Plenty of ceremonies!

Little girl who clung to me for the day
at the naming ceremony - here she is
dancing to the musicians on my lap

It is now day 16 of my Gambia trip and I feel that I am settling into the environment a lot better!
It takes a while to adjust to the Gambian pace of life!!
The last week has been taken up with work and attending ceremonies.


Work at the RVTH has proven to be very interesting for me. I feel as though I am a medical student again as I am learning about new cases and seeing signs that I have only learnt about in books, but here in The Gambia people do not present to hospital early and therefore they display medical signs and symptoms that I have never seen.


It seems that medicine here is split into two paths. The conventional "hospital" medicine and the more traditional  "herbal/ president" medicine.


The President of The Gambia, Dr Yahya Jammeh, has made claims that he is able to cure chronic diseases such as high blood pressure, asthma, infertility and more serious conditions such as HIV/AIDS (which is very common here) with the use of herbal medicine. This is known here as the President's Alternate Treatment Program (PATP). It is believed that once a patient is discharged from this program they are free of disease and cannot transfer their previous illness onto any body else.


I have met several patients who have refused the life saving "medical" treatment in favour of "president" medicine and some have travelled as far as France in order to get it.

Evening events at the wedding

This week I spent the Diabetes clinic with the Consultant Endocrinologist. He is a doctor from Cuba and was explaining to me the difficulties he has in controlling diabetes in The Gambia.
One of the biggest problems is educating the patients about the disease.


Patients do not have the facilities to measure their own blood sugars at home like they do in the UK, so it gets checked at clinic every month and a medication regime is provided for them to take in the meantime.
As a result many of the patients attend clinic with very poorly controlled blood sugar readings. 
I hear that next month will be even worse as it will be the start of Mango season!!!


From observing in clinic, I have decided to try and write a protocol that is manageable at RVTH on how to manage the Diabetic Foot for inpatients. Many are being discharged with little or no follow up and high blood sugars. 
I am hoping that a simple algorithm for management might benefit the patients and staff as there will b a structure to what is needed for them.
Watch this space!!

The men blessing the naming
ceremony

This weekend has been incredibly busy for me.....I am exhausted!!
After work on Friday I was taken to wedding of an uncle! This involved a traditional Mandinka (tribal) ceremony where the man had to agree and prove his worth to the bride's family.
There were a lot of people involved and food aplenty! The whole community comes out for these occasions and drummers/musicians play in the street until the early hours. 
I did not see the bride.....apparently she will make an appearance by approximately 1am after a whole day of being dressed and having her her braided in a traditional fashion and then she will be presented to her husband.


Saturday I was then taken to a naming ceremony. A similar tradition to a christening but it happens exactly one week after the birth of the baby.
This was a very long event that started with the older women in the compound singing and joking with the guests. They will throw money into your lap and sing and dance for you on condition that you return their money and also match the amount!

Musicians at the naming
ceremony

There must have been easily 200-300 people at this ceremony and all the women in the compound cook continuously outside using fire wood to produce large quantities of food which is shared.
When it got dark everyone moved out onto the main road so that the musicians could play and a lot of money was given for the family. They even provide a meal in a take away box for everybody in the evening....just in case you are still hungry!!!


After a very long day at the ceremony, I got home and was told that we would be going out again by 11pm! This time I went to the Senegambia Beach Hotel, in the tourist region, to see a live band - Jaliba Kuyateh and The Kumareh Band.

Jaliba at Senegambia Beach Hotel

The place was heaving, with at least 3000 people at the venue all dressed up and prepared to dance until 7am! It was nice to be in such a vibrant atmosphere with people enjoying themselves every where you looked!
There was a special guest at the concert too, the Champion of the Senegalese wrestling (which has been on the TV since I have arrived!!! They are crazy for it out here!) and he got on stage and did his war dance with the band.

A very small portion of
Serrekunda market

Today I have relaxed after two very hectic days! I went to Serrekunda market for a wander just because it is so busy and you see all kinds of unusual things! I don't think you could ever go there and say you have seen everything!

My Sukuta Home

My Sukuta home

I have now been in The Gambia for 10 days and time does fly here!

I arrived on Friday the 27th April approx 15.30 and was taken to my "home from home" in Sukuta, a small village approximately 35 minutes away from Banjul, the capital.

Living room

My bed!

The beautiful Fatima

I am staying with a very lovely couple and their 8 month old daughter at their compound. I am very lucky as the house is like a mini mansion with lights and electricity, but no running water! Taking a shower can be an interesting experience....and the water is cold!! They family have been incredibly hospitable and accommodating making sure that I am thoroughly well fed with local food!!!


Over the last week I have been attending The Royal Victoria Teaching Hospital in Banjul and getting involved with the Medicine department, especially the Diabetes clinic.

It is a small but very busy hospital with 4 main departments, medicine, surgery, gynaecology and paediatrics,


Unfortunately due to constant staff changes at the top of the hierarchy the running of the hospital has suffered. There is no continuity of care to the patients, they lack basic equipment such as oxygen (there is ONE oxygen concentrator for the whole of the medical department!!!), there is a lack of case notes so no patient can be identified correctly, blood tests are not routinely done due to lack of funds and lab equipment, all scans cost money that the patient and their family have to fund (if the machines are in working order!), mortality rates are high and due to this the enthusiasm and morale of the staff suffer.

Front entrance to the hospital after going through secured gates

On a more positive side the people here are truly welcoming and are so grateful for any help they receive at the hospital and despite low morale the medical staff are very accommodating for the huge number of patients who turn up at the door needing medical attention.


Every Wednesday is Diabetes clinic. The number of patients per clinic can vary from 150-300 in one day!! Incredible!! They arrive at approximately 06.30am and sit outside on a very small wall to wait their turn with very little complaints.

Looking onto the security gates
 Gambian flag and garden

Far left is head matron of medicine's office,
Directly in front -  Sawec ward (female medical)

It really is unbelievable how patient these people are when you compare an average UK clinic of approximately 20 patients sitting inside with comfortable facilities and they complain if the clinic is running late by 20 minutes!

My alarm clock!!!

During my spare time I have been finding my feet around the area and have regularly been at Serrekunda market.

Relaxing on the porch
My bedroom to the left

It is heaving with every material, food stuff, shoes, clothes, bags, spare car parts you can possibly imagine!! It is chaos......and not organised chaos either!! It really is an experience!!


A trip to Serrekunda involves taking at least two local taxis, if you can find one with a spare seat! If you are lucky enough to flag down a yellow and green cab with a spare seat you get in with 4 other people and get out at a junction before entering another car!

One evening it was not possible to get a local taxi so I got a ride in a "banjul banjul".  It is basically a clapped out mini bus with about 10 seats but holds up to 30 passengers carrying their shopping, buckets of mango, raw fish, breast fed babies and animals! How the vehicle moved is beyond me, but it did! (photos to follow!)