Bansang Hospital Appeal
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Laurence's Diary
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Hi from Laurence,
The following, is my detailed diary of a ten day period in the Gambia with my mother, Anita Smith, during July 2005. Our local paper, the Evening Telegraph, asked me to send daily reports during that visit, which they duly published. On my return I created this diary.
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Bansang hospital
the Gambia
Journal of a week…
By Laurence smith
Overview
Having seen Anita Smith, my mother, tirelessly devote much of the past twelve years of her life to the community and hospital of Bansang, I aim over the next two weeks to paint a picture of the hope that now manifests itself in so many areas of Bansang thanks largely to the generosity of the people of Northamptonshire. With the construction of the most advanced children’s ward in developing Africa, Bansang Hospital, once a place so under funded that it merely represented a stopgap between life and death, now comes to represent a place of genuine hope. Undoubtedly, without the huge support the county has given to Anita, the sheer magnitude of the humanitarian crisis that would have faced the upper river division of the Gambia would have been unthinkable. The times, too numerous to quantify, that I have heard sickening stories from Anita whilst in the Gambia of the torments these wonderful people face would undeniably still be continuing unabated but for her efforts, and your generosity. For instance, it would seem inconceivable for even one person in our NHS to die due to an electricity failure, yet in the Gambia this is a very real situation with the tragic consequences borne out daily. Hopefully this account of the daily happenings of this hospital will go some way in showing how the support of the county has saved countless lives and the subsequent gratitude these people have for your continued compassion towards them.
Wednesday, 13th July 2005
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Today, in the offices for the Department of State For Health and Social Welfare, far removed from the hardships faced up country, the fate of the lives of thousands of children unknown to you or me were discussed. As with so many other places in the world, people’s lives in the Gambia are entrusted largely to politicians. Such power vested in so few over the health and indeed survival of so many always brings about thoughts of the huge injustices that apparently occur throughout the developing world; palatial palaces in favour of remedies for extreme poverty and illness. Yet it was heartwarming and a privilege to be in the company of such a man as the Minister for Health, Dr Tamsir Mbowe. So frequently we distrust the politicians in our country, yet the honesty and integrity of this man was so very clear to see and did much to dispel the cynicism that living in a media orientated politically wary world has instilled within me.
Within the meeting, the most important issue to Anita and myself was achieving something nearing the nurse to patient ratio that Dr Peter McCormick outlined in his memorandum to the Secretary of State for The Gambia. A huge exodus of more than 60% of qualified Gambian nurses to the developed world has in recent years left a mere skeleton of both qualified nurses and unqualified nurse attendants numbering not more than 30 to maintain Bansang Hospital; a health resource serving more than 600,000 people. Compounding the problem is that in the last year, just 14 nurses have become qualified and available for the Gambian health service. As such, it seemed hugely ambitious and improbable that in a Wednesday afternoon meeting we should get a one hundred percent commitment by Dr Mbowe to supply ten fully qualified nurses for the new Children’s Ward. However the ministers answer was unwavering and resolute, ‘I guarantee one hundred percent that you will have your ten extra nurses for the new children’s ward…this is so truly wonderful Anita; I feel like dancing with joy!!’. This pledge means the unflinching generosity of the people of Northamptonshire in creating the new Children’s Ward won't be squandered by staff shortages that have become so symptomatic of Sub-Saharan Africa.
The optimism taken from this meeting remained with us for much of the afternoon as we travelled back through the capital, Banjul, by tourist taxi; viewing the sights and sounds of a land and people replenished by torrential downpours that have brought life back to once parched lands. Having travelled to Africa before, it always astounds me to see such resilience from peoples so poor.
However, no matter how poor anyone is, the sight that met us on the back roads coming back to the tourist area of Kololi was one that no-one should have to witness in the twenty first century. The putrid smell of decaying waste and the twisted carnage of mangled car parts as far as the eye could see littering the horizon signified our arrival at the local dump. The residents of the dump wandered around understandably and seemingly aimlessly. Yet upon closer viewing from the pothole riddled road that bordered the dump, it appeared they walked with proud, indefatigable purpose; one to my eyes astounding given their predicament. We approached a group of them discussing their finds and looked on pitifully at two boys not more than twelve, that without education or prospects, tirelessly beat metal cans into smaller forms with the remains of a skittle. Their laborious work earns them 14 pence per kilogram of aluminium.
It was heart wrenching to realise that my camera alone could pay for two or more years of education for both of these children. Yet instead they remain alone, most likely as orphans, to scavenge off of the aluminium cans from the tourists just a few miles away, who are blissfully unaware of their plight.
So, after a day of both huge optimism and equal amounts of heartache, we prepare for the long arduous journey up to Bansang in the morning.
Thursday, 14th July 2005
Having visited the hospital during the dry season more than four years ago, with the oppressive heat and rust-red dust coating everything, it was hugely welcome to travel through a lush green country newly revitalised after the rains. Fortunately we were lucky enough to have the use of the hospital ambulance. With its huge ground clearance, essential for travelling up and down the 200 miles of ridged, pot holed roads, and the air-conditioning normally used for making the patients comfortable, it came to represent a little oasis amidst the sweltering heat of the mid-day Gambian sun. Unfortunately, we eventually came to understand that it was solely due to two severe cases requiring immediate transfer to the Royal Victoria Hospital the day before we arrived in The Gambia that the ambulance was available for us. However, as tragic as finding out such a thing is, it is a blessing that the hospital should have the use of such a vehicle. Without it, many people would unquestionably not be with us now.
