najonajo

So, before moving on to life in Thailand a recap of my last year in Zanzibar (this is Nadine by the way), after leaving the VSO post. Finally John can stop twisting my arm 🙂

Having worked with all hospitals in Zanzibar on introducing tele-medicine within our voluntary placement we came across HIPZ (Health Improvement Project Zanzibar), a UK NGO running and improving the standards at the two rural government hospitals on the main island of Zanzibar, Unguja –  over a ten year period before handing the hospitals back over to the government. HIPZ have been working in the Southern hospital in Makunduchi (with a catchment area of about 60,000 people) since 2007.

Makunduchi Hospital

As things progressed really well down there the President of Zanzibar himself requested HIPZ to take on the second rural hospital in the North at Kivunge in 2012 (which has a much bigger catchment area of about 150,000). A position to run HIPZ’ operations in Zanzibar came up in 2013, and I applied for it.

Why? Well, for some very specific reasons (only partly mentioned in John’s rant post a couple of weeks ago) we were getting a wee bit jaded with our VSO placement and this seemed like a chance to be doing development work with at least some impact. It was clear that something had been going right over the past years at Makunduchi hospital, so why not become a part of that, learn and hopefully contribute a bit, too.

What seemed different: This was not an initiative injecting vast amounts of money blindly and insensibly. a) There wasn’t that much money going round within the organisation and b) it’s just not part of HIPZ’ ethos anyway. In keeping with that no one working for HIPZ in Zanzibar has a big fancy four-by four or a villa by the sea. Actually most people involved with the organisation work entirely for free, only four people earn a very modest salary.

Two of these are the local Hospital Managers, which in a very wise move have been instated in the hospitals by HIPZ to lead on administration (although there are still major issues with getting them recognised within the government system). Seems a no-brainer, a Hospital Manager, doesn’t it? Well, Zanzibar, has an impressive number of 15 or so practising local medical doctors serving a population of well over a million. Given this excellent ratio it is rather wise of the government to request its often one and only doctor or Assistant Medical Officer at a hospital dealing with up to 350 patients a day to manage and administrate the whole place, too. That involves running off at least once or twice a week at short notice to attend seemingly endless Ministry meetings (a lunch and often a “per diem” payment is involved, so actually well worth it for the individual).

And, have I mentioned that the official minimum requirements for a so-called Cottage Hospital regarding staff are a couple of Assistant Medical Officers –  let me spell it out: no qualified doctor needed! Ever thought there was a hospital – even a rural one – that is designed to offer a professional service without the presence of a doctor?

Anyway, it was my job to lead on specific projects, liaise with ministry, partners and donors, and oversee the work of the hospital managers and the volunteer doctors. They are fabulous young doctors from the UK towards the end of their training, who work for free for 6 months to a year and like us live in simple accommodation, that means no warm water, no air con, regular power outages, far too many spiders and cockroaches :-). They are suddenly faced with the massive responsibility of in effect (but alas without formal authority – I could write a book about this issue) being the clinical lead for an entire hospital, no peers or well-qualified technical staff to rely on, and very few tools to diagnose and treat patients with. Think: no ECG, no MRT, no computer tomography, no guaranteed X-ray or ultrasound, not even your basic Full Blood Count (blood tests we could get in a wink for minor complaints), sometimes not even oxygen on offer. But without all of this support they are nevertheless encountering severely sick patients on a daily basis. And the referral hospital they can send them too will most probably not offer better care.  A really tough situation.

Drying X-rays on the fence

Us chilling with fab doctors

And so we all basically got involved in any aspect of hospital management in addition to medical support  – doctors only for the medical stuff, that is. Unlike some of the local administrative (!) staff I decided discussing X-rays and diagnosing patients wasn’t really my cup of tea. Although I’m sure they would have let me give it a shot!

Kivunge Hospital male ward – in dire need of renovation!

Renovated children’s ward at Kivunge Hospital, mainly for malnourished babies

Improvements are addressed wherever possible at a sustainable structural level, rather than on an ad hoc basis (one-off medicine donations for example). So that would involve for example securing 24 hour availability of the ambulance for transfers to the tertiary hospital and trying to find out what’s happening to the petrol made available for this service, regularly leaving the ambulance immobile towards the end of the month. Pity that many of the ambulance drivers, who are supposed to track their patient transfers to the tertiary hospital in a log book, actually have not been taught how to read or write. And there are many other tricky issues that make getting this one to work a real challenge.

We also looked into improving the drug supply chain, as for example patients with high blood pressure would often only be 2-3 weeks a month on medication provided by the government at the hospital, the rest of the time off it – with potentially fatal effects. The idea there was to ensure a regular supply of 4 different types of anti-hypertensives via our organisation. This was then supposed to be sold off without a profit at the hospital whenever the free government supply had run out. Sounds simple but is still not up and running as far as I know. Barriers? Ensuring regular supply of drugs even in small quantities from the Tanzanian mainland seems next to impossible. Will the pharmacist manage to work with two piles of medicine –  the government one and the HIPZ funded one, and know when to switch from one to the other? Also a challenge to set up. And one of the biggest concerns of hospital management: Even though we obtained an official certificate from the Zanzibar Food and Drugs Board to sell the drugs within a clearly outlined process, many people at the hospital were saying it will look like employees are doing dodgy  things, selling drugs to make a private profit. Can you blame them of being afraid when this is actually happening on a regular basis across the islands?

