Volunteers: Conditions and precautions.
All Elective / Volunteer placings for 2010 and 2011 have now been taken.
It is almost impossible to describe how incredibly important volunteers are to the work of The Bansang Hospital Appeal. Suffice to say that without their skills and expertise the Appeals effectiveness would have been seriously reduced over the years.
This page gives a more accurate picture of the conditions that will confront volunteers visiting Bansang and the essential precautions they must take to correctly deal with these conditions.
The volunteer selection process requires a formal application to be completed followed by an interview, in person, before acceptance to the programme can be considered.
The above procedure has been adopted to remove the possibility of a volunteer not fully appreciating, both the conditions they will face and the work ethic expected of them whilst at the hospital.
If after reading the VOLUNTEER BRIEF, below, you consider that you are a suitable applicant then please request, in writing, a volunteer application pack stating your career details and qualifications attained to-date. Address details of the Appeal can be located on the 'Contact' page.
The following document entitled, VOLUNTEER BRIEF, is sent to all would be UK volunteer applicants and was prepared by Dr Peter McCormick, the Appeals Chief Medical Adviser. Please read very carefully before requesting further info.
All Elective / Volunteer placings for 2010 and 2011 have now been taken.
BANSANG HOSPITAL, THE GAMBIA.
PART 1: The covering letter
The extremely poor economy of The Gambia dictates that the health service within this tiny country is always under extreme pressure to offer even basic medical services to the community. Anita Smith started her work at the hospital in 1992 and has worked tirelessly ever since to assist the hospital management team in raising the standards of medical care for its patients. The official Bansang Hospital Appeal charity was registered with the UK Charity Commission in 1997.
The hospital serves a catchment population of approx. 600,000 people and is always under enormous pressure to cope with the day to day demands on its over-stretched resources. Since 1992 the Appeal has sent vast quantities of medical aid, and arranged for many volunteers to spend very valuable time at the hospital. The volunteers have originated from a wide variety of backgrounds and include surgeons, doctors, dentists, nurses, students, electricians, IT specialists, plumbers and builders. All have been crucial to the development of skills and facilities within many areas at the hospital.
It is of paramount importance that all potential volunteers for the Appeal should be carefully considered by us. We must establish that each applicant understands, in advance, and fully agrees, without reservation, various matters we consider important. This is the preliminary preparation to personal conduct and life style conduct whilst in The Gambia.
We do not wish for the hospital to be further burdened by illness amongst the volunteers; illness which could have been avoided by proper preparation and continuing vigilance. Nor do we wish for the Appeal to be brought into disrepute by inappropriate behaviour. Bad news travels fast and far, and the media are ever ready to pounce both in The Gambia and in the UK.
The following standards of preparation prior to the volunteers journey and conduct during the volunteers stay at the hospital should be considered very carefully and fully understood as failure to comply may well result in the Appeal requesting the volunteers immediate return to the UK on the first available flight.
1. The Gambia is a third world country and the environment must be considered as hazardous to health. We ask all volunteers to consult with their GP well in advance of their planned departure in order to ascertain the correct medical precautions required to cover all foreseeable eventualities, including Meningitis, Hepatitis A&B, Malaria prophylaxis, Tetanus and Polio.
2. Volunteers must be in possession of a full course of Anti-Malarial medicaments, Proguanil plus Chloroquine or Meflaquine, to cover the full duration of their stay in The Gambia. Many hundreds of Gambian people die each year due to inadequate protection against Malaria and so daily preventative treatment is absolutely essential. Anti-Malarial drugs are not 100% protection against Malaria and so it is essential that the following precautions are also taken during the volunteers stay. Cover all exposed skin after dusk, apply insect repellant to any exposed skin and always sleep under a mosquito net. Failure to heed this basic advice has resulted in three volunteers returning to the UK early.
3. AIDS is much more prevalent in Africa than in Europe and there are, of course, some AIDS patients at the hospital. All volunteers must take precautions throughout their stay to cover any open wounds on their bodies and to be extremely vigilant of any discarded syringes and old dressings.
4. The Appeal counsels extreme caution in the matter of sexual liaisons whilst working for the Appeal. The reasons are twofold: Firstly as already stated STD & AIDS are prevalent in all African states and the risk to your health would be considerable. Secondly there is the real possibility that news of such a liaison may well come to the notice of the Hospital Administrator where it would be frowned upon, and to the notice of the local media, where there would be repercussions upon the good name of The Bansang Hospital Appeal. The Appeal recognises, of course, that it is unable to police such matters, rather we ask for and expect the volunteers understanding of the implications of such a liaison and that they will at all times act with discretion and dignity as a person working for the Appeal, as a guest of the hospital, and as a servant of the Bansang community.
