Pearls of an Oyster

Neck Breakers

''Common Things Are Common..."

"... & the Commonest Cause of Pain in the Neck in Someone Like You is Either Arthritis or an Aching Muscle..."

"... What Are You Thinking?..."

"Actually Doctor, The Commonest Cause of Pain in the Neck... a HUSBAND!"

-> "Yes I Suppose I Can Learn To Live With the Pain in My Foot. After all, I've Been Living with a Pain in the Neck for Years!"

It's Hard To Sing (Say) I'm Sorry

I'll Show 'House'... 70 Year Old Female... Hears Music Every Night From 1am To 7am... Let Me See... Her Daughter Can't Hear it... The Council Failed To Record it... Now She Wants Me To Visit at 2am To Confirm it!... Oh & She Expects Me To Apologise for Not Believing Her!

a) It Could Be an Ear Pr... NO! ENT Have Ruled That Out! b) It Could Be a Brain Tu... NO! There's No Focal Neurological Deficit! (But Go Request a Brain Scan To Satisfy Your Curiousity) c) She Could Be Telling the Tru... NO! People Lie! d) It Could Be a Psy.... YES! Finally... Where's My Vicodin?

No Apologies Then... Sing Hallelujah)!

Smokescreen

Having a Smoking Area in a Restaurant is Like Having a Peeing Area in a Swimming Pool!

It's Disgusting!

Oh & Why is it That Every Ex Smoker I Meet is Convinced Their Health has Deteriorated Since They Quit Smoking?!

Smoking is a Filthy Habit & as it Says on the Packaging 'it KILLS!'.

Now 'Do One' & Take That Awful Smell with You... I'm Trying To Eat!

Lost

Am I Losing Touch With the Common Man (& Woman)?

I'm Sat on a Train (For Only the Third Time in Five Years). I've Only Been Travelling for Fifteen Minutes & I Feel Like I'm Being Swallowed Alive.

There's Two Asian Girls To My Left. It's Not That I'm Eaves Dropping But They're Doing a Good Job Telling Everybody Their Business, & it's Boring. Shouldn't Their Daddies Be Picking Them Up Anyway?

There's a Dog on the Seat in Front of Me. I'm Trying To Stare it Out But I'm Half Expecting it To Pounce on Me & Use it's Wet Tongue. Why Do They Let Dogs on To Trains?

There's a Group of Guys Sat Behind Me Doing a Good Job of Shouting in My Ear. Goodness Knows What They're Saying But it's Foreign, & Before You Say it, No They're Not Speaking in English.

Please Spit Me Out! Now! I'll Walk.

T = X - 24 Hours

Guess You Didn't See Me in Those Low Dim Lights...

Will The Real Cheryl Cole Please Stand Up

Press 'N' for 'Next' & a Few Seconds Later an Eager Patient Should Barge Through My Door... Now That's How it's Supposed To Work... However... The System Was Down Today!

I Hate Making the 10 Yard Walk into the Waiting Room! Peering Around the Corner & Calling Out One Lucky Name From the Wishful Crowd; Their Hopeful Gazes Turning To Ice Cold Stares. Yet Today I Was Quite Excited! Not Because I Was Expecting the Real Cheryl Cole... But Because I Couldn't Wait To See Their Faces When I Called Out Her Name lol  

I Couldn't Help But Chuckle When My 67 Year Old Cheryl Cole Turned To Look at Them All & Said 'Well I Came First' lol.

Sky High

A Hijabi (Patient) on Concluding Our Consultation Nervously Told Me 'I Looked Religious'... or at Least Hoped as Much... 

She Went on To Ask Me If Smoking Cannabis Was Halal or Haram. Her Reasons for Smoking it... Pain? Depression? Apathy? Habitual? All of the Above?

After Stressing the Obvious 'Not To Judge a Book by its Cover' & Pointing Out That My Beard Did Not Make Me a Scholar... I Gave Her My Honest Opinion...

What Did I Tell Her I Hear You Asking... 

Irony

What a Day!