Other things we focussed on: Fundraising for and purchasing essential equipment, renovations and new buildings…..

Spanking new outpatient department at Kivunge Hospital – weyhey, it’s finished!!

….and training, training, training.

On-the-job training by a visiting surgeon in Kivunge’s new operating theatre

And this is again where HIPZ are very different from other organisations. We are based at the hospitals with the doctors there every day, building relationships with the government-employed personnel, keen to understand the challenges, able to judge quite well what kind of innovations are feasible, and plan all aspects of their implementation. So a holistic, ‘horizontal’ approach. Most big players in the field have a ‘vertical’ approach with a focus on and insight into specific issues only: HIV, Malaria, diabetes, disease prevention, child health for example. And the truth is they don’t know the institutions all that well that they are working with and therefore have a reduced insight into what is actually required to implement changes. Plonking a piece of equipment in a hospital alone certainly has no impact whatsoever…..

So, coming back to HIPZ: What’s so different then in Makunduchi, where they have been based for seven years now? Well, for a start all in-patients are now seen on a ward round every day and have a filled-in observation chart and a drug chart. A massive improvement. I need to explain that people are terrified of being admitted to hospital. They will happily queue for hours for outpatient treatment at the facility but will do everything to avoid staying in hospital. Not a surprise as Zanzibaris traditionally equate hospital admission with being left to fester and more or less certain death. You can’t blame them. But things at Makunduchi have been changing. Some examples:

• Every day a morning meeting is held at 7:30 a.m. to do a handover from night shift, discuss difficult cases and often even get a few minutes of training on a specific issue in there
• An ambulance service has been introduced to pick up women in labour from distant villages
• Midwives fill in a partogram monitoring each woman’s labour to reduce the risk of complications.
• All mothers and newborn babies get checked by medical personnel within 24 hours of giving birth
• It has been reported from a neighbouring village that the changes at the hospital have truly transformed the life of the villagers: Since the volunteer doctors have been working closely with local staff patients are no longer afraid of being shouted at or abused when being treated. They are actually happy to come to the hospital….

Overall, and most importantly in my opinion, Makunduchi has achieved what I have seen nowhere else in Zanzibar: Staff are not a bunch of individuals looking out for themselves only. They are a team that works together and feels responsible and proud to be offering a good service. Well done to Zainab (Hospital Manager) and all the others who have contributed to this over the past seven years!!

So, if you are still looking for a way of giving back over the Xmas period I can vouch personally for any donations to HIPZ. They will be used responsibly and directly benefit the people of Zanzibar.You can donate here: https://www.justgiving.com/hipz/donate/

But now it’s high time to say kwa heri, Zanzibar, good bye, fare thee well…

And Thailand, here we come,  wehyhey 🙂

Came across a few photos of what we have at various times woken up to, bumped into, fought hand to claw with in our shack in Zanzibar.

Millipedes – horrible black glistening things with bright traffic light red legs rippling away underneath. Surprisingly not poisoness.

A furry sort of cuddly African earwig. With enough poison in it to cause serious damage to a small child.

Gecko. Not poisoness. Not particularly horrible to look at but a demon cack bomber. Judging by what  they leave behind, they appear to have a proclivity for wiping their backsides along 2cm stretches of wall.

And needless to say in a land where most things living are in one long interminable fight for survival even gecko crapping territory is worth a duel to the death.

A cockroach resting.

Found a couple of scorpions in the house. On my first day at work I had one fall from the office ceiling onto my shoulder. The college principle seeing this – I hadn’t noticed – casually raised a finger to halt the conversation, sauntered over from his desk and brushed it off with the throw away comment, ‘We get them now and then’.

No idea what this was. Big green and yellow and when you smash it with a broom it oozes purple goo.

I loathed that bloody cockerel.

Everything in Africa looks like it’s either on a forced starvation diet or, like lard-arse here, as though it’s just gorged itself on several small children.

We had a monkey not in our house but in the roof for a few months. Before we found out what it was – it was generally active only at night- it sounded just like a small child scuttling around. Not a rat, not a cat. Unmistakably like something small and human. Weird and very unsettling at night thinking you’ve got the Exorcist demon child in your loft.

No words required. Simply imagine Nadine screaming at me to get the f****ing thing out of the house. She’s a brave cookie is my Nadine. She could handle practically anything but cockroaches and spiders were where she drew the line. They fry them up as snacks in Thailand.

Toilet stingray. They swim up the outlet pipes and end up thrashing themselves to death on the bathroom floor. You do not want to be in the middle of number ones when one is on his way out. All you can do is drag the buggers outside for the rubbish men to clean up.