5. Rabies is found in The Gambia and stray dogs will often be seen in the grounds of the hospital and may be rabid. These dogs may also be suffering with various other conditions including “fly strike” which leads to bleeding ears. The local cure for this condition is to cut off the damaged portion of the ear. It would be unwise to attempt, in any way, to help these unfortunate animals as you would stand a chance of being bitten. An anti-rabies injection administered by the hospital will cost the hospital £170.00 ($250.00) per injection.
6. It is absolutely essential that volunteers do not become embroiled in local politics, local disputes or criticise the government in any way either verbally or in writing. Volunteers must abide by all Gambian laws and observe local customs and rules and at all times respect the Gambian way of life.
7. The Appeal is unable to offer any financial support to volunteers for any costs whatsoever. All funding is required for the direct support of the hospital and its patients.
8. The Appeal will endeavour to secure accommodation and transport to the hospital which is 200 miles from the coast. These two issues are normally offered by the hospital as a good will gesture to all volunteers.
9. All accommodation at the hospital is basic and this includes the volunteer's accommodation. Some volunteers have been distressed by the rat population that frequent the roof void. This distress is caused by the constant noise that the rats make during the night.
10. At all times please keep to footpaths do not venture into long grass. Poisonous snakes including Python and Cobra are resident in The Gambia.
11. Please expect temperatures ranging from 25°C during the Winter months to 50°C during the Summer months. Humidity will be extremely high during the rainy season, June to October.
12. Successful applicants will receive all necessary details regarding their proposed visit to The Gambia well in advance of their trip. The Appeal is well known and highly respected in Bansang and all volunteers can therefore expect to be looked after very well by an extremely friendly community throughout their stay.
13. Full insurance cover in the event of ill health, or other unforeseen circumstances, will be the responsibility of the successful applicant or institution. The Appeal will not be liable for any claims whatsoever in connection with the volunteer visiting The Gambia and will not be held responsible for any such misadventures.
The Appeal apologises to all prospective volunteers for the rather curt and at times pedantic nature of this document but it is essential that any volunteer representing the Appeal must uphold the high standards that have been set by all concerned with the Appeal over the years.
It has been the Appeals experience over the years that simply wanting to be a volunteer is not always enough. Sadly in one or two cases the good intentions of volunteers have jeopardised the Bansang Hospital Appeal. It is for that reason that the Appeal reserves the right to establish the suitability of all UK volunteers who propose to represent it.
Bansang Hospital Appeal.
HEALTH ADVICE FOR VISITORS TO BANSANG
PART 2: Health Advice
Please consult with your doctor, at least six months before your planned departure, on all issues raised in this section. Your doctor knows your past medical history and will be able to prepare you accordingly.
However it is essential that your doctor is also aware of the duration of your stay and that it is your intention to travel widely in all areas of the Gambia. Some specific conditions are more prevalent in the Mid and Upper Divisions of the Gambia than in the coastal areas.
The following notes are intended only as a guide.
TETANUS ~ Have a top-up injection if it is more than ten years since your last one.
DIPHTHERIA ~ Worthwhile having a top-up. This immunization and Tetanus immunization possible in a single injection.
POLIO ~ Have a top-up drop of the oral vaccine if it is more than ten years since your last dose.
TYPHOID ~ It is worthwhile having this. The protection lasts ten tears.
HEPATITIS A ~ Two injections 6-12 months apart. A rapid dose schedule is possible. Seek your doctor's advice.
HEPATITIS B ~ Three injections - at 0, 1, and 6 months. A rapid dose schedule is possible. Seek your doctor's advice.
MENINGITIS ~ Important. Meningitis comes to The Gambia in frequent epidemics. A single injection gives 5 years protection.
RABIES ~ Advisable. The primary course is three injections at 0, 7, and 28 days. After the third injection the protection expected lasts for between 2 and 3 years.
YELLOW FEVER ~ A prevalent disease in The Upper River Division. One injection gives 10 years protection.
None of the above immunizations is an immigration requirement of the Government of The Gambia. You are however advised to give close consideration to them all in consultation with your doctor as health recommendations frequently change.
Please bear in mind that none of these immunizations is available on the National Health Service in the UK. They are your responsibility and are expensive.