Look I Know it's Half Term... But Where Have All the Young People Gone? Surely There's 1 or 2 Who Need a Sick Note or Their Daily Dose of Antidepressants!

Listen I Love Helping the Elderly But Today I've Seen More Old Folk Than Get Together for a Game of Bingo, or for a Day Out To Watch the Bowls! I Mean I'm Trying My Best Here... Sorry I Can't Fix Your 'Problem' That You've Only Had for 20 Years!

Give Me a Break!
Be Realistic Now!
Just Get Out!

The Return

Back from Pakistan... no further diary updates due to lack of internet acess...

Back To Capitals :-)

Pakistan Floods 2010, Doctors Worldwide - Day 9, 16/10/10 - Winding Down

Today I worked at Pir Sabaq & Ripon at Gandheri. It was my last day at the clinic. On my way there I couldn't help but think how courageous the people are. They are working hard to rebuild their lives. Small children do the tough work of adults not because they are forced but because there is a genuine need. I couldn't last a day in their shoes. At the clinic Scabies is seen on a daily basis. It's usual treatment involves treating the entire family with an 'all body' lotion on two separate occasions. A fair guess at family sizes in Pir Sabaq would be between seven & thirteen. Need I say more? (we are out of Permethrin)!

Before leaving Pir Sabaq for the last time, I forced my two helpers to accept £20 each (a gift & not from the 'give to the needy' pot). I could see their intrigue as they examined 'English' money. Unfortunately that was not the last thing I did before leaving. That was to ensure that one of the self declared male volunteers (husband of an employee) does not enter the clinic again. Let's just say his behaviour toward female patients has been inappropriate!

After lunch which included a special treat - fried fish, we completed the medication stock check & provided instructions for maintaining standards & reordering medications. We packed (hastely) & bid farewell to our hosts, leaving them all with a £20 gift.

We had supper at Zeeshans house in Islamabad. It was delicious - no disrespect to 'chacha' (our cook in Mardan), but this food definately had a womans touch!

I am currently in a hotel in Islamabad (no it's not the Serena hotel lol). We are expecting Leah from the UK tommorrow. She's going to film a documentary for DWW & their donars.

We have given AW an amount of money to begin the 'sewing project' & to contribute towards a 'water project'. This includes money given by friends & family to give towards helping the poor.

Pakistan Floods 2010, Doctors Worldwide - Day 8, 15/10/10

This morning I travelled with Abdul Wahab (AW) to the village of Saees Mandi to help oversee the cement distribution programme (Build Nowshera). Those whose houses have been completely destroyed by the floods are eligible for free cement to help with the rebuilding process. DWW have set aside around £40000 pounds for the project. There were a few unsavoury moments when those ineligible for cement became angry & vocal towards us. I empathise with them but given our limitations there needs to be appropriate selection process. The morning also involved filming videos to help promote our work. A journalist/photographer is flying in from the uk on Sunday for this purpose but in the meantime we have made dozens of snippets.

We spent the afternoon writing reports. These included project updates, exit strategies, budgeting & total expected costs. This was painstaking work & really needs to be done by a dedicated project manager.

We delayed supper so that we could 'trek' through our store room & document our stock of medications. We need to put in place a simple process of stock keeping & reordering of medication that can be carried out by the local staff. It's a bit of a shambles at the moment. Hopefully we can avoid diverting funds in order to employ a pharmacist.

I looked into Ripons idea of helping a mother to pay for her daughters wedding. It turns out she has a job & the family have a car, computer & even a pet dog. We have decided against giving her any of the money earmarked for the needy.

Pakistan Floods 2010, Doctors Worldwide - Day 7, 14/10/10 - Pay Day

Today I spent most of the day at the basic health unit (clinic) in Pir Sabaq. I'm beginning to appreciate primary health care in a developing country such as Pakistan. I have no tests available to aid my diagnosis, there is no referral system for further assessment & their is a lack of medication (I'm talking about types not amounts - believe me they're 'downing it' like candy). 