As seems the case with all the African countries I have been to, no matter what the hardships these people face and no matter how stark the financial difference is between us, the rich western traveller and the local Gambians, we have always been welcomed almost embarrassingly warmly wherever we travel. Today was no exception. Most memorable was in Soma, a small township half way between the coast and Bansang. We arrived there around two in the afternoon feeling it only fair to give the two passengers in the back of the ambulance, one being a Hospital Appeal sponsored malnutrition nurse named Lamin, a respite from their inescapable pot hole induced roller coaster ride that they had endured for more than 4 hours. Having finished off our un-refreshingly warm Cokes and Fanta’s, we returned to the air-conditioned luxury of the Landcrusier cabin. No sooner had we got in the ambulance than a girl, straddling the middle of the dust road, started shouting at the top of her voice ‘Toubab, Toubab’ with a beaming white smile. She continued waving and smiling for the next few minutes until we finally moved off. Even above the roar of the engine, still her voice came through. Just why she was so elated to see ‘toubabs’, the translation effectively meaning white people, surprises and humbles me hugely.
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Upon nearing Bansang, we saw fisherman contenting themselves in the ponds that had formed from the torrential downpours, whilst peoples busied themselves in the rice fields, planting the crops that would sustain them for the rest of the year. This is clearly a hugely significant time of the year for Gambians, since for much of the rest if it, intolerable conditions prevent any such activities. As such, it was memorable to see people using such simple techniques to reap the fruits of the land and water that for much of the year are unavailable to them.
Arriving at the hospital late afternoon, it was no surprise looking across at Anita in the cramped cabin to see her face rush with passion and elation at seeing for the first time the Children’s Ward that has been literally her waking thought for the last 13 years. As for me, it is incredible to see in just four years the transformation that has occurred at the hospital. People at the hospitals entrance, both staff and patients, no longer look downhearted and dejected, but full of proud confident gestures and inextinguishable praise for the huge building climbing into the skyline of the main Bansang street.
This Children’s Ward, as the hospital environmental officer stated passionately, will further increase Bansang’s prominence as the hospital of choice for those that already trek from Senegal, Mauritania and countries beyond. The unstinting support of Kettering General Hospital and the communities of Northamptonshire cannot be thanked enough for the unbelievable turnaround that in just four years is clearly evident to me.
After just minutes of arriving at the Hospital, it transpired that one woman’s life was saved where just a few years ago the relatives, friends and family would certainly have tonight been grieving over the loss of a loved one. For the generator supplied recently for the accommodation of the ever-increasing stream of volunteers was rushed across at around mid-day to the operating theatre of the hospital to provide the necessary power in order to under-take life saving surgery. We have yet to visit the wards of the hospital, but shall follow the woman’s progress tomorrow and report back as to the condition of someone whose life is truly saved due to the generosity of our county.
The evening has been equally frenetic as always seems to be the case on these trips. So many people clamour for Anita’s attention that it was very difficult to even make the appointment with Dr Mbowe, the Health Minister of the Gambia whom we met in the capital yesterday. However me managed to make it, discussing the progress of the Children’s Ward in the heat of the Gambian sun, which he once again showed to have a genuine love for. Following this, the student nurses lesson next to the hospital was swelled in number by Dr Mbowe and his advisors, as they continued their surprise visit to the hospital. Once again, it was refreshing to see how he did not flinch at the questions asked by the students about getting extra resources, books and lighting, stating the financial constraints of the government, but that he would promise to alleviate at minimum some of the problems of the school.
We have just finished a meal of pasta and sauce, as the local and only place to buy a meal has no food! I write this awaiting the electricity to go off and so must hurry to get this emailed to you.
Friday, 15th July 2005
The first night spent in Bansang turned out to be largely uneventful and comfortable. Unchallenged by any form of light, the darkness that descended upon Bansang at about 9pm formed an impenetrable wall that only torchlight could remedy. It suited me, as I was able to sleep right through to the morning, apparently missing a huge storm that Anita thought was going to bring a tree down outside our accommodation.
Thanks to that rainstorm the night before, it was a relatively cool morning that we woke to. Seeing rain drops still sitting on the lush green leaves as we walked to the hospital painted a very different picture of Bansang than the one etched in my mind from the previous trip in 2001. Having seen so many images of progress already, it would be easy for me to forget altogether the inhospitable conditions that we experienced during that dry season when I was here last. However, finding out towards the end of today that one of the Cuban doctor’s was leaving because of the extreme temperatures of much of the year, it is clear that these rains represent just a temporary reprieve. We also frustratingly came to learn that the rains had rendered the roads impassable. As such, the eager workforce itching to pick up tools again and commence work on the Children’s Ward were nowhere to be seen today, having to wait instead for the lorry to come from the coast with the necessary building materials.
Having been kept so busy yesterday by the constant throng of people wishing to pass on their thanks to Anita, we were both keen to see how the woman was progressing who’s life had been saved by a generator paid for by the donations of the people of Northamptonshire. Thirty five year old Lami understandably did not really understand as to why she was being pried over by the lens of a camera. Yet she remained remarkably composed considering she had just hours before lost her baby during birth and so very nearly lost her life too. Given that they initially had to wait for the donated generator to be found, the doctors and surgeons managed to perform a minor miracle in saving the life of this woman. Most touchingly, it was not only this woman’s life they had managed to salvage, but with five dependant children, had she have died there would have been five more children in Africa tonight without a mother.
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Meeting with the chief executive, Mr Dampha and other members of the management board of the hospital, an equally touching and humbling story was brought before us. The accounts officer, a young lady of twenty-three by the name of Isatou, sat beside me in the meeting with what was presumably her baby nestled up to her chest. However, the baby was not hers, but a baby abandoned on the steps of the Hospital just days after birth. Despite being in the same dire financial position as many of her Gambian contemporaries and already having a baby of seven months of her own, which she is still breast-feeding, Isatou felt such compassion as to take on this baby as if it was one of her own. She voiced to us how unsure she is to her future having two young, dependant children.Yet despite baby Aminata potentially jeopardising Isatou’s own future, it clearly was not an option in her mind to leave this defenceless newborn abandoned.
