Goodbye, 2015

I re-read the post I wrote this time last year, and I'm pretty confident I can beat it. 2015 has been awesome. 

In my end-of-2014 post I spoke about how lucky I felt to be training for my job. Now I've qualified and been working for a couple of months I feel no less lucky, but often a lot more stressed. It's still very hard to think "on balance, this is still fulfilling" when you have to change scrubs, forget about wearing underwear for the rest of the shift, and try to filter out the lingering smell of amniotic fluid in your hair... but I wouldn't do anything else!

The year where my health is worse than 2014 will probably be the year I die. 2015 wasn't perfect, but it was significantly better. My progress with transverse myelitis has plateaued, but I'm at a point where I'd be happy to stay for the rest of my life. Leg movement is (near enough) back to my normal: I'm bouldering, cycling, and rowing. Sensation is still fairly impaired, and I'm still obliviously breaking toes and bruising legs, but I've only been in complete agony with nerve pain 5 times this year - I'll take that! Now it's been nearly 15 months it's looking unlikely that I'll get any more bladder sensation back, but I saw my urologist a couple of weeks ago who feels the risks of spinal surgery to possibly correct this aren't worth the potential benefits. I agree, and whilst I'd rather not be catheterising for the rest of my life, I'm definitely grateful that I've been dealt retention instead of incontinence.

Earlier this month I met my new gastro consultant in Nottingham. He seemed very unimpressed with my switch to vegetarianism (still going strong!), but conceded that I'm possibly the best nourished I've been in a decade. I got a bit better after my little Crohn's relapse in Africa, but now I seem to be heading downhill again. I've re-started azathioprine (an immunosupressant drug most commonly used after organ transplants), and I'm having scans for a ?bowel stricture (a narrowing of the bowel caused by scarring), but it's barely affecting my life at the moment.

My first Christmas as a vegetarian was surprisingly un-disappointing, and working whilst everyone else was off wasn't as annoying as I thought it would be. Let's do 2016!

Love Emily x

Heidelberg, Germany

Since my last post most of my life has been consumed by midwifery, but last week I had the luxury of a weekend off, so I spent it in Heidelberg, Germany, visiting friends from Leicester.

Heidelberg in the winter is pretty cold so I took along a truckload of painkillers, expecting the weather to trigger a fresh new wave of agony. I was extremely relieved that nothing kicked off, and also quite proud that I managed to climb to the top of Heiligenberg - a mountain which boarders the town. Wheelchair to mountain in 12 months isn't bad :)

As for work: it's going better than I expected it to, I'd been told, numerous times by numerous people, that I'd go home and cry after the end of each shift for the first 6 months, and after that I might see an improvement. I've been working for 4 weeks now, and it's not so bad!

Although the support my Trust has given to ease the transition from 'student' to 'qualified' has been great, I've still found myself becoming a bit stressed - and that's starting to affect other areas of my life. I can't sleep as well as I did, I'm becoming quite prone to minor illnesses, and my days off are just spent sleeping. I feel very far away from the calm and happy person I was in Africa, and I struggle to believe it was only 4 months ago. Luckily Nottingham is a great city for sport: I've joined 2 gyms, a swimming pool, a rock climbing centre, and an (extremely casual) rowing team - and Abbie is always up for a pub session! I'm using travelling as my carrot: I'm off to Norway in January, and hatching plans for inter-railing in the summer. Even at my most stressed I still love my job, and couldn't imagine doing anything else. It's just a case of gaining more confidence, right?

Love Emily x

I've become a proper, grown-up, midwife!

Yesterday was my first ever day at work as a fully independent midwife. I was fairly nervous before I started given that I haven't done any midwifery since Ghana (although I still think what I saw was less 'midwifery' and more 'forcibly tearing babies out of vaginas'), but as soon as I started it all came back to me. Everyone I worked with was incredibly helpful and friendly, and I don't think it'll take long to settle in. I'm still loving living in Nottingham, and I can't believe the difference a year has made to my life. Grateful doesn't cover it.

Love Emily x

Graduation day

Last week I graduated from my training course, with a first class degree. This time last year I wanted to be able to walk across the stage by myself. That stopped being a challenge in February, so I upped the difficulty and aimed for doing it whilst wearing high heels. I managed it, even if they were sturdy and sensible, with a strap so I could keep them on.

For the seriously interested, you can watch the ceremony here - although I recommend saving an hour of your life and skipping to 35 minutes in!

Life is going really well in the Midlands. My house is great fun, if not what my mum expected. It's sort of a cross between Fresh Meat and Men Behaving Badly, but when living with 4 blokes gets a bit grating Abbie is always up for a drink - so I can't complain at all! I start my 'induction' stuff this week at Queens, and I'm sure once they've taught me to manually handle fires safely I'll remember how to be a midwife. That's the plan.

Love Emily x

Settling back down in the UK

It feels so much longer than a week ago that I returned to the UK. I had a shower before I boarded the plane which got rid of the layer of dirt which could have plausibly been a tan, and now everyone at home is laughing at the 7 new freckles I've gained after a month in Africa. I've got used to the crap weather again, and have a new appreciation for health and safety, bureaucracy, and tarmac on roads.

I've found myself a place to live in Nottingham, and I'll be moving up at the weekend. I'm getting a bit nervous about this working as a midwife thing, but if Ghana taught me anything it's: you can be downright negligent and abusive to a mother and her baby, but I didn't actually see anyone die, so if I go to QMC with good intentions and try my hardest then it might all be okay.

I've had a little look at the reader statistics of this blog, and it's crazy. There's a good chunk of people who come via a Facebook link I've posted, but equally as many are now coming directly via the URL, or stumbling on it via Google. I've got regular readers in the UK, Ireland, Spain, Portugal, Turkey, Romania, Croatia, USA, Canada, Argentina and New Zealand - along with hits from France, Ghana, Sri Lanka, and Czech Republic, but I know people who are/were out there which explains it. 

Love Emily x

P.s. I met Archie Brunton on Tuesday... if he's not an expert in African folklore by the time he's 4 I'll be seriously annoyed!

1 Year On

Today has been exactly 1 year since I ended up in A&E. It's been slightly longer since I started getting excruciating headaches; the first signs of what was about to happen next. They were so intense that I couldn't move, talk or breathe whilst they were happening. They'd only last 30 seconds or so, but it took every bit of energy I had trying to stay conscious for those half minutes. I meant to mention them to my neurologist at a routine review I had the week before I started hallucinating, but I forgot. Thinking back, I forgot lots of things in the days before the infection properly took hold - the best example was just not turning up at a hugely important IT training session for the eHospital system Addenbrooke's rolled out in Autumn 2014. Something so significant just didn't stick in my mind. My back and neck were very painful, but I'd been moving house so I put it down to a muscle strain. There were also early behaviour changes; relatively harmless situations would make me a tearful mess.