African rat. These ones are tiny. How tiny? Well in Swahili rat translates into field dog. That’s how big they can grow. We only suffered a tiny one. It still basically ate down the door to get at our food cupboard.

The most lethal of the lot. Small child. Probably a demon cack bomber, faster than any thousand legged millipede, definitely oozes green stuff from a range of orifices and in my estimation, poisoness. Don’t be fooled by the cute smile. He knew exactly where the home baked cocoa biscuits were.

Hello from Zanzibar, kind of.

First apologies for the gap in blogs. We ran out of things to say. Actually, I was waiting for Nadine to write a piece on her amazing experiences working with HIPZ (Health Improvement Project Zanzibar) but she didn’t. A waiting war ensued. She could outwait an elephant.

Second, we’ve just moved to Thailand (an exciting new banner competition will shortly be unveiled), but I still have a few things to say on the subject of Zanzibar so you’ll have to use your imagination and pretend we’re still there for the next few blogs. Perhaps Nadine will also relent and at last write her piece on HIPZ.

Or perhaps not.

In the best traditions of Anglo-Germanic culture I’ve decided to have a bit of a rant and moan about the useless government. No, not the Tanzanian government, even though the money-grabbing corrupt thieving bastards could fill several blogs with their criminal practices. No, I’m going to blether on about western governments for, even out here, you cannot escape the sheer ineptitude of our own incompetent political classes. If you’re seated comfortably . . .

Zanzibar is black hole, a hole into which Western government aid flows like a gushing torrent. It has for the past few decades and shows no sign of slowing. Yet, surprisingly, all the standard indicators of aid impact: education, sanitation, roads, power, poverty, none of it, not one single indicator has improved in any meaningful way over that period. Zanzibar to all intent and purposes might as well be a failed island state.

It is estimated that between 20 to 40 billion US dollars is stolen every year from developing countries in Africa through bribery, misappropriation of funds and other corrupt practices. Only five billion US dollars of this stolen money has actually been returned over the last 20 years, one third of it from Switzerland. There are currently 200 million US Dollars sitting in Swiss accounts held by Tanzanian officials that the government can’t account for. You could actually argue that the only concrete development of the last 60 years and $3 trillion (to put that into perspective if you spent $1 million dollars every day since the birth of Jesus you wouldn’t be anywhere close to spending even one of that 3 trillion) of large scale foreign government donor aid in Africa has been the biggest money laundering, corruption ring the world has ever seen. Oh and a few billion more poor and impoverished people in a litany of failed states. All, one could argue, largely thanks to western government aid.

So how does this happen? Western governments, our governments, surely want to alleviate poverty not create it, prevent corruption, not encourage it? Well, the reasons are a highly complex interconnected set of socio-economic factors. . . . . actually that’s a load of rubbish. The reasons are simple. Western governments are completely useless at alleviating poverty and preventing corruption in their own countries. Why should they be any better doing it in countries thousands of miles away with cultures they have no real understanding of?

There is a more cynical viewpoint on all of this, one that evidence on the ground unfortunately tends to support. It goes along the lines of …. ‘Hey you, poor impoverished country government man, here’s a few million dollars to help the poor and impoverished in your poor and impoverished country . . . What? No, we don’t need a receipt.  No, we’re not going to check up on what you do with the money. Just write us a report every now and then saying everything is hunky dory. But you remember, poor and impoverished country government man, when our oil, coal, gold and engineering firms come knocking on your door asking for contracts, you remember who gave you those dollars. So long poor and impoverished country government man’. You might say, back door imperialism with cash instead of guns. So the political, power classes in Africa, Zanzibar included, drive ever bigger 4x4s, their beach side villas get bigger and more numerous, their kids get sent to the best schools (there are none of note in Zanzibar). If they need medical treatment they fly family members to India, and the UK to get top notch care (again none of note in Zanzibar). It’s a classic poverty wealth gap only this one suckles at the teat of western government aid.

Either totally ignorant of the impact their donor aid policies have in Africa or totally aware and completely comfortable with the consequences. You choose which is worse.

The problem with being crap at governing in your own country and crap in a country a few thousand miles away is that in a place like Tanzania bad, externally imposed pan-national decisions spiral out of control and leave you with a pile of dire consequences, you couldn’t even dream of, let alone plan for and contain. A few pertinent examples follow:

Example A: Some bright government spark in the west (a few governments have done this including the UK) decided the best way to improve education was to build schools. Cue a school building spree in the 70s and 80s. The result were thousands of empty school buildings splattered willy nilly across Tanzania with no regard for school catchment areas (‘No, we’re not going to check up on what you do with the money. Just write us a report every now and then saying everything is hunky dory’). Teachers were still untrained, underpaid and brutal with the kids, who basically associated school with fear and arbitrary physical beatings. So seeing that their nice schools were empty, the same western governments threatened Tanzania with reduced aid if school attendance didn’t reach a certain standard. Literally overnight, attendance in Tanzanian schools all the way up to secondary level shot up 90+% (in the existing old schools. The new ones were unusable) Why? The Tanzanian government simply made student non-attendance a criminal offence punishable by gaol terms for the family head. Tanzanian school attendance is still one, if not the highest in Africa, a fact loudly trumpeted by the UN and others. Educational pass rates on the other hand are not loudly trumpeted by the UN and others. Perhaps because they’ve crashed to 10% over the same period. The outcome is, Tanzania still has untrained, underpaid teachers who brutalise their pupils and kids still associate school with fear and arbitrary beating, but now they have even less chance of escaping it thanks to western government aid.

