a mission to reach as we had to manoevre our minibus through very narrow streets lined with hundreds of textile shops and a marching band! On arriving at the health centre we were met with huge queues of patients waiting to be seen by nurses. There was also a chest clinic which specialised in TB and leprosy cases. The second health centre was in Fajikunda and was mainly antenatal and postnatal patients. There were many small babies all being weighed and vaccinated (there was also a welsh ambulance!) This clinic was purely nurse led.
We then headed back to relax by the pool before heading down to the beach to see an amazing sunset - now off for dinner!
Written by Sian and Ellie

2008-12-15T12:32:00.000-08:00

Monday 15th December 2008.

Hi everyone! Sorry not to have written recently but we've had a very busy weekend. Saturday started with a visit to Makasutu, a big forest nature park where we had the opportunity to meet a local healer or 'Maribou' and were persued bu the local craftsmen, wielding various wooden creations for sale! Yesterday, we went on a visit to James Island on the northern shore of the Gambia which was our first time 'crossing the river' on the slowest ferry possible! James Island is famous around here as being the place where the treaty for the abolition of slavery was signed thanks to the mighty brits, so made for a very interesting day out for us and our Gambian Friends.
Today, Mike Nathan Dan and I have been working with a cuban surgeon which was very interesting. We also had the opportunity to see patients in a surgical clinic which was largely run by our friends from the Gambia medical school, who were very knowledgeable and explained a lot to us.

(Cathy & Mike)

2008-12-12T12:38:00.000-08:00

Wednesday 10th December 2008- Day 3

We visited St Charles Lwanga Nursery School- run by a branch of the Marist Sisters with whom we have a contact. We delivered presents for the children and were given a tour around the school by the Irish sisters who run it.
Over lunch we visited the crocodile sanctuary at Kachikally- receiving a tour of the museum and then risked our lives by touching crocodiles which freely roam the sanctuary!
As it is day 2 of Tabasci we then went on to have another feast at Momodu's house. Once again we were overwhelmed with their generousity. We were fed to within an inch of our lives and then danced with the children- introducing them to the "Hokey Cokey", which proved very popular.

Thursday 11th December 2008- Day 4

Our first day at The Royal Victoria Teaching Hospital!
Most of our morning was spent making courtesy introductions to various key members of staff who had helped with the link including the Provost Dr Ousman Yan and Microbiology Professor Dr Patrick Addy.
We also visited all major wards, male, female, medicine, surgery, dialysis, TB and HIV. We were lucky to be escorted by a certain Cuban Dr Felix who kindly made a brief surgical ward round for us seeing interesting cases including a women who had swallowed caustic soda and was having oesophageal resection and a man who had been tranferrred from Guinea Bissou with a knife wound to the abdomen.

Friday 12th December 2008- Day 5

An early start saw us divided into groups- 4 for Medicine the other 4 for Surgery.
From the medical perspective, we had an exciting morning seeing 2 cases of Chronic Renal Failure, Diabetic Foot Ulcers, HIV, Broncho-pneumonia. The surgical students spent time being introduced to theatre and the conditions in which surgery takes place.
We then had a constructive meeting on the future of the Swansea-Gambia Link, followed once again by a delicious traditional lunch and fresh fruit shakes.
After lunch, we rushed off to see the end of a lecture on Neuroblastoma by a visiting Nigerian Paediatrician and then concluded the day in the lecture theatre by some of our students giving a presentation on a case of Head Injury in Swansea (Helena, Nathan, Sian and Cathy).
The lecture was well-received and stimulated some interesting discussion and we also presented our gifts of text books and medical supplies to the students.
We did some brief sightseeing around Banjul before heading back to the hotel this evening. Filming for our documentary is going well and we got some interesting footage today.
Hope to write another blog soon,

by Gemma Peachey and Helena Wilcox

The first 3 days

2008-12-10T11:49:00.000-08:00

Hello,

Firstly, we would like to apologise for not blogging sooner. Internet is extremely hard to come by!

We are currently sat in a "communications centre" on Wednesday evening after a very busy 3 days!

Day 1 - We arrived at out hotel mid afternoon and were greeted by the Gambian students who held a poolside welcome meeting. We were shown out itinerary and introduced to everyone. All the Gambian students are extremely friendly and welcoming. Later that evening, Miniru took us to a local favourite eatery of his - The Sultan Sweets - the food here is very spicy. After a v.v. long day, we all crashed out.

Day 2 - This was the first day of "Tobasci" (sp.) an islamic festival akin to ede. This meant that Tuesday and Wednesday are Gambian national holidays as the country is 90% muslim. After a morning stroll along the beach, the Gambian students picked us up and took us to Sousou's house where we were invited to celebrate tobasci with all his family and friends. This was an amazing experience, we ate freshly slaughtered ram and danced with the students and all their families.

By Dan Leopard

2008-11-21T00:59:00.000-08:00

To the right is a picture of Banjul.

Count Down Is Under Way

2008-11-21T00:35:00.000-08:00

Blog 1:
17 days until lift off... !