The meeting itself was extremely interesting; as a geography student at Manchester University, listening to the financial constraints a developing African countries hospital has to work within was enlightening as much as it was engaging. Such discussions as how the hospital is to remain in contact with its various departments when all communications fail, as they so frequently do, highlight once again the huge gulf between our country and theirs. We have taken for granted for fifty years or more the ability to pick up a phone and speak to the person we desire. Yet Bansang Hospital has never had a reliable form of communication between the key medical, security, administration and maintenance workers let alone the rest of the population. Such simple technological solutions as walkie-talkies appeared until today unknown concepts. Hopefully they may be a reality for the hospital workers in Bansang in the very near future.
After the meeting finished, becoming a surprise and very welcome shadow to our trip, health minister Dr Mbowe once again met us. Despite being late for an appointment, he talked openly with the locals who were clearly somewhat surprised. After his departure, and after two hectic days, Anita was finally able to quench her passion for the children’s ward by finally being able to go and visit the child patients. As is so often the case, the nurses were tending to the children when we arrived, although mercifully, the ward was not as busy as it is at other times of the year.
However, what was the same as other times of year were the malnutrition cases. Gaunt faces, glazed, distant eyes and muscles withered to nothing more than faint outlines on the edges of jagged, protruding bones. They are images that have become synonymous with Africa; yet television images do little to numb the thoughts that cross any human beings mind when confronted by such a sight. As we walked onto the ward, the play/malnutrition nurse attendant, Lamin, was gently trickling stabilising food from a pipette into just such a young girls mouth. Admitted three days ago, Ida has tuberculosis, malaria, pneumonia and malnutrition; a formidable barrage of illnesses for such a small body to contend with.
She is clearly in a very poor condition. Yet with such dedicated members of staff like Lamin that have received expert tuition from volunteers such as Dr Peter McCormick, there is hope yet for this girl who would have stood no chance just a few years ago.
We are currently amidst a torrential downpour, preparing to feast on a tin of baked beans. Due to the temperamental nature of the phone lines, which tonight are working and against any normal sense and logic, I shall be venturing out into the thunderstorm in order to take this report to the Internet connection. Tomorrow is going to be another day of travelling, with a trip to Basse, Gambia’s second city, in order to see a young woman by the name of Mariama who shall be coming back in August to have a prosthetic limb fitted.
Saturday, 16th July 2005
Leaving the house this morning, we were once again reminded of the perpetual struggle for life that the people of Bansang and beyond face daily. Yet we had not even reached the hospital. For across the dense grass outside our house and just beyond the boundary fence that marks the beginnings of the Cuban quarters, there was feverish activity. We found out that a doctor’s young daughter, having finished her errands at the market, had almost stumbled onto a spitting Cobra, a snake with a potent cocktail of chemicals sitting at the end of its fangs. With no available antivenom, the maintenance men were beating the land with sticks in order to find and kill the snake. Removing this snake and others is clearly essential since they are a very real danger to the medical staff, having taken one of their lives this year already. It would seem that no matter how healthy a person is, within the flicker of an eye, lives that endure all the other medical threats seen daily at the hospital, could be extinguished by something completely out of our control. This explains to me why The Gambian people are so self-less and generous since at all times they are facing the very real prospect that they will not be around to see another day.
Arriving at the hospital mid-morning, we were met by Dr Amadou Bah, who was clearly a passionate and very committed eye doctor. Dr Bah took us straight to his ward. As we are now somewhat accustomed, all the patients on his ward looked at us as we entered with a mixture of surprise and disbelief. I thought nothing of the significance of this, since white people are something of a rarity this far inland on Africa’s west coast. However what I was to learn surprised me hugely, since all but one of the five patients on the ward had arrived without being able to see at all. These patients had previously depended upon others to guide them through each and every hour of every day. Losing so many capable hands to look after these blind village elders places a huge burden upon the communities they come from, where the average monthly wage of a full time job does not even buy one bag of rice. As such, the significance of Dr Bah’s Work cannot be emphasised enough.
One such case, fifty-year-old Omar Bah, had endured complete blindness and its debilitating effects for more than five years. He would still be contending with it now, placing an intolerable burden upon his fellow villagers, but for a friend of his who had the surgery himself. The two used to go fishing together for many years he told us, until they both became blind because of cataracts in both eyes. No longer able to fish or help the community he had once been an integral part of, Omar had been forced to rely on others for help. He originally shunned the expert medical help of Dr Bah because witch doctors had warned him against western medicinal care.
His friend however had chosen to have the operation that involves replacing the cataract with a synthetic lens. Having seen his friend now fishing again, Omar decided to get the treatment himself and having had it done now ‘feels like he could fly’. Considering the cost of just 350 dalasis, which works out to be seven pounds, it is incredible that Dr Bah is reducing the amount of dependant blind people so successfully. Once again, it was humbling to be told that frequently he pays out of his own meagre wage of no more than fifteen pounds per month in order to get the patients transported here.
Mid-day saw our daily check up on the children’s ward, which undoubtedly is one of the chief drivers behind Anita’s inexhaustible energy to see this hospital grow in strength. As has become a welcome trend on this visit to the hospital, yet more good news was awaiting us in the ward. Lying cocooned in amongst a multitude of vivid coloured blankets lay little Awa Dampha. Being cuddled adoringly by her mother, this diminutive young thing defied the expectations of Dr Peter McCormick who was deeply concerned when he left in early July as to whether she would survive. His concerns were borne out of the fact that on birth, she weighed just 1.3 kilograms, which instantly reduces any baby’s chances of holding on in this and other developing countries. Yet she has not only been weaned back onto breast milk, but has gained half a kilogram. Dr McCormick was understandably elated when we informed him of the news, having been fearful for the girl’s life just a few weeks before.