For example I made a clinical diagnosis of malaria in a patient, however for a number of reasons including geographical, monetary & personal health beliefs, she (like almost all others) is unable to have a simple blood test for confirmation. Then there's the man who is having what sounds like epileptic seizures but is unable to afford to attend a hospital for further tests & possible treatments. This sort of management is so routine in the UK that we take it for granted.

During a much needed break I spoke with some of the locals (including staff members). After hearing the stories about of previous volunteers we are well aware that most of the people we have come into contact with will be hoping for some amount of financial help. I do have an 'amount' of money including that given by friends & family that I will give out over the next few days. Everybody seems so poor but I hope I can find some of the neediest people to help. As someone who is well known for his charity work in the surrounding villages, Abdul Wahab (AW) is often asked for financial assistance (for a number of reasons). Ripon has asked me to consider joining him in helping a widow in paying for her daughters wedding.

In the evening we visited the Bazaar in Nowshera. It was busy & I did well not to be run over by the dozens of motorbikes making their way through the crowded streets. AW brought along one of the women from the clinic who was able to ensure we only paid 3500 rupees for our purchases. The initial asking price was 6000 rupees.

I've spoken to a relative in the army. Hopefully we will meet up tomorrow.

Pakistan Floods 2010, Doctors Worldwide - Day 6, 13/10/10 - Hope for Humanity

Along with a group of friends (who also happen to be Doctors) both Ripon & Me are founders of the registered charity 'Hope for Humanity' (HFH). We have completed a number of small projects such as buying a centrifuge machine & storage unit for a blood bank in Pakistan. We have also donated money to a library for the blind as well as contributed to other charities including Doctors Worldwide (DWW) & the 'Orphan Child'. We are open to projects from all comers (See below for proposal template)

Once back in Mardan we discussed opportunities for a HFH project. With the help of Abdul Wahab we have come with a possible project. Below is a provisional plan which we will discuss with our fellow trustees once back in England.

Ganderi Village (Nowshera) Sewing Class Project Proposal

Project Aims

- Approximately 150 women to be trained during a one year period; all will be given a sewing machine on completion of training.

- Empower women with a new life skill so they can earn money & not rely on donations.

- These women can make clothes for themselves & their families (reducing living costs).

- Give these women more financial independence

- Improve living conditions for these women & their families.

- Additional benefits include psychological wellbeing e.g. through social interaction.

- Pilot project; if successful can be expanded to other areas.

Time Frame

- Start as soon as possible, lasting for an initial period of one year.

Location & Facts

- Location = Ganderi village, District Nowshera, Khyber Pakhtun Khwa (KPK), Pakistan.

- Population of Ganderi village: ~30,000

- Ganderi is next to Risalpur, behind the Pakistan Air Force Academy base.

- The adjacent village ~ 0.5km away is Saees Mandi (submerged by the floods).

- 1km away is the Afghan Kheshki refugee village (very badly affected by the floods).

- Nowshera city is ~ 3.5km away.

Target Population

- Initially women from Ganderi, Saaes Mandi, Kheshki & Nowshera. All ages will be considered. Children will be allowed to attend the afternoon classes after school.

Background

- Ganderi is an old village from the British Colonial Period. It was used by the British Colonials as a Cant for their horses. The majority of the people here are Pushtoon. There first language is Pushto. The people here are very poor & the majority of those who work do so as manual labourers (e.g. brick work, building, farming etc). ~ 20% of the men are literate whilst most women are illiterate. However both boys & girls now go to school. The women are mostly housewives. These women do not have any means of income & it is difficult to feed even a small family with the basic earnings from a husband’s wages. The average wage is 6000.00 Rupees per month.

- Ganderi was ~ 1/3 submerged by the floods in July 2010. The people who are already struggling to live above the bread/roti line are now poorer after the flood. The floods have put this area further behind. Many families can only afford one meal a day.

- The Basic Health Unit (BHU) in Ganderi was one the bases for Doctor Worldwide.

Local Coordinator/Contact

- Mr Abdul Wahab (AW), Field officer for DWW since 2001. Lives in Ganderi village & will be able to oversee the running of the project from start to finish (e.g. acquiring site, sewing machines, hiring teachers etc – already in the process). This will not affect his current work & responsibilities for DWW.