So much has changed in this year, but in many other ways most things are still the same. Being ill is still my default thought and, as you can probably tell from the above paragraph, I'm still coming up with new "what if?" and "why not?" scenarios on a daily basis. But also, when I think of being in hospital and the months of recovery afterwards, I'm only able to recall 'false memories' of things which I have a photo or blog post about - and even then it feels like I'm thinking of someone else. It's possible the heavy doses of opiates and anti-convulsants I took/take has something to do with this, but I think it's far more likely to do with the avoidance and disassociation strategies commonly used by people with PTSD. Without doubt, admitting the dangerous state of my mental health and getting appropriate help for this was significantly harder than all aspects of my physical recovery. Although I no longer feel constantly at risk or on edge, I still have to make a conscious effort to keep my mind occupied at all times to stop it wandering back to an unhappy place. 

I've been fortunate enough to be able to choose which areas I work in as a HCA, and I've been drawn towards neuro departments. In some ways this has given me a lot of closure, but seeing the specialist NCCU (neuro critical care unit) and neuro re-hab at Addenbrooke's also made me angry that I wasn't able to be treated and recover there. The more my neurologist in Cambridge (I was his patient before all of this kicked off) explains what my scans and LP results mean the more my anger towards Kettering grows. I was mismanaged from the start: I should never have sat in the waiting room at A&E (I honestly think the triage nurse thought I was drunk), it shouldn't have taken 20 hours to have a brain CT, I should have been told about the hydrocephalus before I forced their hand by threatening to self-discharge, and I shouldn't have found out I had transverse myelitis by reading the 'diagnosis' section of my discharge letter. In Northamptonshire neuro-rehab was neuro-rehab: it was the same unit whether you'd had a car crash, a stroke, a disability present from birth, or an acute illness like I did. At Addenbrooke's (as it's the regional major trauma centre for the East of England) there are separate units for each of these areas, so I would have been 'living' with other people of a similar age and starting point. It's easy to say "I would have chosen that option" now I know I've completed my training and it's not a decision I have to confront again, but I honestly think I would have given it far greater thought had the Addenbrooke's option been there. 

My 25th birthday happened between my illness and now. It seems 25 is the magic age where you stop being 'young, free and single' in the eyes of friends and relatives and edge into 'potential spinster' territory, so casual enquires about my love life are regularly slipped into conversation. I started 2015 in an extremely unhappy state for all sorts of reasons, but over the course of the year I've changed lots of things and now I really do love my life. I don't think a relationship would create any additional happiness, and nor do I think 'the one' is currently in my life. I think meeting someone new would re-trigger anxiety about explaining my health and history: trying to balance conveying how much meningitis messed me up vs not making my health a factor in destroying another relationship. I think I'm years, not months, away from being able to trust another person to not leave me when I'm at my lowest - and that's fine.

But, positives, because there are plenty. Looking back at what I've achieved in 2015 so far is quite satisfying. I walked out of a wheelchair, and got rid of my walking stick. I admitted - to myself and those close to me - that psychologically I was breaking down, and got the right help to get me back on track. I've qualified as a midwife. I've earned myself a first class BSc. I worked abroad. I trucked across Africa. I've moved to a new city. I've made myself a complete and happy person. I'm very grateful for all of these opportunities, and I'm overwhelmingly glad I put the hard work into getting better to enjoy them all.

Love Emily x

Leaving Joburg

I've finished my journey around Africa, and now I'm sitting in the departure lounge at Joburg airport, ready to board my Heathrow-bound plane. It has been a fantastic month. 

I struggled with Ghana in the first week. The hospital wasn't what I had expected at all, and my presence there felt pointless. The staff had no interest in changing their practice based on anything I suggested to them, and all I learned from them was how not to do things. The Work the World house also wasn't quite what I expected, but that was far easier to adapt to, and contained some great people. Possibly the prospect of cold showers wouldn't have been so irritating if I hadn't come back to the house from a day of watching dangerous and dispassionate midwifery at Kwesimintsim. But after accepting I wasn't going to change anything about Ghanaian healthcare, and instead making small differences to individual women when I was working, it became a lot easier to detach myself from the awful things I saw staff do to women most days. Other aspects of Ghana were brilliant: the people I lived with, the day we went to Lower Dixcove and health screened the residents, meeting a village Chief, choosing fabric to make clothes with, surviving marketplaces, learning to hand-wash clothes, Busua beach, Hotel Fespa (only with hindsight...), Cape Coast Castle, crocodile stroking, catching tro-tros, Kakum canopy walk, trying Ghanaian food, learning some Fante, the friendliness of most of the people, and the 'personality quirks' of some of the others! 

For the rest of the trip the good times are almost too many to list. Collecting dozens of new stamps in my passport, exploring the Cradle of Humankind, caving in the Sterkfontein Caves, seeing Victoria Falls from both sides, and above, camping in some beautiful places, seeing hundreds of animals in their natural environment and living according to nature, driving on some stunning mountain roads, seeing the stars with no light pollution obscuring the view, trying all kinds of African food, trying all kinds of African alcohol and (apparently legal) 'traditional herbs', doing stupidly reckless things, having a bash at dancing with a tribe, trucking across the Kalahari Desert,, meeting people from all over the world, and mastering the art of walking in fli flops with numb feet. I crossed Victoria Falls, a safari, and seeing an underground lake off my bucket list (plus saving a life in Ghana, I guess), and sowed the seed for more adventures over the next few years to complete some more.

There are also little things which I'm proud of doing. The flights to Ghana were the first I've ever taken on my own. 10 months ago I couldn't stand up, but now I've just got myself across Africa and back. I had extremely good medical insurance so the moment my legs started hurting, new parts of my body started going numb, or Crohn's relapsed I could have called it a day and either got to a hospital, or gone home on medical grounds. But I didn't, and that takes a hell of a lot of willpower when the alternative is having the shits at a campsite in Zambia. I think biggest of all, after leaving Ghana no-one really knew about my medical history. It was all on a form somewhere at Acacia head office, and I think our driver knew one of us had a bit of a history, but I don't think he knew it was me - and even if he did, he didn't treat me any differently. I loved being able to take part in everything I wanted to, with no-one asking "are you limping?", or "are you sure you can do that?", or "do you think that drink is a good idea?", or "have you remembered your drugs?", or "have you missed an injection?", or "let me see your pupils", or "do you need any help with that?", or "are you getting an aura?", or "you're slurring your words, you must be smashed!", or "do you think you need to go to a hospital?". Having travellers tummy was left at that, and the only person who had 'this is actually a Crohn's relapse' or 'could this be a trigger for another autoimmune attack?' at the back of their mind was me. It was so good to feel normal for a few weeks.