Example B: Another few government and UN bright sparks decided they wanted to help Zanzibar build up its health sector. A good idea you’d think, and one backed by cash, millions of it, every year and medical equipment and supplies, tonnes and tonnes of the stuff.  This has been going on for decades in Tanzania. Again great, but for a few minor oversights. Practically none of the cash, equipment and supplies comes with any contract, auditing or accountability structures and where they do exist they’re either under the control of the very local decision makers receiving the cash and equipment or, even worse in my book, careerist western government aid officials who can’t afford to rock the boat (no government wants to hear it’s their cash and equipment that’s getting nicked or misused). I know what I would do if some money shovelling foreign government suit from over the horizon dropped a huge stash of dollars or top dollar medical kit into my lap and didn’t ask for a receipt. So, yes, endemic, systematic, large-scale corruption. An entire political class and a swathe of leaders and decision makers from the very top (stand up the president of Tanzania) down to middle management (doctors, mid-level ministry officials etc.) dedicated not to the improvement of health but to swindling as much money, equipment and supplies from idiotically managed large scale government donor aid as they can get their hands on. Those individuals trying to fight against it are too few and simply become marginalised. They either sink, join the corruption ring or leave the country in search of a better life.

Example C: It costs a local up to a week’s wages to have a baby here. It’s supposed be free, by the way. Before going to hospital, a pregnant mother must buy her baby delivery kit complete with plastic sheeting, bottle of disinfectant, scissors etc. It entirely consists of supplies from a range of international health organisations that are syphoned off by crooked local officials. They’re sold in pharmacy shops in ready bundled little pink baskets. The expectant mother hands over her little basket to the nurse and . . . it’s never seen again. Never used. It will miraculously appear back in the same pharmacy the same day untouched and ready to be sold on to the next expectant mother. Why? Donors provide medical supplies to the hospitals for free dispensary to patients. Hospital make sure most of it is syphoned off to their controlled pharmacies (all pharmacies within spitting distance of a hospital in Zanzibar will be owned by doctors on the make). Locals are then charged for supplies, most of which they don’t need, but since the doctor is writing the prescription who’s going to question?

Example D: There’s a new sonography room in one of the ancillary hospitals in Zanzibar, containing state of the art kit. Again provided for free by some government body, Dutch perhaps, who cares. It’s only opened when the local doctors or nurses are short of cash. They charge up to a week’s local salary for a scan. Remember health delivery is free in Tanzania. They make so much money with this, they’ll only come in to run off a couple scans and then go home again. They pay orderlies to fill in for them. By orderlies I mean cleaners, people with no medical training. Most can’t even read or write. As a patient you have as much chance being treated by an orderly as a nurse in Zanzibar. Some of the orderlies have picked up so much that they even masquerade as doctors. Their training? On the job. Perhaps a 15 minute run through of the basics by a nurse then a quick buck before the nurse pisses off home. You end up with babies being forcibly pulled one handed (and that’ll be a filth covered hand) from women. Women simply die because the orderly didn’t know what to do next. Or they got bored or they weren’t paid so didn’t hang around. The common sight in wards apart from dirt (orderlies are too busy nursing to be cleaning) and empty medical cabinets (all of it whisked away to private doctors’ pharmacies) are of nurses slouched over chairs tip-tapping away on their 3G phones or sleeping in patients’ beds. The actual western doctors and medical staff out hear can do bugger all to combat this as they have no authority and are viewed as threats or hindrances to lucrative money making operations. Their attempts to train staff or make changes to improve health care delivery are met with disdain, apathy and lies as local staff try to protect their ‘turf’.

How bad is it? Well, if you ask a local Zanzibari why they go to hospital, the usual answer will be ‘to die’

Hey ho, just a few small examples what large scale western government donor aid can achieve.  I need to point out here that small scale donor projects, usually based on personal relationships built up over time and in targeted, controllable environments does appear to work, in stark contrast to the vomit loads of easy cash and equipment preferred by government organisations. Just ask Nadine about her experiences working with one great example, HIPZ. Go one Nadine, write that article.