Method & Costs

- The approximate cost of the project to set up & run for one year is approximately (350000rupees/£2500).

- Setup costs (i.e. buy the machines, tables, chairs etc) = £1000

- Monthly running costs = £125/mth (2 teachers from Nowshera for 6hrs/day - monthly salary = 8000 rupees each, & electricity, cloth & room hire).

- AW is currently trying to procure some free/donated machines (from ‘Five Pillars Charity’) which may help reduce the start up costs.

-How will women find out about this project? Word of mouth & flyers. We will pick the poorest people & there will only be one person per household.

- We are hoping to transfer the funds to a registered charity account (e.g. DWW Pakistan) in order to maintain a transparent audit trail. AW will keep a record of the costs & receipts. Once the project is started, AW will forward pictures/videos in due course & keep all donors updated.

The Teaching Plan

- The teaching plan is for 2 full time teachers to teach a group of 20-30 women sewing over a 3 month period.

- The women will be taught in 2 sessions: morning & afternoon classes (3hrs each). Each class will have about 10-15 women. There will be classes 5 days a week.

- Therefore every 3 months there will be a new set of pupils.

- On finishing the course, the plan is to try & donate a cost effective sewing machine (~3000 rupees) to each woman to get them started.

Project Evaluation

- AW to keep a register of the women trained for audit purposes.

- One year on, if deemed successful we can decide on either continuing in this location or moving to another village

Pakistan Floods 2010, Doctors Worldwide - Day 5, 12/10/10 - Hotel Reservation...

Zeeshan picked me up at 8.30 am. We travelled to the Serena hotel in Islamabad to attend a World Health Organisation (WHO) cluster meeting. Clusters are essentially groups such as 'health, hygiene, food, clean water, education' etc that allow for better coordination of relief work. Every Tuesday representatives from Non Governmental Organisations (NGO's) working in the 'health' cluster, come together to provide feedback on their progress. As mentioned this allows better coordination of relief efforts, e.g. in our case to identify a location in the south of the country where flood related relief is needed the most but where there is also a shortage of aid agencies. 

The hotel was the biggest & best I have seen on my travels abroad. I phoned Ripon to tell him about it & he was keen for us to spend a night there. The cheapest rooms are about $600 per night. The business complex plays host to the Office for the Coordination of Humanitarian Affairs (OCHA), which is part of the United Nations (UN). We visited OCHA to collect up to date maps of the current flood situation. By the way we couldn't justify spending so much money on ourselves given the context of our visit. Maybe next time?

The cement delivery to Mardan has been delayed until tomorrow. Instead I have come to my home village some 3 hours from Islamabad to meet up with my mum. Village life is just something else! Back to Mardan tomorrow.

Pakistan Floods 2010, Doctors Worldwide - Day 4, 11/10/10 - Work Hard Play Hard

I here there was an earthquake last night. We were up until 4am but didn't feel a thing.

We spent a good 5 hours working at the clinic at Pir Sabaq. It was hectic. Over 3/4 of patients were women & children. Two or three patients were allowed into the room at any given time & so privacy was non existent. A translator was present for patients unable to speak Urdu. It felt like the entire village had turned up with a mixture of acute & chronic problems. Some were expected e.g. infectious diseases, but others were not flood related e.g. Women complaing of aches, pains & feeling tired all the time. I have a feeling that vitamin D deficency may be prevelant despite the sunny climate as the women are often covered from head to toe. Unfortunately there is no blood testing available & no provision for prophylactic treatment.

After the clinic we met Zeeshan who is joining the team in the position of 'project manager'. He has plentiful experience with working with charities & will have the responsibilty of formulating our plans for the next 6-12 months. With this in mind, I am going to tag along with him for an important meeting taking place in Islamabad tomorrow.

I've just spent the evening with relatives in Islamabad. I've had a lovely time. Apart from the great company & food, I got to see the bazaar at night. I'm looking forward to spending the night in a proper bed & to a HOT shower in the morning.