A key part of my safari was camping. As a child I loved camping holidays, and I loved animals, and combining the 2 meant an unbeatable trip. I loved the sense of feeling self-sufficient, and so connected to the environment around me. Also, I love trucking. At first I saw it as a necessary evil for a safari spanning several countries, but now I've been converted. The feeling of sitting there with other like minded people, knocking back beers, swapping travelling stories, playing cards and glancing out of the window to catch a view of whichever desert, mountain or animal you're passing is hard to beat. After the first couple of days of the 2nd leg I felt so light and carefree, a feeling which I hadn't noticed was missing until I felt it again. As much as I love my job, it was the first time in 3 years that I was able to not think about it, and that was refreshing. 

Eating meat is a luxury in Africa, and after the first week of my trip I opted for temporary vegetarianism in view of the 'meat from miscellaneous origin' which seemed to be an ingredient of most meals. After 3 weeks of being a vegetarian I'm not missing meat nearly as much as I thought I would, and I'm toying with the idea of making this a long term choice. Ever since watching Babe (in 1996) I've refused to eat sausages, but having had iron deficiency anaemia for most of my life I've always thought, or been told, removing red meat from my diet, would be a recipe for malnutrition. Since being in Africa, I've seen first hand that meat isn't just produced from a storeroom of a supermarket; it's the goat or chicken I was stroking a couple of hours earlier. For the past few years I've only bought cosmetics and toiletries from companies which are against animal testing, so perhaps becoming vegetarian is the next step of this hippy spiral. On a sort of related side note, I also try not to buy Nestle products - but it's really surprising how difficult that was to stick to in Africa... I thought here would be the first place to boycott! 

I'll be very sad to board BA0054 and leave this wonderful continent behind, but necking champagne in the departure lounge is taking the edge off it, and I'm already making plans to return next year.

Love Emily x 

Kruger National Park day 2

Today we packed up camp and left Kruger NP (where we've been for the past couple of days) to leave for Joburg. It was very much a camp of two halves: one of us who chose to make a proper night of our last evening on safari, and the other made of those who were annoyed at being woken up by this. We started the evening off by having a liquid dinner, and watching a song and dance performance by a local Zulu tribe. It was great, and they started dragging us up and making us dance with them. It was one of the funniest things I've seen all trip. 

After this some of us headed for a bar, and when our driver/leader ushered us into a circle and whispered "what happens at the bar stays at the bar" I knew it was going to be a good one. Alcohol is crazily cheap in South Africa - even cheaper than in Ghana. I was paying R18 per drink: in my mind I thought 1 rand was roughly equivalent to 1 pound so I started off slowly, but after I got told R18 is about 87p I thought it'd be rude not to take advantage of this opportunity.

Round after round later, the bar staff were obviously getting irritated by us and called last orders 5 times (over 2 hours) before chucking those of us still standing out. The final 7 got back to the truck and carried on. And on. And on. Between us there were 3 Brits, 1 Zimbabwean, 1 Aussie, 1 Irish and 1 person from Luxembourg. It's amazing what alcohol and this melting pot of cultures can lead to: we had a bash at river dancing, the benefits of polygamy were laid bare, we observed in-truck acrobatics, played Dobble, and learned all there is to know about tax avoidance. At 3am, after we'd trashed the truck and completely drained the battery by pumping music out of the speakers, I did the conscientious thing and collected up the metal mugs we'd been drinking from, along with all the other tin crockery we'd been using. Getting on and off this truck is hard enough completely sober in daylight, so drunk me at 3am didn't stand a chance. I fell from the steps, bringing an entire steel dinner set crashing down with me, and provided the final straw for everyone else on the campsite. I think the annoyed people were expecting a degree of sympathy and mediation from our driver/leader; instead they got something along the lines of "shut up, we're drinking".

The sensible thing to do at this point was go to bed. That is far easier said than done when there are 10 identical tents and you've got to remember which one is yours, without resorting to trial and error, and then get into the right one without making your co-camper want to smother you with a pillow. It took a few goes but somehow we managed it, and were up at 6am to take down our tents and load the truck - still absolutely hammered, and feeling the wrath of lots of sleep deprived onlookers. They were seriously unimpressed when the truck needed jump-starting.

The rest of today will be spent driving through the mountains from Hazyview to Johannesburg. We had an 8am McDonalds stop, and the survivors from last night are about to bed down at the back of the truck.

Love (from a dog rough) Emily x

Kruger National Park day 1

I spent all of today on a game drive in Kreuger National Park. Our driver told us how many square miles this park covers but I forgot... the point is, it's big! When I say "all day" I mean all day - we started out at 5:45am. The company I went with have walkie talkies in each of their trucks, so if one driver spots something interesting they can let all of the others know. The downside to this is lots of vehicles rock up at one place (+ other drivers who happened to be passing by) and scare the animal(s) away.

Within a couple of hours I had seen the Big 5 (lion, leopard, rhino, elephant and buffalo) and over the rest of the day I saw giraffes, zebras, hippos (in and out of the water), crocodiles, kuda, waterbuck, springbok, eagles, wildebeest, hyena, and lots more animals I'm too tired to remember the name of. Seeing these animals in their natural habitat was awesome, and is something on my bucket list which I've been able to complete.

It's been a great day,

Love Emily x

Zimbabwe day 3

Most of today has been spent on the road, driving from Gweru in Zimbabwe, through the infamous Zimbabwe/South Africa boarder point, crossing the Limpopo river, and arriving in Tshipise. We managed to cross the boarder in under 2 hours which is apparently a result!

Antelope Park, where we had been camping, is the centre for a lot of research into rehabilitating captive bred lions into the wild. We had the opportunity to do a nighttime game drive to see the results of this in action. This sounded incredibly exciting, and we all got on the truck (driven by a sober bloke, this time) to watch these lions catch and eat their prey. There were 2 key problems with this which seem very obvious now, but didn't before we set off. Firstly, it was dark and secondly, these lions were crap at hunting. The guide was explaining to us that they tried only feeding the lions every third day and chucking a zebra in there to see if their hunger could help trigger the 'kill the zebra' instinct in them, but ultimately the lions just lost weight and played with zebras. The more questions we asked the clearer it became that these lions were never going to make it into the wild, but the Park had to continue making this seem like a plausible objective so researchers would keep chucking research funding at the place because hey, everyone loves lions. 