And since I’m in a groove here’s a few more western government numbnut aid ideas. Western governments provide scholarships for training including overseas bursaries. Again, you’d think smashing idea. As it turns out, in Zanzibar, and I suspect in other African states, there’s a mismatch between the training on offer and the person getting it. Imagine financial accountants flying off to Vietnam for 1 year midwifery training. Receptionists, who can’t point to the PC in their office, being sent on database design courses. Social workers being sent off on 2 year courses in dentistry in Australia. Why? Most western government donor funded training is policed by local administration and on a use or lose it basis, again with inadequate auditing and reporting. It therefore gets dished out by local decision makers as a perk. A nice little holiday or a means to a quick buck on expenses. We had one bloke who was supposed to be our counterpart turning up after a year on some donor funded MSc in the UK. He jacked that in after the first 6 months and spent the last 6 stacking shelves in Tesco somewhere in Scotland. He finally returned to Zanzibar because the work and the cushy donor money dried up.

Another amazing scheme cooked up by western government aid agencies is something called the ‘per diem’, a fee paid to attendees of donor sponsored training. What a wheeze this one is. It was initially created because donor agencies couldn’t get locals interested enough to sign up for their workshops etc. so in their wisdom decided bribing them with cash to attend would do the trick. Surprisingly enough, it did. However it also created a per diem price inflation war between competing donor agencies ratcheting up the rates in order to get the largest audiences for their workshops so they could in turn write super little reports for their government bosses. And yet again it’s managed by local officials or aid agency officials with no power or no will to exercise it. So another perk bonus system is created and the results are workshops for health workers filled with cleaners and secretaries and whoever else hasn’t had a per diem hand-out for a while.

Here’s a weird but interesting insight into how a lack of cultural understanding by donor agencies can screw things up. AIDS. Millions pumped into its prevention and even today the results are at best questionable. For a start as AIDS is socially stigmatised most cases are hidden from public view in remote bush villages so it beats me where these ‘official’ figures come from. Certainly not from roving bush reporters (the average UK Department for International Development staff member in Kenya spends just one day in the field per year). Secondly, a big government donor agency drive in fighting AIDS was via legislation to discourage polygamy. Whether you agree with it or not, a significant part of the male African socio-cultural value system revolves around polygamous sex. Legislating against it simply drove them to the illegal kind and a spike in prostitution and, strangely enough, a spike in AIDS. It also left a significant number of unmarried girls having to be supported by their families. Who couldn’t, so the result was an ever increasing proportion being sent to the cities to earn their way. For most that meant prostitution and a one way ticket to the AIDS clinic.

There are tonnes more stories like these all across this government donor infested continent. However I shall finish on a high note.

This is what volunteer inspiration looks like.

Juanito is his name. Every time I start whinging about my lot in life or start thinking I’m going through a hard patch then I turn my thoughts to the ‘Philippine Dynamo’. In placement for his 4^rth year in Pemba the poorest island in the Zanzibar archipelago as well as roving volunteer specialist on the Tanzanian mainland, he’s a volunteer’s volunteer. He makes his own candles, detergent, soap. Foraged and fished his way through a couple of months when his VSO allowance didn’t get through. He plants mangrove trees, literally an entire mangrove swamp with his bare hands as foreshore protection for the village. Suffered racism from his local employers the first year. Discovered and confronted the ministry on corruption involving falsification of volunteer records. His house (a shack) was broken into 9 times in the first month. He had huge resistance from a lot of local teachers and head staff to his project so he circumvented the lot of them and set up shop in his own place for those teachers who wanted to learn, using his own cash. In his spare time he teaches the local village guards to cook, reps for the other island volunteers, hands out free condoms in his personal crusade against AIDS and has set up his house as refuge for villagers suffering abuse and for kids running away from beatings. And yes, I have a tattoo of him on my arm.

While the dark continent might have sucked me in, laughed in my face, spat me out a bitter, twisted, and cynical shadow of my former happy go-lucky self, stronger men and women like Juanito have fought through the above obstacles and have indeed brought lasting impact in places such as Zanzibar. Perhaps not on a national scale but they have made a positive difference.  I was very lucky to have come into contact with a few of them (Juanito, Jackie, Tim, all you HIPZ doctors and VSOs who fought through the bureaucracy, ignorance, corruption, and general bullshit, take a bow). And I was also very lucky enough to have hitched a ride along with one of them. Nadine shall now tell you her blood and guts tale (literally, blood and guts) of how you do aid with impact and style. Over to you Nads.

Dear All,

Well, Movember over and finished. Xmas around the corner. Segueing seamlessly from one to the other in a blogette of less than 300 words Najonajo proudly brings you, possibly for the first time in blogonet history, the Movember Yuletide message.

Nothing more than the traditional simple statement of peace and goodwill to all on earth but, as is also tradition, accompanied by a festive visual that attempts to convey the true power of the message. No, not the Queen in her wellies, and santa hat standing over yet another shot-gunned deer. Nor some lame politician and their family cavorting along a freezing beach. No, this message needs to be delivered by the only two dudes I know with the firepower to deliver peace and goodwill to absolutely every goddamn asshole on the planet. They also happen to have impeccable taste in all things retro-cool. Ladies and gentlemen, our Xmas photo to you all is, using our left over Movember growths, a festive interpretation of the two coolest hustlers in town. Starsky & Hutch.