Malaria is endemic in The Gambia, being present there all the year round. It is however much more prevalent in the Rainy Season - which corresponds to our Summer months. It is a serious problem, and a disease which though treatable - is quite capable of killing people. The indigenous community builds up some immunity to it, but only by contracting it many times during childhood. Europeans do not have any such immunity, and should therefore take the matter very seriously. All health workers know of ill-prepared and unprotected European travellers in Sub-Saharan Africa who have died of Malaria. In Britain alone a dozen or so people die every year as a result of Malaria contracted in the tropics.
In addition to this an ever worsening problem is the resistance of the Malaria parasite to the treatments available. Indeed such resistance is present in all Sub-Saharan African countries. This fact makes it even more important for you to study these notes and act accordingly. The Organizers of the Bansang Hospital Appeal insist that you carry with you anti-Malarial tablets and expects that you will take them properly. The choice of which regime you use will be in consultation with your doctor.
It should be noted that the anti-Malarial tablets may not give 100% protection against the disease. It is therefore important that you follow the additional following advice.
1. Mefloquine ( “Lariam, Mephaquin”) ~ At the present time this is the drug of choice for people visiting parts of The Gambia remote from a Hospital. It is particularly important for people who will be spending a long time in the country, and those living and working in a rural setting where standards of accommodation and general hygiene are lower than might be encountered by a holiday-maker living in a fine tourist hotel for a week or so. There are occasional unfortunate side-effects associated with Mefloquine, and a few people have become ill enough from it to be incapable of work. Airline pilots are not permitted to use it. Many people however have no problem at all. It is very convenient since the dose is only one tablet per week. Discuss the matter of Mefloquine side-effects with your doctor.
2. Chloroquine ( “Avloclor”, “Nivaquine” ) plus Proguanil (“ Paludrine”) ~ For travellers to The Gambia who are living close to a hospital - the combination of these two drugs is considered safe. It is also the desired alternative for people who cannot tolerate Mefloquine. Chloroquine is taken once a week; Proguanil is taken once a day. Which ever regime is chosen it starts one week before you leave, and continues for four weeks after you return. The cost of your anti-Malarial prophylaxis is not covered by the NHS. Mosquitoes carry the parasites that cause Malaria. The parasites are passed to the human host when he or she is bitten by a mosquito. It is only the females that bite, and they are looking for blood meals to ripen their eggs. They only bite during the evening, the night, and the early hours of the morning. This knowledge of the mosquitoes’ behaviour enables you to plan further protection against them.
SPECIFIC MALARIAL ADVICE
Sleep under a bednet ~ Preferably one which has been impregnated with the chemical called Permethrin or Deltamethin. This single measure has been shown by the Medical Research Council in Banjul to reduce the incidence of Malaria, and the mortality from it. You will see that every bed in Bansang Hospital is provided with a net. You must do likewise.
Cover arms and legs ~ To sit on your verandah as the sun goes down, absorbed in an interesting book, wearing shorts, sleeveless shirt, and sandals on your otherwise bare feet - is asking for trouble from mosquitoes. Long sleeves, long trousers, long skirts and socks for evenings.
Insect spray ~ It is a sensible idea to spray the room you are most likely to occupy in the evening - also the bedroom.
Windows and doors ~ Keep them shut in the evening and during the night. There will be a ceiling fan or air conditioning apparatus in your accommodation.
Insect repellant ~ Designed for direct application to your exposed parts. Usually contain the chemical DEET. Known to be safe and effective. Available from Chemists.
Coils ~ Widely available, but of less proven effectiveness than the foregoing measures. At the same time don't discard local knowledge, and traditional measures. Professor Brian Greenwood of the London School of Tropical Medicine, and the MRC Laboratories at Banjul, is on record as stating that some local remedies in The Gambia are undoubtedly effective in repelling mosquitoes.
THREE POINTS WITH WHICH TO CONCLUDE ON MALARIA
1. If there is a stagnant pool or puddle near your accommodation, try to have it filled in. Mosquitoes love stagnant water, and breed there.
2. Take the reality of Malaria very seriously.
3. If in spite of all your precautions you feel ill with a temperature, that you can't explain, seek medical help at the hospital. Don't run any risks.
GENERAL HEALTH ADVICE
Always wash your hands before eating.
Wash all fruit and salad stuff.
A good general rule is ‘ wash it, peel it, cook it, - or leave it’
Beef available from Bansang Market. Wash it. Many flies.