The campsite we arrived at today was nestled between several koppies, which was a stunning place to sleep. The drive through Limpopo province to get here was also amazing, made even better by knocking back the beers, playing cards, and Red Hot Chilli Peppers. The campsite also had thermal springs. I gave this a go, but I knew after putting one foot in that my lesion wouldn't be happy about it - it felt like an uncomfortably hot bath. I joined some others in a heated outdoor pool (at the perfect temperature for my legs), and got cracking on the drinking again. We went back to the tents to rustle up a dinner, and I was taught the rules of Flip Cup (much of the description is in the name). For the 2nd time in about as many months I impressed a bunch of blokes (who think they're boozers) with my ability to take my drink, and successfully anchor a boat race team. Stringer blood.

Tomorrow I'll be travelling through the mountainous area of north SA to get to Hazyview, and ultimately Kruger National Park.

Love Emily x

P.s. The cracks on my iPad screen have been growing since my first day in Ghana when I dropped it. I've been trying to keep it together with micropore, but bits of glass are starting to fall out now, and I think it's only going to take a couple more pieces to go and it'll be completely unusable. If communication suddenly stops, that's why!

Antelope Park, Zimbabwe

We had a hungover 5:30 start this morning to get our tents packed up and in the truck for 6am. That'll teach us to get drunk and play with wild animals. Today has mainly been a day of driving across the kalahari desert to reach the Antelope Park. "Because where else...?" is their official slogan, and I think there's something in that; where else would name themselves after an animal which I have yet to see here? We were given a list of optional activities to do before we arrived, and the idea of giving a lion cub a bottle (like I used to do with Jaws...), and riding an elephant really appealed. When we arrived I was told there were no lion cubs (fair enough) and the elephants had gone (where...?!).

The campsites in Zimbabwe have been seriously impressive, especially compared to all of the European ones I've been to... although that could just be a negative reflection on them. The place we're pitched up in for tonight is next to a river, we've been allowed to make a fire, and the showers are so, so, good.

The next few days will be spent on the road; getting to South Africa and then exploring Kreuger National Park. This means the internet access available will be patch - at best! Anyone with a rudimentary understanding of iMessage would have my undying gratitude if they could explain to Megan that I can't read any of the frantic sounding messages she sends until I have internet access, at which point I would have replied to them anyway!

Love Emily x

P.s. the Crohn's situation still isn't great, but isn't trip-threatening any more. I just keep ringing that bell in the truck!

Hwange NP

I had a nap at 2pm yesterday, and woke up at 8pm. "In for a penny" I thought, and rolled over. Monkeys jumping on my tent made me stir sporadically, but it was the 'I need to get to a toilet NOW' urge which came at 4:30am which properly woke me up. If you're a Mitchell & Webb fan (and if you're not, I suggest you become one!), think of the run (and also the expression) Sir Digby Chicken Caesar does at the end of each of his surprising adventures. That's how I must look each time I leg it to the loo. I returned to my tent, got back into bed (these aren't 'proper tents' at this campsite - there's a bed, a lamp, a fan and a bin in there) and nodded off again. I woke up at 6:20 (the monkeys were shaking things out of trees), which perfectly coincided with the 'I'm going to vomit NOW' urge which struck. I grabbed the only object fit for the job (the bin) and got the first load out of the way. Then I went outside, knelt on the floor and profusely chundered, many times, everywhere.

After clearing myself out I went to reception to hand my key in and explain the bin situation. They were very unimpressed, and clearly thought I was doing a good job of fulfilling the Brit abroad stereotype! I felt a lot better so I returned to the truck to try some solids for breakfast. After this we boarded the Acacia truck (a huge 24 seat vehicle with enough room for everyone's bags, a fridge, tables, and even a bell we can ring if we want to let the guides in the cabin know we'd like to pull over!) and crossed the Zambia/Zimbabwe boarder. Seeing the Falls from the Zambian side was very impressive, but viewing them from the Zimbabwean side completely re-defined amazing!

If you're thinking of visiting the Falls (and I'd urge you to do so), my advice would be to stay, and do activities, in Zambia - but go to the Zimbabwe side to view them. Hyperinflation in Zimbabwe means everything is crazily expensive compared to prices over the boarder. Zimbabwe has the better ground view of the Falls by far (admission to the park is $30, + visa fee to get into the country), but activities like helicopter and microlight flights are far cheaper in Zambia. Although Zambian aircraft aren't allowed into Zimbabwean airspace you're at a high enough altitude for it to not compromise the view. The monkeys are equally intelligent, though: they're opportunistic in Zambia but resourceful in Zimbabwe. I spotted one who bent a bin over, rummage through it, and drink the last little bit in each bottle/can.

We left the Falls and drove to Hwange National Park, the former home of poor Cecil. We set up camp and then headed out on an open top safari truck. Hwange has no fences to allow the animals to roam freely (but this has the disadvantage of helping poachers do their thing), and we saw a herd of ~200 elephants before we were officially inside the park. Our guide spotted some fresh lion prints and drove us around a good chunk of the park to spot some, but we didn't have any luck. We did get to see lots more elephants, giraffes, antelopes, crocodiles, warthogs, and even some hippos considering getting out of the water. It was a great drive, and we finished it by watching the sun set behind a heard of elephants who were having a wash. 

We had an amazing dinner (some kind of vegetable stew) made for us, and then our day got really fun! We were at a bar and saw the Hwange guide we had earlier, who took us for a night drive. We grabbed a couple more beers for the road, and jumped in the truck. He drove us down a track and the engine cut out. We waited for a few minutes, had a look at how clear the stars are in a place with no light pollution, re-started the engine, and drove off again. What could go wrong?

Turns out the routes game drivers take during daylight (when their boss could be watching) and nighttime (when their boss is asleep) are very different. We were definitely off-roading, in an area teeming with wild animals, in the dark, with no lights (they scare the animals), in a less than mechanically sound vehicle, being driven by a man we saw drinking lots of G&Ts less than half an hour before. I see no possible problem there.

Predictably, the engine cut out again. The driver hopped off the truck, fiddled with something underneath, and got back on again. Admittedly that solved the problem, so we carried on. Some of us had finished our first on-truck beers and were standing on the seats for a better view. Our driver wanted to keep things interesting, so he drove us through some trees. We quickly got the hang of ducking each time a low branch was coming, so then he increased the difficulty by varying the speed of the truck. Some people ended up with bruises; I am glad I was wearing glasses. As we approached the end, he said "wanna know a fun fact, guys? I've got no idea who's land that was".

Once we came out of the woods, we arrived at a watering hole with 4 elephants drinking (2 adult female, 2 little ones). We could see perfectly from where we were, but our guide took us to within touching distance of them. He turned the engine off, and we sat there drinking beer in an open top truck, in silence, in the kind of darkness I've never seen in the UK, listening to 4 elephants slurping, less than a meter away. If I had to pick my favourite moment of my trip so far, this would be it. 