However, such good news is an exception rather than the rule with a baby borne so prematurely as Ama was. This is because there is a chronic electricity shortage that negates equipment such as life-supporting incubators useless for much of the day. It is a pitiful, but unavoidable situation, since the fuel for the generator is prohibitively expensive for a hospital trying to balance huge societal obligations on what amounts to little more than a shoestring budget.
Having learnt of the good news with baby Ama, we found yet more good news waiting for us with the continuing story of the woman whose life was saved by the generator donated from the donations received from the people of Northamptonshire. Lami, who tragically lost her baby in the ordeal that almost cost her own life, was not only recovering well but also walking about the hospital grounds.
However the good news, as is so often the case in these difficult conditions, did not continue. Ida, the little girl emaciated and withered by malnutrition and suffering from malaria, pneumonia and TB was going from bad to worse. She has been unable to keep the balanced food down that is critical to her progressing and beating the multitude of illnesses attacking her. Just whether she will remain with us much longer is difficult to say; hopefully a little miracle may happen. A little miracle that may let their doting mother and father take home their little baby girl and give her a chance of a life filled with happy, normal memories instead of one ended long before its time.
Having decided it best to leave the little girl alone with her parents, the afternoon was consumed with trying to send an email report back to the UK, which took 1 ? fruitless hours. Finally conceding defeat with sending the report, we set off in the Mercedes of Mr Bayo, the records/information officer for the hospital and liaising officer for the appeal, with a plan of arriving around an hour later in Basse, the second city of The Gambia. This was no ordinary Mercedes however. With 330,000 miles on the clock and on its previous effort with Anita having managed to break down just over 60 times in one trip, it was a car like no other. Never before have I got into a car expecting it one hundred percent to break down. The journey to Basse however was unproblematic. As we cruised serenely through a landscape becoming greener by day, Mr Bayo put on the soundtrack to a drive in The Gambia; George Michael’s Careless Whisper and Bryan Adams. Offset by the many hundreds of people tending the land it was certainly a very memorable journey.
The purpose of the trip to Basse was to finalise travel plans with a young lady named Mariama Sowe, who will be coming back to the UK in August to have a new prosthetic limb fitted. She was clearly very excited about the prospect of visiting England; a country that Gambians seem to have a real affinity with and a huge desire to visit for its culture and people. Her brothers and sisters seemed to share in her excitement, clamouring to be the first to get their picture taken.
Mariama’s brothers and sisters at play…
The return trip back to Bansang was rather more fraught, with a two-hour breakdown, attended to by 8 mechanics for a sum of four pounds, being the major problem. After this problem was resolved, we drove back problem free to Bansang, with the falling sun painting many different hues of orange on the ever more imposing clouds. With just a few hours rest ahead, tomorrow once again looks to be another busy day. Hopefully the relatively cool 35-degree heat will hold.
Sunday, 17th July 2005
Entire days spent on our feet under the beating Gambian sun may have taken its toll on us this week, but Sunday was never likely to be a day of rest. Having become such a pivotal figure throughout her 13 years of involvement with Bansang Hospital, morning and early afternoon was to be spent adjusting the layout of the new children’s ward. Further to this, the figureheads of each branch of hospital staff were also to spend time discussing Anita’s future project; providing suitable staff accommodation and recreation facilities for the highly skilled workers who currently have little incentive to work in such conditions.
It cannot be expressed in words just how excited the staff are at the possibilities the new children’s ward offers. Indeed, Dr Peter McCormick in his experience of 6 hospitals in 3 West African countries sees this new children’s ward as being a service unparalleled anywhere in developing Africa. Spending nearly three hours walking through the one hundred metre ‘mighty house’ as the workers affectionately call it, discussions were passionate and intense about making sure every single detail of the new unit is exactly how it should be. The midday sun did little to dampen the spirits of the key figures of the hospital. They all see this as a monumentally big step towards attracting, as chief executive Mr Dampha described, staff of the ‘right calibre’. Even as we sheltered under the huge mahogany trees that will be the shade for the outdoor play area, workers twenty or more in number shuttled wheelbarrows back and forth full of concrete for the floors.
Their efforts are just the final link in a production and logistics chain stretching more than 200 miles from the construction company’s headquarters on the coast in Banjul to the quarries of Senegal. The scale of the project is enormous, with 1 or 2 dumper trucks every week collecting cement, steel and other raw materials from across the Gambia, traversing roads that are sometimes near impassable to deliver their cargo to the hospital. How they can all work so hard is astounding given the temperatures. Yet they not only labour tirelessly, but they do so with smiles on their faces knowing they are laying the foundations of something very special and unique. The change I have noticed in four years is immeasurable: the donations from Kettering and the surrounding areas helping to create a building of a symbolism far greater than the cost to build it.
Having finally worked out a plan of action for the children’s ward that suited each party, cool drinks were bought for all the workers, who were unbelievably appreciative and grateful for such a small token of thanks…
They did not use this opportunity as an excuse to not work, instead turning straight to the equipment and materials just deposited by dumper truck in order to continue the building.
Leaving them to busy themselves, we hastily made for the shade of the current staff accommodation. Shade it may have been, but there was no other redeeming features in the first accommodation block we came to. These buildings literally were not fit to keep animals in, let alone key staff that save lives everyday. The toilet block was falling away from the rest of the building. The kitchens, dark, imposing and sinister were fit for nothing more than bulldozing and the bedrooms were little more than grimy concrete boxes that must be infernos of heat when the dry season comes. It is little wonder that the staff find it such a struggle trying to live in this area.
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The other accommodation blocks were only slight improvements over this original, macabre find. Fortunately, a legacy of the colonial era still remains in the form of the Medical Officers old house built in 1938. This grand house with high ceilings and huge spacious rooms, although requiring significant amounts of renovation, will provide housing for up to 20 medical staff. To my eyes, it has real potential to alleviate the morale-sapping situation all the medical staff here find themselves in.
