A Long Walk

I'm in a truck in a world I've never been in before; a world not many people like me are privileged to see. I'm beside one of the trustees of the Nana Foundation, and in the back is an 8 year old girl and her mother. The child is sick with malaria. We're in a remote village in Southern Malawi.

I spent the morning helping in the Chipwaila health centre. It's a small, simple building with two rooms that serves this very rural community. There is usually one doctor here for whoever turns up on the day. As part of our work, we support the clinic with manpower and resources. Many people were waiting when we arrived, one of whom was this young lady.

One glance told us she was sick. Semi conscious, dehydrated, and very hot. We established that she needed urgent treatment for malaria and intravenous rehydration. This is treatment that cannot be offered in the village. Her mother told us she needed to go home to collect her things. She was not clear about where home was. Fortunately, my Trustee colleague, a Malawian, recognised that there may be some distance involved. This child needs urgent treatment.

And now I'm about to find out where home is. We follow unmade tracks across vast expanses of dusty land. We see people walking, carrying huge quantities of sticks on their backs, buckets of water on their heads. The occasional bike. Dogs. Goats. As the tracks get smaller, so do the homes, changing from brick built structures to mud huts with straw roofs. At the beginning of our journey there was a small shop or two, selling basic items. Now those have disappeared. The dwellings are fewer and farther between. We see children collecting water at the pump. They wave at us. Many will not have seen a car; hardly any will have seen a white person.

We arrive. We're outside a circular mud hut. It's about 8ft across. There are one or two other huts within a few hundred meters. The child's grandmother comes to greet us. She grabs my hands, looks into my eyes. She talks to me in Chichewa. We don't understand each other's words but the meaning is clear: thank you for your help. Look after my granddaughter - she's precious. I will. I promise. I later find out that she has lost three of her eight children. She can't lose her granddaughter as well.

Within moments, children have gathered to say hello. They're intrigued by us. They wave, and the more confident ones come and touch my hands. I've been taking a few photos and they're excited by the phone, overwhelmed when I show them the pictures, especially the ones of themselves.

The child's mother returns. I'm struck by the tiny quantity of possessions she has collected. I compare this to the vast amount of belongings most UK families bring into hospital, even to the bits and pieces I carry around every day.

As we retrace our journey, I am struck my the distance. This mother and child must have walked for hours, over harsh terrain, the child in bare feet. This is the reality for many of the poorest people in one of the world's poorest countries. Hours, sometimes days, walk to reach any sort of healthcare. Is it any wonder then that people access help late, sometimes too late?

Context is everything. Today I've been granted a privileged insight into a world not many like me will see. It's an experience I won't forget and one which I hope will make me better at what I do.

Humanity in Healthcare: my experience as a patient

In honour of #ExpOfCare week I want to share my experience as a patient. 

“What do you need today?” my oncologist asked me. A clear signal that my goals would be his that day. 

I had breast cancer a few years ago. My children were still small and settling into their first term at primary school. I was determined that my illness would not impact on them any more than it had to. 

My wonderful oncologist had promised me he would do everything he could to make my treatment fit my life, not the other way round. 

I need to be able to stay upright without vomiting for an hour at 2pm this afternoon I told him. My children had their first assembly and I had to be there.

Companionable silence



I’ve come to the end of a 24 hour shift and am reflecting on the day that has just passed, here in the DTC. 



I spend much of the early part of the night with a seven year old girl who needs to be treated with diphtheria antitoxin. She has a significant pseudomembrane and will be at risk of severe complications if left untreated. 



She is terrified when she arrives, scared of the treatment she was about to receive, unable to understand why she needed injections to treat her. At home, I would be able to reason with most children her age but not speaking the same language prevents this. My rudimentary grasp of the language allows me to say hello, thank you, make a basic assessment of pain and specific symptoms of diphtheria, to understand when people are asking for water. It does not extend to this level of complexity. Even with the help of an interpreter it’s not the same; subtle nuances are impossible to grasp. 



I set about finding other ways to build trust. My colleague draws pictures (I am no artist!) and  we provide her with pencils we found in the local market. We sit together colouring. We find a few sweets and give them to her. She calms enough for us to be able to start the treatment. 



Over the course of the next few hours, I am beside her bed constantly, monitoring for early signs of a reaction to the treatment. Her mother is close by, sharing her attention with her three small children. 



I know from some of the stories I have heard around he camp that this child is likely to have seen some horrific sights, will have endured more in her seven years that most will in a lifetime. Now she has a potentially life threatening disease and I don’t want her to suffer any more. 



We find ways to communicate: it’s possible to tell whether someone is smiling or frowning, even behind the masks we wear to prevent the spread of infection. It’s all in the eyes. We use thumbs up and thumbs down to good effect. Her arm hurts where her drip is sited; periodically she holds it out to me and I stroke it gently. It seems to comfort her.  My colleague described a feeling of companionable silence. She’s right: that’s exactly how it feels. 



A few hours in, she is restless and I try to think of a way to amuse her. I find a piece of paper and some scissors, fold the paper and start cutting. She’s curious and watches with interest. After a couple of minutes I hold up the paper and unfold a string of people, holding hands. The look of  pure delight that illuminates her face is something I will never forget. I fold the chain of little people a couple of times and hand it to her. She handles it as if it’s a precious jewel. 



So much of what we do here relies on making do when we don't have quite the right thing, being innovative with not much in the way of resources. I love the simplicity of it all and I know that in that moment, for that little girl and for me, what we had was enough.