Fish available at Market or Hospital gate
Pork not available ( Muslim country)
Fowls (chickens) are available - alive. The menfolk will sell and kill them for you.
Frozen meats and poultry not available in Bansang
Potential hazard with cassava (manioc). If you wish to eat it wash it well and soak the sliced root for twenty-four hours before cooking.
Some European foods available at the ‘Supermarket’ in Bansang
Put eggs in water before cracking them. If they float they contain gas, and are bad. If they sink they are safe.
The supply comes from a deep bore hole in Bansang. As such it is very pure at source. Thereafter it is pumped into a metal reservoir on the hill in Bansang. From here it comes in pipes to the hospital and its houses. Contamination can occur from faulty cracked pipes. Occasionally there will be brown water from the tap. It is as well to save several litre's of clear water in plastic bottles to keep in your fridge. There is no need to boil or purify water from the taps when it is running clear. Water from the numerous outside stand pipes is clean and drinkable. There is one water pump by the Hospital - its water is fine. Avoid river water, and avoid open top wells. The water supply will fail from time to time e.g. pump failure in Bansang. It is generally reestablished in a few hours.
It is as well to have a dental check before departing. A Dental department exists at Bansang Hospital, but copes only with extraction's. No conservative treatment is possible. Toothpaste and tooth brushes can be purchased at the Hospital gate market.
It is a wise precaution to wear sunglasses outside. If you have trouble with your eyes there is a well-equipped Eye unit at the hospital.
If you are fair-skinned and/or freckled it is wise to avoid direct sunlight to the exposed parts. A wise precaution would be to have with you high factor sun screen. The local people avoid direct sunlight, and will advise you to get into the shade if they see you in the sun.
The combination of sweat and unaccustomed heat may result in an intensely itchy red rash - sometimes called ‘prickly heat’. Frequent showering helps prevent it, but is not always possible. Piriton tablets (chlorpheniramine) are antihistamines, and help take the fire out of the itch.
What has been said above applies particularly to the feet, which are prone to become hot and sweaty. The misery may be compounded by sodden skin being invaded by fungal infection - Athlete's Foot. Anti fungal cream may be needed, but frequent washing and changing of socks is essential.
It happens, but in general is not a serious matter. Drink plenty of water, or fruit juice, or tea. If there is blood in your motions (that is - ‘dysentery’), or if the diarrhoea is accompanied by vomiting or abdominal pain, seek medical help at the hospital.
You may wish to delay a period by using hormone tablets prescribable in advance by your doctor. The sanitary arrangements in the hospital accommodations are however satisfactory, and you should not experience problems. Dispose of sanitary protection in the hospital incinerator. Sanitary pads are available at Bansang. Tampons are not.
Sexually transmitted diseases (STD's)
There is a considerable risk in The Gambia of HIV infection and STDs including Hepatitis B. Treatment is available for STDs at Bansang. HIV is a death sentence. We ask and advise all Volunteers to avoid casual sexual liaisons whilst working for the Bansang Hospital Appeal.
This miserable African fly lays its eggs on the ground. Especially ground which has been contaminated with animal urine or faeces. When a suitable host - such as you - lies on that ground the eggs hatch, and the larva (maggot) immediately burrows into the adjacent skin. It causes eruptions that look like boils. Several may occur in one patch of skin. Each boil contains a living maggot. It is not serious, but it is best avoided. The eggs can also attach to clothes spread out on the ground to dry. Best to hang them somewhere, or if you do dry your washing on the grass - iron it well afterwards. This will kill larvae and eggs. Several holiday-makers have returned from The Gambia with Tumbu fly infestations. NB : There are no Tse flies in The Gambia, and therefore no Trypanosomiasis (Sleeping Sickness) in humans.
You are likely to pity the state of the wretched animals you will encounter near the hospital. Leave them alone. They are often full of sores. It is a potentially serious matter to be bitten by one.
You are advised not to bathe in the River Gambia. The reason is the presence in it of a tiny parasitic worm called Shistosoma haematobium. With the help of riverside snails as intermediate hosts, the schistosome can invade the human body, and lead to serious generalized illness, Schistosomiasis, or Bilharzia. Stick to the swimming pools of the hotels in Banjul and district. There are no Hotels in Bansang.
ADDITIONAL HEALTH INFORMATION
However please consider all of our advice above as, Must Do or Must Comply! and any additional information is exactly that, additional Information to be used accordingly!
Bansang Hospital Appeal a UK registered charity ~ 1064469