Fieldwork

I've pretty much work out what I'm going to be doing out here over the next six months : it will mainly consist of organising follow-up for Tuberculosis patients and their families, trying to see who develops TB amongst the family members.

So, all this follow up is going to involve me doing lots of driving round to various peoples compounds (collections of houses), and asking about everyones health and asking them to come to the MRC if there are any problems. As few people speak English as a first language, most of the talking is done through a translator, who also doubles up as a navigator and mechanic on the fieldwork trips...

This is my fieldwork assistant : Mr Abdoulie Cham with our trusty MRC jeep



Abdoulie (which is pronounced "Ab-lay") is great company and knows all the roads around MRC like the back of his hand ... though many of the roads are semi-submerged at the moment because of heavy rains the last few weeks ... He also gives me advice on Gambian driving etiquette (eg "If you see a space, just go for it!"), and on lots of other useful things, like how to get through deep puddles (basically go as fast as you dare). He is a big Arsenal fan, which is quite unusual out here : everyone else seems to be a Manchester United fan ! I think he speaks about five languages, and doubles up as one of the public relations officers for the MRC - quite a guy.

Abdoulie is very curious about British many things : he was fascinated that British women were mainly trying to LOSE weight, as Gambian women are generally keen to PUT ON a few pounds. He explained that a lady who is "a bit more round" is more attractive and probably a happier person ... I don't think the concept of going on a diet exists here... He reckons that I need a Gambian girlfriend to feed me up a bit, and I'm inclined to agree : I seem to be getting ever thinner since I got here. Must be the heat and all the swimming.

I'm not actually able to view the weblog becuase of filtering by the MRC site, so I'd appreciate any email feedback about this weblog : you could email me aikenalex@yahoo.co.uk ... or even give me a call on 00220 7015784 , there are some cheap call options for the Gambia at www.niftylist.co.uk .

Clinical work

It's been a busy week, so I'll concentrate on one of the clinical things that I've seen here this week.

I've got myself a once weekly slot in the rota of general "open-door" clinics that the MRC runs - a bit like a GP walk in centre service, combined with a some blood tests and Xrays available on site. About 80 to 100 Gambians queue up for this daily, it is free (though they pay a small fee for prescriptions) and there is a 40 bed ward which deals with medical-type admissions (all surgical things go to the government hospital 15 miles away).

So I was doing my first stretch of clinic on my own this week, with a nurse/translator and another doctor next-door for questions. All kinds of patients came in : young and old, follow-ups and new presentations , but one really stuck in my mind ...

A young woman came in to the clinic and started telling me about the pain in her chest: she had a pain behind her sternum whenever she swallowed for the last few weeks. She looked quite thin and said that she had been losing weight recently... it was sounding suspicious already, and so I asked her about the health of her husband - she said that he died a year ago after having had the same kinds of problem.

I looked in her mouth and there was a massive fungal infection all over the place - almost certainly meaning that she was heavily immunosuppressed with AIDS, and the pain in her chest was probably oesophageal candida. She did't seem too shocked when I suggested that she go to the clinic for an HIV test, I guess she probably knew in her heart of hearts already.



This what oral candida looks like, its an image from the web not my patient. This was the first time I'd seen this since doing the DTMH course in Liverpool, and her mouth looked really painful.

Here at MRC they are running anti-retroviral based treatment programs, so I guess this lady has a better prospect than most Africans with AIDS, but it is still a dreadful thing for her to have. I don't know what will happen to her and her family over the coming months and years, but this week in the clinic was just the start of something that will dominate the rest of her life. Which is a bit grim really.

Some photos

I'm trying out putting on photos... not sure if this is going to work !



Front gate of MRC facility in Fajara



View from my flat



Amazing sunset over the Atlantic



Local kids, down at the beach on Sunday

Do these photos actually appear on the thing ? I'm struggling to get it all to work!

Fajara

After my first few days here, everything seems to be going well. My address is

Alex Aiken
c/o Bacterial Diseases Office
MacGregor Building
MRC Site
Fajara
Gambia

Things seem well set up at the MRC and only drawback is that the internet access is highly controlled, in an attempt to prevent people from spending too much time surfing the web ... So I'm writing all this from a internet cafe-cum-bookshop called Timbooktoo (groan) in the nearest town. It's going to be a bit tricky to put photos up as this has a rather slow bandwidth... . The bookshop is great : lots contemporary African literature and interesting local stuff.

I've now made it to Gambia, and started at the MRC in Fajara. My first impressions are very positive : the facility is huge and (appears to be!) well organised, loads of staff who are all very friendly. They have a pretty new website which gives some useful information : I'm giong to put the link as a permanent one for this blog.

My flat here is also totally awesome, I'll have to do a whole series of photos to show off how great it is ! Suffice to say that it has views of Atlantic Ocean and a private beach !

Before leaving ...

I'm off to the Gambia tomorrow, probably for six months out there as a researcher on a TB (tuberculosis) group. The project I'm involved in is looking at developing and trying out new tests for diagnosing TB. I can't say much more than that at the moment as I don't yet know exactly what I'm going to be doing while I'm there.

As regards to the Gambia, at least I can say a few things about the place : it is a small, strangely shaped West African country. If you look on the map above, it is the little line of yellow within Senegal at the furthest western part of the curve of west Africa.









The flag of the Gambia gives a bit of a clue about the history and geography : the thick blue line across the middle represents the river Gambia, which flows along the length of the country to reach the Atlantic at the capital Banjul. A long history of use of the river as a trading route by colonial British, originally for slaving and later for other goods led to the foundation of Gambia as an independant country in the 1950's.