Having devoted much of the day to looking towards the future, visiting the malnourished little Ida brought us very much back to the present. Being such an important time of the year for sowing crops, it is a sad fact that the indigenous peoples who dot the land are reluctant to disrupt this important period if their child becomes sick, choosing to wait until the problems become critical. This is the case with Ida who had been in steady decline for more than 3 months before being brought into hospital. Having learnt of her problems yesterday with feeding, today was even more worrisome since she had not only been eating very little, but what she had been eating she has been unable to keep down. Even with the relatively quiet state of the hospital, the chronic staffing shortage means that the level of care British medical teams would give to such a malnourished case is just unfeasible. As such, a naso-gastric feeding tube that would have been given to the little girl many hours or even days before was only given to her whilst we were there. Just whether this vital means of feeding was given in time can only be seen as the week progresses.
So as another day draws to an end, once again it is a story of hope for the future, offset by the tragedies of the present. We hope and pray that little Ida may start to show signs of improvement, however her chances of seeing another birthday have been lessened by the events of today.
Monday, 18th July 2005
There are very few days at Bansang that can be called almost entirely positive. Indeed, if we were to spend more time looking at all the patients we would undoubtedly find crises and situations that would profoundly touch us. However, the at times hectic day we have had left nothing but a feeling of real progress and optimism throughout the hospital.
On our now regular morning walk from one hospital department to another we were met with the sight of what can only be considered a little miracle. As his father washed in the early morning sun with water from the hospital bore hole, a child no older than 5 stood attentively and proud. Despite having two large bandages on his head, the little boy clearly had little concept of what he had survived, instead looking longingly at the ‘toubabs’ standing before him with their cameras.
Having spoken to the father, the boy had evidently been playing with a friend in their village. Curiosity was the chief culprit for the mixed fortunes of the two children. They had both chosen to play at the top of the village well; a climbing frame with an eight-metre death trap lurking in the middle. The two children, unaware of the danger shadowing their every move, went that little bit too far in their innocent games. Having seen the depths of these wells, this little thing standing before us was indeed so very lucky to still be with us. In time, he will learn of the tragic fate that met his friend at the bottom of the well.
The menacing shadows cast upon us by the vultures circling high overhead suggested an unwitting feast was being made for them somewhere in the hospital grounds. Intrigued as to what should have raised the attention of these scavenging beasts we left the miracle story of this young child and ventured towards the source of their interest.
The remains of the cow that had lost its life to serve the patients of the hospital for the coming week made for grim viewing. Yet hearing the people tasked with the job telling us how it was all to be used so that it may ‘make patients be strong again’ showed and confirmed once again how caring these people are. For they are not trained medical staff, they work for an almost unsustainable wage and yet they care enough to ensure that every part of the animal before them be used to help make the patients become strong again. It is welcoming to see that all the levels of staff have the same passion for the hospital as Anita does. As Dr Peter McCormick observed, without the staffs passion and commitment, this and any other hospital is merely a factory full of equipment for the saving of lives, yet no one to save them.
Becoming emotionally attached to patients is something that can be very testing and heartbreaking. Too many times to recount, Anita has come to the sanctuary of her home in the UK speaking of morbid cases where patients just faltered and died right in front of her eyes. The heartbreak is amplified all the more when the patient is seven years old, has a body weighing just 11 kilogram’s and is riddled with an almost fatal combination of malaria, TB and pneumonia. Yet Ida, who we have
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followed for much of the week, has made promising first steps away from the eternal darkness that was absorbing her little body. With the new naso-gastric tube supplying her with key nutritional food, she has maintained her weight and even began starting to show signs of becoming interested in stimulus. Her mother looked overwhelmingly appreciative at the small but significant steps the medical staff have helped in allowing her little daughter to make. Leaving her impossibly thin arms clutching the musical picture book gently playing her ‘twinkle, twinkle little star’, there was a real sense she may yet be given a chance at a life many take for granted.
From the malnutrition food, to the toys for the children to play with, to the music playing gently in the background, to the lighting above the beds; all of these things were alien until just a few years ago for the children of Bansang Hospital. Yet thanks to Anita and her donors in Kettering and the surrounding areas, the hope and stimulation these as well as many other items provide for the children have given a new sense of purpose to the staff of the children’s ward. They care for the children not only because they are paid to do so but evidently because they believe passionately in their work. The outcome today of this passion; two women riding a rocking horse designed for three year olds!
Clearly this came out of no medical handbook, but the raptures of laughter it brought must surely be as good a medication as any administered by injection or tablet. Such spontaneous actions from the staff show the new children’s ward will be in capable, loving hands when its projected opening happens in January.
Before leaving the children’s ward for the day, another malnutrition admission focussed the mind on the inherent struggles an impoverished society such as this continually has to withstand. Mohammed, much like Ida, was brought in suffering from severe malnutrition. Being orphaned, presumably by the death of both his parents from AIDS, he was being nurtured by his weary grandmother. His tired, cracked skin contorted wildly above his pronounced ribs, as he struggled to get away from the sharp cannula needles repeatedly being inserted in attempts to find a vein. Having finally found a vein, the little boy was once again taken back into the caring arms of his grandmother. Although heart wrenching watching such a small boy suffering so greatly, he is showing interest in all manner of stimulus, which is a crucial indication of someone’s body being able to fight and overcome malnutrition. We hold hope that this boy may yet remain a fundamental part of his grandmother’s life; a life already afflicted by the death of her children.