Before we set off we were specifically told not to use flashes on our cameras, but someone forgot that nugget of information. The flash scared the elephants, and they started making noises to warn us away. These noises got the attention of Daddy elephant, who came out of a bush on the other side of the truck. We had to sit quietly and let them 'haruuuumph' it out before we could risk scaring them again with the headlights or engine noise. They piped down, so the guide started tapping on the side of the vehicle to prepare them for headlights. They didn't like the lights though, and were flapping their ears and trunks (a sign of aggression), and started to encircle the truck. The people at the front of the vehicle were getting pretty scared by this, but at the back we were well into our 2nd beer on the truck and a bit less bothered. Slowly, though, even the tipsiest of the group recognised the very real possibility that our truck was about to get tipped. 

At this point I did the mental risk assessment which it might have been sensible to do earlier in the evening. I was a Brit in rural Zimbabwe with no phone or first aid kit, in a temperamental truck being driven by a tipsy bloke, with angry elephants capable of killing us all to our front and sides. We'd riled these elephants up too much to sit and wait, but we'd be exacerbating their anger by starting the engine. And even once the engine was going we had to rely on it to keep going, otherwise we'd just dug our own graves. We heard "right guys, hold tight!" coming from the driver, the engine started, and using his last bit of sobriety (and some kind of mechanical miracle) the truck shot backwards and we got away safely.

"I don't know how you guys stayed so calm", he said, once we got back to camp. "I was fucking petrified".

Zambia day 2

I'm loving Zambia! Today I went to the Zambian side of the falls which was great. I'd read a lot of information before, but I think the numbers involved are so huge that they start to lose meaning. I was viewing them from the other side of the gorge, and the spray I felt was welcomely refreshing! I don't think anything can prepare you for the size and the power of the falls, but I'd urge you all to put it on your bucket list! Unfortunately my little gadget which lets me transfer photos to my iPad has broken so I can't post any more photos until I get home. 

Whilst walking through the forest to get to the Falls we saw monkeys... lots of monkey. There were baby monkeys being groomed, and then riding on their mothers back. I was walking along a path with my hands by my sides; holding a water bottle. An adult monkey came up to me, swiped my bottle out of my hand, and then started to drink from it. I didn't realise they were that clever!

As for the Crohn's situation: I think I'm making a (tentative) recovery. My pulse is still consistently >110bpm, but it's heading in the right direction - pulse there are so many other factors which could be exacerbating this (heat, dehydration, not eating much) that I'm no longer worried. I've not needed steroids, and I've got codeine and morphine with me (both are painkillers with a constipating side effect; win-win!) for when the pain gets really bad. I'm finding the new sensible mindset re. my medical conditions quite strange. When my B12 and Hb dropped to life-threateningly low levels, prompting my pernicious anaemia diagnosis, I knew that I'd been badgering my GP with symptoms for months and the outcome wasn't affected by anything I did, or didn't, do. The same applied to Crohn's and sepsis: I presented at the hospital early enough for antibiotics and steroids to do their job, and the only long term issue was the Crohn's diagnosis - which entirely incidental and no-one could have prevented. However, with transverse myelitis, I often wonder if I could have prevented it by taking the meningitis symptoms seriously earlier. Maybe if I acted on my excruciating headaches earlier, and acknowledged the uncharacteristic behaviour changes, I might have been diagnosed and treated sooner, which could well have stopped my immune system going crazy and creating a spinal lesion. Instead I kept thinking "I'll go to my GP once I've finished moving", or after I'd had some chats with James, or finished a string of 12.5hr shifts, and now I'll live with reduced leg function, neuropathic pain, and a broken bladder for the rest of my life.

Because of the Crohn's flare I didn't get to go to Devil's Pool, which is a shame. I spoke to some people who managed to do it and they said it was terrifying! I had a mental image of a nice little rock pool where you could float, have a cocktail and marvel at being so close to the edge. Wrong. I was told by the others that you spend all the time in there fearing for your life, so maybe it's for the best that I didn't do it!

I'm heading to Zimbabwe tomorrow, so I'll be off grid for days at a time. From now on I'll post blog entries as and when I have internet access, not straight after I've written them.

Love Emily x

Zambia day 1

Today I arrived in Zambia after having a few days in South Africa, which was great fun. Yesterday I went to the Cradle of Humankind which is where the earliest fossil evidence of humans has been found. Part of this site is the Sterkfontein Caves, which I also explored. They were stunningly beautiful, and have underground lakes. If you're a Harry Potter fan, imagine the caves and lake Harry and Dumbledore went through to find the horcrux (minus the poison and zombie folk) and you've got a fairly good mental picture. Again, the old 'white girl in Africa' issue came to the fore when my tour guide told me I "mustn't feel guilty". I don't feel guilty. I was born in the 1990s, long after this slave trade and apartheid rhubarb kicked off. I don't know my family tree that far back, but even if my ancestors turned out to be raging KKK members or obsessive slave collectors, well, it wouldn't be a subject I'd bring up at parties but I wouldn't feel personally guilty - in the same way that I don't expect most Muslims to beat themselves up about 9/11, or most present day Germans to feel personal responsibility for the Nazi regime. 

The flight here was the scariest I've ever been on... including the one from Nairobi to Johannesburg! The pilot seemed like a code red nutter and kept turning the plane from side to side as we started to descend. These weren't just a normal couple of little turns though - they were full on 'things sliding off the table' turns, and I'm sure there were far more than necessary. As we got lower he managed to keep the plane the right way up, and I could see groups of trees, and then individual trees, and then branches, and then leaves, and then a fence, and then finally runway. There was also a group of school children sitting on the runway... TIA (This Is Africa). Once I'd got there unscathed, and no children got hurt, Livingstone airport felt like one big tourist trap. Of the entire flight (approximately 250 people) only 7 were Zambian nationals, meaning the other 243 had to queue up to have their passport checked by the 2 people working there. It felt like I was the only person on the flight to have thought of getting visas before I set off, because I had to stand behind 240 of them buying them at the desk. The 2 people behind me were so obviously American - they had the guidebooks, the hat, the rucksack, the shorts, the sandals with socks, and the Nikon around the neck. They introduced themselves to me (Mary and John from Utah, if you were wondering) and as soon as they found out I live in Cambridge they asked if I know Prince William. They were the perfect cliche, bless 'em.