Enjoy.

Happy yuletide punks. 2 gods of 70s cop thriller funk fashion

Our homage

OK, More a sort of Village People meets Starsky and Hutch. I still think we would have looked better in tinsel fringed hotpants. Anyway, while my Movember effort is commendable, I’m sure you’ll agree, Nadine went way, way beyond an extra mile for the team.

A big thank you by the way to all the contributors to our Movember cause. You managed to raise well over GBP500. This will go to helping Nadine and the medical volunteer team here in Zanzibar begin setting up a men’s mental health clinic at one of the hospitals. They’ve asked me to test run it which I’m very excited about.

Merry Xmas and, who loves ya baby. (Kojak, if you’re wondering)

Every year for the month of November men around the world unite in a show of solidarity by growing out a moustache to raise awareness of men’s health issues such as prostate cancer, testicular cancer and mental health. It’s a smashing cause and an opportunity to raise some much needed funds for HIPZ, the medical charity Nadine works for. One of the HIPZ volunteer doctors (Pete McGovern) has set up a fundraising page here  and all the gentlemen working with HIPZ have taken the solemn oath to cultivate luxuriant top lip ‘tashiness’ for November.

So, if you are a gentleman of style or a lady knowing certain gentlemen of style, come and join us, but more importantly make a donation to an excellent cause. Go to the site to find out more on how you can make your facial hair contribute to men’s health issues.
And a final word from a son of Zanzibar who is no stranger to under-nose hirsutism. Tell ’em how it is Freddie.

No time for looosers! HIPZ wants your ‘tash’!

Yep, it’s true. I’ve left VSO.

For an exciting new job! I’m now the local Manager of a small British NGO called Health Improvement Project Zanzibar, which is a pretty special organisation. We’ve leased the two district hospitals of Zanzibar’s main island from the Ministry of Health over a ten year period after which they will be handed back to the government. Hospital 1 is in year 6 and making great progress, hospital 2 is in year 2 and has a long way to go.

The great thing compared to other aid and development organisations is we take a whole-systems approach, which includes  creating new or renovating existing buildings, sourcing equipment, improving and more often than not developing new managerial, administrative and financial processes and structures, training staff etc. And we are based on the ground so are much more aware of what the real situation is and what is actually needed. I’m responsible for the 2 local Hospital Managers who we have employed  (nope, Zanzibar doesn’t do hospital managers. Can it not all be done by the one and only doctor working in the hospital? Surely that is not expecting too much…), and currently 4 volunteer doctors from the UK and Ireland. Since these two hospitals cover a catchment area of over 300,000 people, and since the second hospital in the North of the island had been without hospital management for over 25 years, you can imagine that it is a matter of all hands on deck. So life these days is incredibly busy but very versatile, and I am learning loads!

Still living with John in our little house but our living room has become my office and I drive up to the hospital in the North of the island and down to the hospital in the South of the island every week. My tasks range from, for example, developing  an effective training system over raising funds for and organising the purchase of equipment such as oxygen concentrators or operating theatre lights, or enforcing disciplinary procedures, to holding speeches in Kiswahili (read from my piece of paper, so nothing to boast about) for re-openings of renovated hospital wards.

More details to come in future posts, for sure. You will not be spared.

As John has mentioned to you UK-dwellers: Watch wonderful Peter Andre’s reality show in the UK on ITV2 on Monday 7 October (9 p.m.) and part two on Monday 14 October, and you’ll get an impression of the two hospitals I work in. And of lovely Zanzibar.

Enjoy….

In case anyone would like to find out a bit more on Zanzibar and the organisation Nadine is now working for there’s a programme on ITV2 this Monday (7 Oct) 9pm GMT called ‘Peter Andre, My Life’. Yes, Peter Andre. The connection with Zanzibar and Nadine is long and labrynth but, in a nutshell, Peter Andre supports the organisation Nadine now works for, went out there last year to do a sponsored charity bike ride and visited the two hospitals she works at. The rest will be explained fully by Peter Andre in all his glory this Monday.  I need to add Nadine wasn’t managing the hospitals at the time so she doesn’t make a personal appearance but hey, you do get Zanzibar, her place of work and Peter all in a one hour segment. Does reality TV get any reality’er ?

Be with this man in Zanzibar this Monday, 9pm.

Lifelong learning, the mantra of numerous philosophies, none of which I am familiar with, and also a mantra of my wife, who I am very familiar with and who I am always keen to impress. To that end a list of things I have learned in my short volunteer career.

1. How to gut fish

If this fish isn’t gutted it is at the very least, upset.

2. How to grow pumpkins.

From this . . .

. . . to this, and . . .

. . .via this, a spot of artificial insemination

. . .to this little cutie

. . .and this! Drum roll. Round of applause. Thank you.