Before leaving the hospital for the day, a young boy by the name of Baba nudged us to get our attention. Unable to move his hands, with feet that have grown back underneath themselves and with one elbow fixed in place by years of bone growth that have rendered the joint useless, he would seem to many eyes a tragic, helpless case. Yet this boy’s intelligence and warmness was absolutely incredible given the extent of his problems. Abandoned at the hospital many years ago, he was taken in by a nurse despite the extent of his disabilities rendering him dependant almost entirely upon her and his new brothers. Looking as though he should barely be able to walk, he defied the startled Cuban, Dr Fromita, in telling us that he can not only walk but also play football. In
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a very touching moment, Baba told us of how he would like to walk without pain for the first time in his physically troubled life. As Dr Fromita conceded, but for the new surgical equipment supplied to his department by Anita, this boy would never be able to be treated in Bansang. Such stories show how irrefutably important the continued support of Anita and the wider community of Northamptonshire is for this hospital in the Gambia.
Finally getting ready to head to bed, an all too familiar tapping at the door was found to be three young boys. Malang, Osuman and Alpha had come the previous night dressed in tattered rags. The small tokens of clothing I gave them cannot mask the problems they face. They lost their father less than a year ago and now find themselves unable to fund their educations. It is tragic to see such caring young children who are so polite, losing not only their father, but also their future simply down to a lack of one hundred pounds each per year. I have seen people my age flippantly spend that money on one night out. As such, it is tragic knowing that a frequently forgotten night out could instead have helped safeguard the futures of Africa’s needing children.
Out of sight, out of mind…this is Africa. But Anita and others such as those in the Kettering and surrounding areas undoubtedly are helping alleviate this modern day tragedy…
Tuesday, 19th July 2005
One of the most interesting and striking things that my time spent in an area such as this has come to reveal is the huge difference between western views of nature and those of the developing world. The western civilisations see images of the rains in Africa as being almost wholly beneficial to the places on which they fall. After all, how could something that changes deserts of rust-red dust into lush green savannahs and parched grasslands into odysseys of life possibly be considered a thing of malice? This understandable conviction means we frequently pity those countries that are consumed by droughts of biblical proportions, yet dismiss out of hand that regions with heavy rainfall could possibly be in even greater jeopardy. Having spoken to the community of Bansang, it is clear however that the rains are indeed merely a blessing in disguise.
It is true, they have alleviated the oppressively high temperatures that afflict this region for much of the year. They have also brought a radiant array of flora out from their dry season cocoons, painting a lush vibrant picture across the landscape that I thought inconceivable given the barren land I witnessed in April four years ago. Yet whilst people busy themselves about their daily chores, creatures swarm and multiply in the festering pools of water that the rains have left littered across the Gambian countryside. These creatures are mosquito larvae. When they rise from their murky domains, Mr Bayo, the records/information officer for the hospital and liaising officer for the appeal assures me that simply clapping my hands together would leave ten or more mosquito carcasses strewn across my hands. Given that there are so few mosquitoes in the air at the moment, yet out-patients is treating one hundred children a day for malaria, I struggle to comprehend the effect that this living shadow of mosquitoes will have on these poor people. As I sit here watching the rain cascading down off the roof, I no longer look at it with such a high regard. I sit here instead in the knowledge that the rains will indirectly lead to the suffering and death of many thousands of Gambians.
Away from painful thoughts of the unavoidable suffering this country will soon have to embrace, Anita’s work is undoubtedly helping paint a brighter picture not just for Bansang, but the whole country. Meeting with Emmanuel, the chief scientist in the laboratory at Bansang, he informed us that the parliament had recently passed a bill to ensure all blood must now be screened for Hepatitis B. This has come on the back of Anita’s pioneering introduction of Hepatitis B testing on all blood donors. Indeed, Bansang holds the accolade of being the first institution to embark on the testing of Hepatitis in the Gambia. The virus is contracted in much the same way as HIV, causing damage to, and the eventual failure of the liver, as well as affecting the hearts ability to function. Emmanuel emphasised that it is as much a threat to life in the Gambia as HIV, yet until Anita’s intervention, blood even for children remained unchecked. Before this testing kit, doctors were as likely to be handing a prolonged death sentence to their patients during operations, as they were likely to be saving their lives.
Having extended ourselves to so many branches of the hospital throughout the week, the humidity finally drained us today. As much as possible, we attempted to keep to the schedules dictated by the many people clamouring to discuss their hopes for the hospital. However we finally ground to a halt around midday, choosing instead to walk from one department to another, speaking to the people that underpin the hospital; those that sew the uniforms, that wash the clothing, that cook the food and maintain the buildings. These are the lifeblood of the hospital; working on wages per month many in England spend on snacks in just one of their lunch breaks. I don't want to know how they survive, or why they smile; I am just thankful and humbled that they can be content with so little.
The children’s ward is always a place that has the power to invigorate and revitalise weary bodies. Seeing such strength from mothers who spend night and day keeping vigil over their children lying stricken before their eyes is nothing more than inspirational. The mother of malnourished Ida is one such woman. How she can have remained strong for her child is incredible given the condition that her little girl had come onto the children’s ward in.
Most touchingly, the little emaciated shell of a body that Ida now finds herself in did not prevent her from repaying the bedside vigil of her mother. A nurse confided in us that early this morning, she had heard Ida’s mother sobbing to her daughter about the prospect of losing her. Her stoicism in the daytime had clearly been an effort at holding back her emotions towards the potential death of her young daughter. The nurse told us how she listened from afar and heard the weak voice of Ida say to her mother, ‘don't worry for me, if I die then it is the will of Allah’. How a child can be so strong when there are so many illnesses attacking her frail, failing body, I will never really know.
Having learnt of the faltering Ida and the death of another malnutrition case that had come in earlier today, it was a day of powerful feelings of empathy for everyone associated with the little children dying before us. Much like Ida, Mohammad, the other boy suffering from malnutrition has deteriorated further; his body is seemingly unable to draw strength to build itself up again from the crumbling ruin we first saw two days ago.
…Tomorrow will hopefully bring good news for Ida and Mohammad. Today, we can but hope and pray.