Arriving at the campsite was amazing. Okay, so it was called 'The Waterfront', but Luton airport is 'London Luton'. A healthy degree of TIA and some cynicism that perhaps my £22.74 British Pound Sterling wasn't going to go very far made me feel like quite the pessimist when I arrived. I checked in at reception and could see the Zambezi. There are bars and swimming pools where you can lounge around and watch the sky change colour over the river. It's the best £22.74 I've ever spent; plus the shower situation is a HUGE improvement on Ghana, although unfortunately not quite level with my Joburg hotel. The hotel itself is situated within the Mosi-Oa-Tunya ('the smoke that thunders') National Park, and there are lots of signs saying "please do not feed the monkeys" and "beware of crocodiles". Given that I've seen plenty of monkeys already I'm trying not to read too much into this, but I have a feeling Zambezi crocodiles might not be coked up to their eyeballs like they were at Hans Cottage. 

The part of my adventure which I'd been looking forward to most happened this afternoon; my microlight flight over the Falls, which I had to lie through my teeth on the medical declaration to do. Richard had briefed me to expect a complete disregard for health and safety so I felt psychologically prepared for the experience. Now it's 2015 you DO get a seatbelt, and a helmet too, which makes me think it's probably just a platitude. On reflection, I'm not sure what I expected the degree of ascending trajectory to be (possibly similar to an aeroplane?), but it was not the 45 degrees I got. The pilot and I could communicate via a mic and earpiece, and I could hear him muttering something about "it fighting with [me]". I grabbed onto the side, and then realised I needn't be worried because I had a belt and a hat, so I was definitely protected if we went down! I opened my eyes again to see a family of elephants having a wash on one of the islands in the river, and a rainbow in the falls. That's the second time in my life I've seen a rainbow from above, and it gets no less beautiful. I was really enjoying it by this point, so he told me to close my eyes and stick my arms out to feel like I was flying. I did this and then felt some bloody massive turbulence because he was doing the same. I felt quite strongly that I had not paid him $180 to voluntarily surrender control of the big metal bird thing I was trusting my life with, and verbalised this. When we landed (a far nicer landing than I had courtesy of BA) I felt a bit bad, so I had a look through the pictures he took from a wing mounted camera. They were great, so I asked how much they were, and he said $20 for a disc with dozens on. Sold.

This evening I met up with the people I'll be travelling through Zambia, Zimbabwe, Botswana and South Africa with. We went out for dinner (a main meal, alcoholic drink, and taxis to and from the hotel cost me $10!) and they seem like a great bunch. It's quite a young mix of people, and I think it's going to be brilliant fun. Tomorrow I'm doing a tour of Victoria Falls, and I'm hoping to have a dip in Devil's Pool, too. 

The only bad bit of news I've got is I think my Crohn's is relapsing. I had a bit of travellers tummy in Ghana, but in Joburg I had the agonising feeling of being pulled apart which only those with IBD - and not just IBS - can understand. The feeling of horrible tenderness even after the cramps have subsided, and knowing you're internally bleeding without having to glance at what's just come out of you. At one point, in Joburg, I considered cutting my loses and flying back early (feverish, cold sweats, tachy of 120+, couldn't eat, every muscle ached, excruciating headaches), but I'm necking loperamide and opiates, and staying well hydrated, so I'm sure it'll be fine. I've not had any eye symptoms which is encouraging, and I've got prednisolone with me if it gets that bad. I was incredibly lucky to go almost 2 years with no major relapses, and this still could turn out to be extreme travellers tummy.

P.s. I've had a read through past posts and noticed they're littered with typos and autocorrects. I've been doing all my blogging from an iPad with a smashed screen whilst I've been travelling, and it seems to love inappropriate apostrophes!

South Africa

Today I arrived in South Africa. The flight here was terrifying: there was a lot of turbulence, so the pilot told us we were going to fly at very low altitude... over some mountains.

Before leaving I was told (many times) that South Africa (particularly Johannesburg) is a dangerous place for a young white woman travelling on her own, but I've had no problems so far! 

My plans for the next couple of days are visiting the Cradle of Humankind, exploring the Sterkfontein caves, and enjoying having hot water again. But first... I need to sleep off Ghana and my flights.

Love Emily x

P.s. Laura Homan has produced an absolutely adorable little man called Archie, and I'm only just able to resist the urge to buy him lots of different animal suits...

Goodbye, Ghana

I'm writing this from Accra airport, just before I board a flight to Nairobi. I've said goodbye to the friends I've made over the past couple of weeks and I'm ready to start the second leg of my adventure. Ghana has amused, enraged, amazed, disgusted, mesmerised and baffled me. I arrived here with no expectations which was definitely the sensible thing to do. In some ways this is a surprisingly developed country; but it is almost medieval in many others.

I still struggle to comprehend that the average Ghanaian doesn't have hot water, but does have a touchscreen smartphone. People are happy to buy uncovered meat from a bowl balanced on top of someone's head who's walking alongside an open sewer, but would be appalled by blemished clothing. I've seen thousands of vehicles (most have been broadly road-worthy, but some I've been in were most definitely not) driving on mud roads littered with rubble: in the UK these would be 'dirt tracks'. Ghana feels like a country where all the ingredients are there to fully develop, but there is something stopping that from happening. I've not spent long enough in the country to have an opinion on if it's an issue of governance, motivation, religion or simple contentment, but few Ghanaians I met were troubled by this.

Christianity plays a huge role in this country, complete with all the contradictions and hypocrisy religion brings. As I've written before, businesses everywhere allude to Christianity (my most recent favourite being the 'God Is Love Chop House'). The attitude of 'God works in mysterious ways' is embedded in healthcare, and the mindset of there being a higher power in ultimate control is reflected in road safety. (On the way to the airport our minibus came within inches of being in a multi-vehicle pileup; my tolerance of crap driving has increased since being here, but I thought I was going to die. That's 4 out of my 9 lives spent!) I've seen hospital staff judge unmarried and/or very young mothers, but not consider the part of the Bible which tells them to help these same people. I'm not sure exactly which part of the Bible this is, I've never read it, but I think that's meant to be the overarching theme...?

Possibly the strangest thing to bother me in Ghana has been the nation's approach to their environment. For a country which relies on natural resources for the majority of it's income (cocoa, gold, fruit, tourism) it's incredible how neglected the environment is. Whilst I'm no member of Greenpeace, I care a lot about recycling and sustainability. Within my first couple of days I asked how I could recycle the bottles and cans I'd been drinking from; there was no recycling bin in the house, and no-one could tell me where I could find a public point. Frankly, most people seemed confused by the question. I'm not sure there's any public service to remove household waste, either. I couldn't say for sure where this ends up, but personal observation makes me assume it's probably at the side of a road. There is also a large degree of aspiration to the West; not re-using things is seen as a sign of affluence. 