I really should be hosting my own gardening programme. Everything you need to know about pumpkins, with a 10 minute slot at the end on gutting fish.

3. How to remove weevils and then keep them at bay. With a bay leaf, of course. Yes? Never mind.

Or you can sit in the backyard in a pair of alluring boxer shorts and sieve them out.

4. Ride a motorbike. Not something so impressive you might say, however, the complete sentence should read, ‘ride a motorbike that has no 1st gear and doesn’t like turning left’. That, is a skill.

5. How to use water and your left hand instead of paper in the toilet – I know, yuck. However, once you’ve mastered water pressure, nozzle direction and wrist flexing, this is a surprisingly contemplative, almost meditative experience.

Your gateway to another state of mind

6. How to hand bake bread, tea cakes, croissants and stottie cake (Google it. You don’t know what you’re missing).

One of the North East’s finest exports

She ate the lot.

7. How to cure a wood termite infestation. During a full moon, coat the infected area with cow saliva. A dose of varnish thinned with spirits seems to work too.

8. Speak Kiswahili – Baby Kiswahili. Nadine is much better than me. However, I can barter and haggle for fish at the local market. Last week I managed to knock the price of meat down at the local market from 6000 shillings for one kilo to 4000 shillings for half a kilo. I play hard.

9. Speak dolphin – Kakaa! Kakaa! Perhaps not. I’d like to though. There are huge pods of them, up to 20 or 30 all around the island. Very cool animals. Why? Well, apart from primates, they’re the only animal known to have sex for pleasure. What the scientific experiment to work that one out is I have no idea. (Dolphin researcher to Dolphin: You little minx! Did you enjoy that Flipper? Flipper: Kakaa Kakaa!’) They also have bigger brains than us. Admittedly no proof they’re more intelligent than us, however, males apparently use their penis as a navigational aid and to pick up small objects. Clearly, a higher sentient being.

If you could do what he can do, you’d also have a permanent grin.

10. Put to work every, and I mean every, single blade in a standard 8 blade Swiss army knife (Steve, my lad, that was an inspired leaving gift). It’s been used to mend the washing machine, make clothes line, saw through 2 inch planks and plastic piping for the gutter, gut and clean dolphin (just kidding, I could never eat something with a multi-jointed GPS penis) gut and clean squid, repair punctures on dodgy Chinese bicycles, open bottles of even dodgier African wine, cut the tops off coconuts, spear passing ants crossing my path in moments of boredom, dib holes for pumpkin seeds, throw at the wall during moments of frustration (Nadine has forbidden me to use the sharp end on my work colleagues), the list goes on and on …     and bugger. I’ve just found what the blurb describes as a horse shoe toe nail cleaner. There are no horses on Zanzibar.

Apparently this is a horse toenail fluff remover. Recommendations on how I could best put it to use. Most creative suggestion gets put to the test.

An impressive learning list? Yes, I think so too.

Last weekend we visited the Zanzibar equivalent of The Oscars. The Zanzibar International Film Festival or ZIFF. The largest gathering of film professionals, stars et al to celebrate African film. Among the celebs were no less than Morgan Freeman, Laurence Fishburne and Forest Whitaker (go and watch the King of Scotland if you haven’t already. A cracking film for which Forest Whitaker got the Best Actor Oscar). I’m sure you’ll agree, a pretty impressive line-up.

He didn’t show up

He didn’t show up

He didn’t show up

Oh dear. Never mind. The hoi polloi from the mainland did show up but had to mingle with the sweaty massed ranks of the rest of us. And the odd goat. Unlike the swanky elitist Oscars, €1.50 or being edible was enough to get you through the door. There was a reddish carpet, unfortunately overlain on loosely concreted rubble which constituted the auditorium floor. It made the ladies in heels not very happy. It was held in an open air auditorium. The starry night sky was a nice touch. The washing up hanging from all the building windows above and behind the stage and some old bloke on his balcony scratching his nuts wasn’t so ambient. The sound system kept cutting out. Half the nominees didn’t turn up so some poor bloke, an usher, an ice-cream seller, who knows, was shoved up to collect the prizes.

He was getting in to it by the fifth time of asking

The intermission performance included a traditional African dance troupe resplendent in local grass skirts and Nike Air Skin Shorts and a snake charmer. At some point the snake charmer figured out the biggest reaction was when he stuck the snake’s head in his mouth. At which point his efforts to repeatedly shove it in and out of his mouth began to look disturbingly sexual. He was gently dragged off after gagging on it. The snake, dripping in snot and phlegm, had to make its own way off. It was a night out.

. . . and she died.