Wednesday, 20th July 2005
Inter laced with episodes of Simpson’s and other such programmes, the images presented to us by aid organisations on television adverts begging for funding to alleviate chronic food shortages all to often seem a distant and unreal issue. Coming from a country of excesses, where food is so cheap and plentiful, it is such a diametrically opposing situation that Africans find themselves in that I have frequently found myself unable to fully comprehend the difficulties they face. However, in The Gambia, where the average wage of ?12 per month fails to buy even a single sack of rice, the crises I have witnessed and been unable to appreciate in the media for so many years are borne out in front of my eyes. Just this morning, a young man by the name of Amadou visited us. As he broke away from his embrace of Anita, his voice quivered as he fought to keep back the emotions clearly long pent up inside. Earning just 250 dalasis as an electrician’s apprentice, the equivalent of ?5 a month, he has lived a tortured life. Having been bullied at school he was forced to drop out after losing his sponsorship due to his slip in grades. He now exists on a wage that would not buy him a sack of rice in two months. He now finds himself losing the one thing Gambians hold most dearly, his dignity. Forced by his hunger, he begs for food from the hospital staff, getting the hand outs usually allocated solely to the patients. It is tragic and touching beyond anything I've ever felt that someone should live such a lonely existence, fraught at every turn with the possibility of dying through starvation.
It is through stories such as this that Anita is broadening her scope of work within the hospital. As well as providing the much-needed medical supplies, Anita has been researching the possibilities of providing a poultry farm for the workers to get subsidised eggs. The Rotary club of Wellingborough Hatton funded an initial effort that saw 25% of the chickens die within the first two, swelteringly hot months. From this, it seemed inevitable that a project that offered a very real solution would, like so many things, be consigned to history because of the unrelenting heat. However a chance encounter with a Texan member of the American Peace Corps, named Shacca, has helped bring Anita’s dream of providing a self-sufficient means of nourishing the dedicated, impoverished workforce of the hospital, one step closer. The problems that the project faced were very familiar in this country of poor road networks and an unutilised river. The logistics of not only getting 200 chickens to the hospital from Senegal more than 470 miles away, but then providing them with affordable feed, seemed almost insurmountable. However, Shacca and the large Peace Corps contingent in the area have been working for over 2 years now on agricultural projects across the country and have promised that they will aid the project as much as they can to ensure the hospital will indeed have its own poultry farm.
Looking every bit the backpacker, Shacca saddled up his bike and left us mid afternoon, determined to make it to other poultry projects in the area. He is just one of a great many people that Anita’s efforts have helped attract to the appeal. Another such philanthropist is Bob Parfitt, a veteran charity administrator much like Anita. Having worked in the ex war-torn regions of Croatia, Mr Parfitt became involved in Bansang after hearing of the appeal and the problems the area faced. With years of experience in co-ordinating large-scale movements of key items of all types, from disinfectant to refrigeration units, gloves to furniture, he has in a very short time become an indispensable asset to Anita’s efforts. As is the case with all the volunteers who give their time to help the community, he has been adopted as a Gambian. Spoken and revered by all of the staff, they wait with huge anticipation for the day their ‘uncle bob’ comes back again.
Staff with uncle bob’s donations.
On our way back from the sewing room, having seen the positive effect Mr Parfitt’s efforts have had upon the staff morale, we were met with a sight for sore eyes. The fragile, withered girl that we have been following whilst we've been here, who was merely a heartbeat from death just a few days ago, stood proudly with her mother by her side in the late afternoon Gambian sun. Dressed in her finest clothes, little Ida has made an incredible recovery; one she would never have made without Anita and the unsung heroes of Kettering and beyond. Her mother beamed with joy, elated to be able to show off to us a daughter she had wept uncontrollably for just days before, having thought she was to lose her.
Still just a shell, Ida is by no means out of a critical state; her body has endured 3 months without nutrition, which will have undoubtedly weakened her internal organs. Yet we can truly hope for the first time that she will live to see another birthday and maybe one day grow old and tell her grandchildren of how Bansang Hospital and its donors helped save her. Such stories are undoubtedly what make Anita endure the heartache that will continue to be rife in an under funded medical resource such as Bansang.
Visiting our other little pint-size patient, Mohammad, we found equally promising signs of progress we thought utterly improbable just days ago. Ida would surely have known little of the parallels between her case and that of Mohammads, yet as she walked past the little boy who was sitting up in bed who himself was determined not to let go of my camera, it dawned in a very powerful way that these children were indeed recovering. They were no longer clutching onto threads of life, with glazed distant eyes, but children again as I new children to be. Inquisitive, attentive and alert.
So, with the humidity finally having sapped much of our energy, it will be a relief to have a day that can be spent as we choose. No doubt our time tomorrow will be spent largely in the children’s ward, especially as the stories we have been following are unravelling so promisingly. With a celebration for the children’s ward workmen planned for the evening, it will undoubtedly be a special way to finish a deeply thought-provoking, life altering experience.
Thursday, 21st July 2005
Without having had barely a moment to notice it coming, the final day in Bansang is now upon us. Serving a population of 600’000, yet hidden eight hours from the nearest coast deep inside West Africa, this hospital suffers greatly from a lack of funding, resources and staff. Having heard all the horror stories Anita has told us for many years back in England, I never anticipated that this diary of our experience here would have an uplifting ending. Yet the images I have seen of a lush green land, relatively quiet hospital and promising progress on many projects could quite easily lead me to paint a wholly wrong picture of the plight of this hospital. After all, the rains that have made my stay so pleasant, that have cooled the temperatures and brought life back to the land, have also helped keep people at home on their farms instead of bringing their sick family members to the wards. The rains will also bring huge numbers of malaria carrying mosquitoes out from the many stagnant pools that litter the land. A huge bottleneck is forming of sick and dying people that the currently overstretched hospital workforce is ill prepared to absorb. It was therefore symbolic that juxta posed with the many promising stories this hospital has revealed over the week, the final day should expose underlying problems that could very well spell catastrophe for the hospital.