As for my experience as a midwife living in Ghana... it's been a totally mixed bag. I got used to the basic way of living quite quickly: living without hot water and 3G didn't bother me. I can't pretend the perpetual lateness and disorganisation didn't annoy me, but you just learn to expect it. Initially I felt vulnerable in public as an extremely white person in a society which has received little migration, but once I acknowledged that people were only pointing and shouting "ABRUNI!!!" at me because white people are rare in Western Ghana it stepped down from 'intimidating' to 'irritating'. I've done things I never thought I would do: hitchhiking (tro-tros), walking through a jungle, meeting the chief of a rural village and stroking crocodiles - all have been great fun. 

I struggled a lot more at work, and I'm still not sure I could explain the rationale for many (most?) of the things which happen inside Ghanaian hospitals. Hospitals were far better resourced than I was expecting, but donations from well-meaning benefactors arrive without instruction or training, and are therefore almost useless. It was the deficit in care and compassion which shocked me the most, and I don't think that will change for a long time, simply because the staff I encountered were amused rather than intrigued by our notions of patient respect, dignity, choice - and even consent. 

Overall it's been a great trip, although not one I'd repeat in Ghana, and not one I could have completed if I didn't have a house of likeminded frustrated medics to return to for evening de-briefs. I believe improvement in healthcare is possible, but it has to come from within the country: Western technology and practices will only be utilised once medics in Ghana understand, and appreciate, evidence based rationales for adopting them. It was a once in a lifetime trip (and it will definitely be just the once!) made far better by the Work the World staff and other students. I've met a great bunch of people, made some great memories, and ticked a few things on my bucket list. 

Ghana, you've amazed me in ways I didn't think were possible,

Love Emily x

Ghana day 5

Today has been my third day at the hospital, and it's been as head-bangingly frustrating as the others. Ellyn and I arrived at 8:25 (Ophelia, our housekeeper served breakfast at 7:45 instead of 7:15) but no-one had noticed, never mind cared! I am now accepting this as 'the Ghanaian way'. As soon as we arrived we saw there were no labouring women. With Work the World's advice of being proactive in our minds, we went to theatre to ask if there was an elective caesarean list running that day. "No", we were told, "but there will be an emergency case soon". We legged it back to the staff room to put our theatre kit on, and went back to theatre hoping we hadn't missed it. The doctor (who is awesome) told us to wait in the corridor and we'd be told when the woman was brought over. We waited for an hour, and again thought "this is just the Ghanian way". After another half an hour I asked a nurse when the woman was coming. "We've just had a phone call", she said (bollocks; we didn't hear a phone ringing) "we'll do it tomorrow". How big an emergency was it?!

Another biting-tongue moment came later on in the day when a para 4 (woman giving birth to her 5th baby, for the civvies!) came in, and Ellyn and I suggested she stood up to use gravity to help her baby descend. The midwife in question replied "no, we don't allow that because when the baby is born they'll hit their head on the floor". We mentioned that in the UK we have 1:1 care in established labour, to which the response was "we don't have the resources for that". I tactfully replied that there were presently 5 midwives staring at this poor woman (2 of which had previously been kipping on patient beds), and perhaps we could deviate from their normal practice on this occasion. They were fairly insistent I VE-d (vaginally examined) this poor woman, and couldn't accept that just because she wasn't fully dilated at the last examination doesn't mean we might not be now, and no, it's not okay to shove your fingers in on an ad hoc basis with no warning or consent.

After the day at work and a big debrief a group of us braved Takoradi's circle market. If there are any GoT watches reading this: think Flea Bottom. For everyone else, try to imagine the smell of rotting fish being a welcome distraction from the stench of the open sewers running alongside each pavement, and rats. lots of rats. The people living in the inner-city had no issues with grabbing us and steering us towards their stall. Children were grasping us and shouting "abruni!" and "osei!". The passageways were so narrow we were walking single file, and even that was too hard at times. Walking through that market was the closest I've come to feeling unsafe here: the residents could see we were the only white people for quite a way, were trying all tactics to get us to buy from them, and got fairly irate when that didn't happen.

Patient and marketplace assault aside, I think I'm getting the hang of other aspects of Ghanian life. I've woken up to find I've been sharing my bed with a lizard. I've become an expert at negotiating prices for EVERYTHING. I've managed with no running water for 2 days. I've chosen fabrics and am having them made into custom clothing. I've stopped bracing each time a taxi swerves off the road to avoid hitting a goat. I now dance slightly less like a white woman.

After we all returned from work we had a house BBQ (goat is surprisingly tasty), with lots of alcohol and dancing. The stereotypes unfortunately turned out to be true; the black men were dancing like pros and us white girls were sort of shuffling 2 beats behind.

This weekend a group of us are heading to Cape Coast to do the canopy walk at Kakum forest, stroke some crocodiles and stay at a hotel with running water, and hot running water at that!

I can't wait.

Love Emily x

Ghana day 12

I had another frustrating day at work on Thursday. It started off fairly quietly, with one postnatal mother and a lady with a late miscarriage who is having possibly the worlds longest induction of labour (3 days, and not a single contraction). There are 12 beds on the ward, and I find it particularly insensitive that she is in the only one with a breastfeeding poster above it. Two other ladies came in during the day, and this is where things unravelled. 

Both of these ladies were multips (civvies: they've had babies before) and they came in within an hour of each other. Neither were obviously in labour, but as expressing pain verbally during childbirth is discouraged in Ghana, and they had had babies before, Ellyn, Amy (a WtW student nurse) and I kept a close eye on them. Ellyn took one lady (who was slightly pre-term), I took the other (who had thick meconium in her liquor), and Amy helped both of us out. We were confident that they were both in established labour, and interrupted the staff's mid-morning kip to let them know this. Ellyn's lady still had intact membranes (civvies: her waters hadn't broken), so she was taken to the delivery room to have these broken for her. In the UK we use an amnihook to do this (a sort of knitting needle with a tiny plastic hook at the end) and it's not a very pleasant procedure, but in Ghana they use a snapped needle. Before they did this they thought she was fully dilated, then they thought she was 8cm, then 9cm, then 6cm, then 28 weeks, and finally back to 9cm - all the while moving her, naked, from ward to delivery room as they continuously changed their minds. 

Whilst this was happening, I was confident my lady was cracking on. I decided to examine; an hour before she had been 4cm but I thought she was involuntary pushing, so it made sense to see what was going on. I got my gloves on, she opened her legs, and I could see they baby's head. I decided that examination might not be needed after all. I let staff know this, and let Amy know so she could deliver her first baby. My hand was on the baby's head to slow it down a bit, and then a midwife shoved me out of the way. It was the same midwife who did an awful job of delivering a shoulder dystocia baby on my first day, and it's scary to see her skills don't improve in a non-emergency situation. She put her hands into the vagina, and starting pulling on this baby. I was repeating the words "why are you pulling the baby? Stop pulling the baby." over and over again, but she only stopped when I asked her if the woman had been having a contraction during her pulling (she definitely didn't). The midwife asked the woman, who confirmed this. This didn't change the midwife's management, and she kept on tugging. With the next contraction the shoulders were born, as anyone who knows the rudimentary mechanisms of labour guessed they probably would do. The midwife kept on tugging, and the baby was born.