Not because she was invited to ZIFF, but of timely old age. The dodgy ZIFF link allows me to point out that up until her demise, Bi Kidude was the leading exponent of Taarab, the traditional music of East Africa. And yes, she was well over a hundred years but no one quite knows exactly how old. I’m not going to say rush out and buy Taarab as some liken it to the sound of someone and their cat having hot pokers stuck in them. I however, think she was fab . Nadine and I have been lucky enough to have seen her perform and she was quite an act. Swaying her booty and belting out Taarab tunes. I’ll leave you to conjure up the image. If that’s an image too far you can catch her here http://www.youtube.com/watch?v=bxBf5z3eoqo

Sorry folks, this one is a bit of a counterpoint to John’s recent more appetising post, so a little word of warning: if sanitation topics are not really for you you might just want to consider skipping this one.

It’s that time of the year again at the College,  graduation ceremony: a  dissonant but cheery brass band, no end of speeches, lots of singing – we reported last year.

Happy Graduates

Given the glorious weather it all happens outside on the College grounds. Two days before the ceremony, Salum, one of the Environmental Health teachers, catches us in the corridor and drags us to the notice board: ‘Good news, good news! Tomorrow from 8:30 to 11:30 a.m. we will all tidy up the College grounds to prepare for the ceremony – and we have an NGO to help us!’ It goes without saying, each and every task can be tackled with donor support only…

That aside, why do the grounds need such serious clearing up? Well, as you know we actually live on the campus, a stone’s throw from the main buildings: Our rubbish goes into a big barrel near the house, gets picked up by a truck, if we’re lucky once a week, often once a fortnight. Smelly business. It is an open barrel and you will remember we share the grounds with ravens, cats, bush babies, cows, chickens etc. That reminds me: I’d like to report we believe El Bastardo breathed his last breath last night. I know we hated him but it really is not a lot of fun overhearing a chicken being slaughtered right next door while you’re trying to watch an episode of Dexter.

RIP, El Bastardo

Anyway, back to the main point: especially the ravens are experts at dragging anything and everything previously dumped in the bin out of the barrel and distributing it, all over the place, right across the campus. Early on we asked College management why there were no lids on the bins and they said they kept getting stolen. Errr, okay. So John went on the hunt for a solid piece of wood to more or less cover the barrel and keep the birds out. It never stayed on the barrel for more than a day though. We were rather puzzled. Surely everyone would prefer to keep the rubbish inside the bins where it belonged? Is it really that difficult to put a piece of wood back on a barrel once you’ve emptied your rubbish into it? But apparently El Bastardo and his clan come first and the bin seems to be their little fast food restaurant. Yummie…. What disgusts us most about this though is that there are lots of kids on the campus who roam the area every day. So rubbish is what they play in.

The Handy Takeaway

Gosh, this is a College which is supposed to teach students about environmental health! If they can’t get it right, who will?

So let’s have a look inside the buildings: Ever had dead rat whiff blowing out at you from the air con in your office? There was an initial half a minute attempt at getting the carcass out of the air con box but apparently it was just too difficult for the student who had been summoned to do so. So, a bit of shoulder shrugging and that was it.  My Nursing teacher colleagues I shared the office with told me not to worry, after three days the rat would be dry and no longer smell, so we would just need to wait. Well, the smell did disappear after about 3 weeks, the rat itself is still in there….

The general cleanliness situation has actually improved a bit with management changing but when we first arrived I quite naively thought using the student toilets was an option. I’ll spare you with illustrative information on the state of the actual loo, but will mention that all wash basins had a thick crust of dried dirt in them, and there was no soap, and indeed no water.

Which brings me to the right-hand rule. Many of you will know that in a lot of Eastern and African countries you are supposed to eat, touch other people, hand over money only with your right hand, as the left hand is considered to be dirty. The reason for this is that toilet hygiene is quite different, toilet paper is not part of the routine. Actually some cultures find our habits of using paper instead of water to clean oneself utterly disgusting, and I do get the point. So, without going into too much detail, how does it work without toilet paper? Most local toilets are squat toilets.

A clean looking specimen

To wash your body while still in situ you have either access to a spray hose  or a bucket full of water with a small ladle. The actual washing happens strictly with the left hand. Now that is all very well as long as there is water and soap to access afterwards to wash your hands properly. Very often not the case here. The consequence is that the left hand is really dirty, not just metaphorically speaking.

But, sorry folks, obviously the right hand rule is just not the answer. It is accepted to carry boxes with two hands, to open bottles with two hands, to hold onto the rail on the daladala (the bus pick-ups) with two hands etc. So, hey, simply making it a rule to hand over your money and touch food with your right hand is really not going to make the world a much cleaner place. Okay, okay, let’s just not think about it in further detail….

Our local daladalas – always a rail to hold onto,  with either hand…

I’ll share with you just one last anecdote on cleanliness from the world of public health: Instructions on proper hand-washing are a component of one of the first lessons for nursing students at our College.

In accordance with these rules there have been sightings of nurses in hospitals standing by a dry tap (many wards either don’t have any running water at all or only sporadic access), rubbing their hands thoroughly, in the air, with not a drop of water or soap to go with. Hongera – congratulations! They have now spread the germs evenly across both hands and wrists. But more about the consequences of rote learning in this society as opposed to problem solving and independent thinking another time….