Walking across at 1 a.m., we found a hospital filled with the motionless, sleeping bodies of dozens of waiting parents, relatives and friends all with nowhere to sleep but the rough concrete floor of the hospital waiting areas. Tiptoeing through this silent, resting hospital, we finally reached the children’s ward. Covered in their white shrouds, the young children lay partially concealed by the thin mesh protecting them from the voracious mosquitoes. It was an eerie scene, walking in on a ward usually alive with sound and motion that now lay silent. The flicker of the light from a television donated by a concerned resident in Bansang drew us to the only people still awake; the nurse attendants. They enlightened us as to the plight of the two children we have been following throughout the week. Mohammad was said to be making promising progress, whilst little Ida, the girl we had jovially stood next to just hours before having our pictures taken with had once again regressed into a critical condition.
A poisonous infection on her head was complicating yet further her almost fatal combination of medical problems. It was difficult to think that just hours before, we had felt the little child was on the long road to recovery; now, she once again lay stricken and on the edge of death. Unable to aid her, we retired to the house, taking with us mixed emotions of the huge highs and equally huge lows this hospital can deliver in an instant.
Having taken with us to sleep the worrying news of Ida, the day started more promisingly. One of the Cuban doctors had seen to the abscess on the little girls head, which had once again brought her from a critical to stable condition.
With this worry lessened, the interviews for a new play nurse added a comical element to the day almost inconceivable as we looked on at Ida just a few hours before. Unlike England, where as much emphasis is placed upon interview technique as the content of a curriculum vitae, Gambian play nurse interviewees rely solely on their past academic and sporting achievements. It was almost painful listening to the mumbled responses of many of the fearful candidates. Finding myself begging inside for just one to be forceful, passionate or even audible, I felt sure we were going to struggle to fill the position being made available by the charity. However 19 year old Kadijatou Jallow, who herself had worked as a volunteer without pay for a month already on the children’s ward, came as something of a revelation to the disheartened hospital panel. Young, passionate and loving of children, her position was confirmed by the board as soon as she left the room and by Anita in person just hours later. To celebrate the new appointment, food was bought for the patients by a generous donation from Bob Parfitt. Willing or unwilling, the children were then subjected to three grown women, clad in monkey, rabbit and cat masks, prancing about the children’s ward.
The worries of the night before seemed merely distant memories as Ida smiled at the strange Toubab and her play nurse accompaniments running and hiding from each other.
However, seemingly as soon as the activities began, a message was relayed that the chief executive had convened an urgent meeting. In just moments, Anita learned that the subvention fund, barely able to cover the current expenses of the hospital, had been cut by a third for the year of 2006. This was non-negotiable, as the government was being forced into meeting the required International Monetary Fund criteria for receiving debt relief. It would seem bitter irony that in a world where rich countries convene regularly to discuss how they can possibly alleviate poverty, the mandatory servicing of debts to rich western countries should cause a hospital barely able to cope currently to lose one third of its budget. With the escalating fuel costs only allowing the hospital to afford 4 hours of electricity per day, how they can work at all, let alone effectively under the economic conditions 2006 promises, only time will tell. What is certain is that the hospital will rely ever more greatly on Anita, who will herself become ever more dependant on people’s compassion in Kettering and beyond to sustain the hospital through the dark times ahead.
My Final Thoughts:
Whilst we watch our children play in their safe, sheltered lives, a continent still reeling from centuries of European interference sits begging and helpless, watching as its children falter and die. According to World Health Organisation figures, child mortality rates in Africa are eight times that of Europe. Within 3 weeks of your reading this, 50’000 children under the age of five, equivalent to much of the population of Kettering, will have died from extreme poverty in Sub-Saharan Africa. By the end of the year, 11 million children will never experience the feeling of having their sixth birthday, 60% of these losing their unfulfilled lives because of the indifference of a world that has for years held back the remedies to their problems. Children like Ida, Mohammad and countless others are everyday needlessly dying, often doing so having never experienced the feelings of happiness and security that we in the developed world take as being an inalienable right. This thought troubles me hugely. After all, but for the fortune of being borne into a rich, developed geographical region, it could very well be you or me that is at this moment withered and gaunt, fighting to stave off death in the hospital of an impoverished West African Hospital.
So as I come to the end of this experience, these are the thoughts that I continually find filling my mind. I find it impossible not to compare myself to the patients. What troubles me greatest is that I am vaccinated for tuberculosis, take tablets to protect myself from malaria, am never in jeopardy of running short of food, rendering me safe from malnutrition and know I have a health service back home that would almost certainly save me should I develop pneumonia. Yet sitting in front of me are two little children that may very well die of illnesses that because of my socioeconomic fortune of being borne British, I could never get. Why should this child die when I should be considered worthy of living? Why should images of malnourished children be symptomatic of Africa, when food surpluses paid for by huge farming subsidies sit rotting and unused? These convictions about the injustices served on Africa gain ever more authority each day spent here.
Time spent with the community of Bansang has shown however that the unflinching 13 years of dedication Anita has given to the hospital is reaping huge rewards. With the help of the people of Kettering and beyond, Ida has a greater chance of surviving than she ever would have done before. Countless untold stories would undoubtedly mirror this one of Ida; lives that would be extinguished long-ago but for Anita and the generosity of the community of Kettering. In becoming so dedicated to the cause of the people in Bansang, I have witnessed the lives of other dependant peoples in The Gambia, Mali, Mauritania, Senegal and beyond becoming ever more safeguarded.
The continuing support for Anita’s charity cannot be emphasised enough…
Without it…
…who knows what the future holds.
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(Laurence's Diary)
Bansang Hospital Appeal a UK registered charity ~ 1064469