Once again, it was a botched delivery with a baby needing resuscitation. Because Ellyn's lady was in the delivery room at this point, my lady gave birth on the ward. I'm so glad I had the forethought to anticipate this would probably happen, considered the meconium risk factor, and took the bag/valve mask out of the delivery room and into the ward. Once again I was the only person with a stethoscope which I gave to Amy who was telling me what they baby's heartbeat was doing. Amy is great at resuscitating adults but has no training in resuscitating babies, so I was having to tell her exactly what to do. We needed to use the mask to help bubba with breathing, and once again were the only people who noticed/cared about the condition of the baby. Neonatal deaths are seen as so normal here that often babies born in this condition are left for dead. We got the baby breathing, Amy started wrapping her up and giving her to her mummy, and I took the mask back to the delivery room - conscious that Ellyn could deliver a preterm baby with no resus equipment available. I gave her the mask, and heard a scream from the ward. 

It came from my lady: the lady who laboured to fully dilated silently, and made minimal noise during birth. She dealt with pain well. I legged it back to the ward and saw the delivering midwife doing a bi-manual compression. At this point I stopped being tactfully ignorant and asked the midwife to stop, and to explain why she was doing what she was doing. She said she felt the woman was bleeding excessively... she really wasn't. I asked her what she hoped to achieve by stuffing her fist into a vagina without consent, and she said she wanted "to expel clots". In the UK I would feel I had to report her actions to managers, but in Ghana there's no system for that. You can sleep on the ward, and if there's an adverse outcome it's just 'one of those things'; there's no infrastructure for patients to complain through, therefore staff know they can do/not do whatever they like because they are completely unaccountable. 

After this I was very ready to leave Kwesimintsim and not return. Ellyn and I went to Circle Market to pick up some more fabric, and were taken there by a sleazeball taxi driver. He asked us if we were married. Ellyn truthfully said yes, and I decided I could prevent another proposal by doing the same. It's amazing how difficult it is to think of a convincing back story on the spot but I think he brought it... just. We returned to the house, and got ready for the Thursday night BBQ.

This turned out to be messy occasion with lots of vodka and Ghanaian dancing. Some of us decided to go 'out out' afterwards, and had to battle with the house security guard to get out of the house. We managed it, got to the bottom of the rubble hill with no twisted ankles, and flagged down 2 taxis to take us to the only club we knew of. I was in the first taxi which sped off and left the other one behind, so we got the the club and saw it was shut. We cut our losses and went to one on the other side of the road. We weren't quite sure what had happened to the other car with our friends in it, but we were too tipsy to be worried and danced instead (when we got in we found out they'd found out the first club was shut, and were driven to a series of other bars which also turned out to be shut, cut their losses and went home). 

If you've see the first Inbetweeners film then you've probably got a good mental image of this club. There were about 10 people there, including the 4 of us, and we were the only ones willing to dance. We hit the floor, 'We No Speak Americano' came on, and we did some Inbetweeners dancing towards the only 2 men in the place. They were a bit leery, and we remembered about the others, so we left and went back to the house where we found them tucked up in bed. I've been told something about a table cloth and bra being stolen/worn/thrown, but memories are hazy and I'm sure there'll be photos on Facebook in due course. We woke the others up and convinced one to come back out with us. Being a group of thinkers we took a can of mosquito repellant with us to use as pepper spray of we bumped into any more creepy men, staggered to the bottom of the hill again (being chased by our poor security guard win a torch), waited for a vehicle to take us to Takoradi's best bar at 2am on a Friday morning, got bored after 10 minutes, and then walked back up the hill. On the way up I launched a one woman mission to rid Ghana of all bugs by liberally spraying insecticide over the road, and I'd love to say something else interesting happened, but it didn't.

Love Emily x

P.s. I've since learned the club we went to is a notorious pick up place for prostitutes (which explains the 4 girls sitting on their own in hotpants), and white girls fetch almost double the price, but the black prostitutes tend to attack them because they don't like their clients being 'stolen'. It's amazing what you don't pick up on when you're drunk!

As horrible as it sounds, today has been the first day of working in Ghana which I've enjoyed. The BBQ last night really cheered me up, and I went to the hospital this morning with enthusiasm (and a slight hangover). A labouring woman came in and Ellyn and I looked after her. Her baby's heartbeat was a bit slow, and staff were willing to cannulate and start IV fluids. Short of starting a CTG (certainly not available at here!) their management of the situation was exactly as I would have done in the UK. Whether that's a positive reflection on them or a negative one on me is for you to decide. The baby came far quicker than any of us anticipated, and as I was the only one wearing gloves I delivered (#48, if you were wondering). As the baby came so quickly the woman had quite a nasty tear. Watching this being repaired was horrible - especially as it was being done with no anaesthetic. I could see a 10ml vial of lidocaine, and tactfully suggested we used it. "Okay" said the midwife, "get me 1ml". Ordinarily I'd use 10ml, so I didn't expect this 1ml to go far. She infiltrated half of it, and commenced suturing again. Unsurprisingly 0.5ml of local didn't really touch the sides, and I persuaded the midwife to give the other half as it had already been drawn up, and couldn't be used on another patient. As awful as this was to watch, I knew it didn't happen because any member of staff was being deliberately cruel: it happened because that 10ml of lidocaine had to last for many other women too. Today, I felt everyone tried their hardest with the available resources - for the first time since I've been here. 

The lack of effort and care in Ghanaian healthcare terrified me on a personal level. I was diagnosed with transverse myelitis in November 2014, and assumed cold British weather worsened my symptoms. As they improved as the weather became warmer I took this as causation and not correlation. Having been in Ghana for a while I've learned extremes of temperature - be it hot or cold - trigger pain. I hadn't expected to be needing analgesia stronger than co-codamol whilst I was out here, and got quite worried at the thought of needing morphine: from what I've seen of African hospitals so far, I'd rather return to the UK to get it. I mentioned this to Joe, our project manager, and he told me not to worry because there is a local hospital which will only treat ex-pats. Hearing this completely confirmed my opinion of Ghanaian healthcare: this is the place where staff sleep in front of patients, staff collect vague 'fees' at outpatient clinics which are then pocketed, and every ward has a staff television but can't provide bedding for patients. 

I think the biggest lesson I can take from Ghana to my own midwifery practice is how not to do things.

Love Emily x