Jahun General Hospital

The Jahun  Hospital Compound full of trees

If you came to the Hospital and you weren’t pregnant you would have to be seen in the part of its that’s run by the  Governments Ministry of Health. From what I am told, the facilities there are very limited, and the two doctors still working there are struggling to keep up, managing only to achieve a bare minimum of medical care. It sounds very much like the set-up I encountered in South Sudan, where the MOH run facility is almost non- functional, and people lie about and survive by good luck more than anything else.

The Hosital Gate looking out

But what you might first notice as you enter the hospital compound is a tidy cluster of newly painted cream buildings with British racing Green roofs and trim, looking rather efficient and ready for action. In the sandy courtyards between them, among more of those nice trees with straight trunks and thick green leaves that line the road you will then notice a huge animated crowd of bright colourfully dressed women and children sitting on mats on the ground, wandering about with pots and cups and bags. 

And most of them are facing in the direction of the MSF part of the Compound, areas that can only accessed by passing through a strong gate manned by two  friendly MSF Security guys. These women and family members are waiting to visit and look after family in the hospital but not many of the patients being waited for are in the MOH wing - most of the patients are women in the Maternity Annexe, which is more or less the entire MSF project in Jahun, and people are flooding into it from near and far, from all over the state and even from beyond. In Aweil, South Sudan where I was last year, the MSF projected also cared for neonates and children up to 5, and had a feeding program for malnourished children. This meant we had other MSF doctors there besides nurse anaesthetists and obstetricians and midwives – we had paediatricians and physiscians, but here in Jahun there are none. It is all Obstetrics. Crowd control is paramount.

To avoid upsetting anyone I take my photos when there aren't too many people about...the place is rarely empty like this

If you were pregnant, the security guard would let you through into a small room where your story is taken and some basic tests are done. Your Blood count is checked, you are tested for HIV and Malaria, your BP and temperature are taken and then a decision is made if you should come forward for further assessment, or be given some advice and simple treatment and sent home.

This all sounds quite tidy and orderly – in fact theres usually a constant stream of people pushing about, trying to squeeze through, shouting and clamouring and not so infrequently a  small mass of people pushes in with a half collapsed woman in the middle of them, groans, or worse, silence from her lips, spots of blood, anxious shouts and panic and she gets hurried through to the “PreDelivery Ward, (PDW) maybe shes about to have a baby, maybe shes had one and lost half her blood volume afterwards, maybe shes been in labour for two days and is half dead with infection, the baby is dead and stuck inside, maybe shes been having convulsions…..

Welcome to Jahun, Paradise!

“Welcome to Jahun, Paradise” is what everyone says when you meet them for the first time here, and they laugh, while my mind goes back to Sapphhire Breeze at anchor in Fiji, diving in  for a swim. I guess we all know its very far from paradise out here, a poor dusty muslim village of 30,000 with exactly what on offer? Nobody seems to be able to say. And not being able to travel about and find out for myself, all I know is the MSF compound, the MSF Hospital facilities and the short drive between the two, along a wide main  sealed  but dusty road that has as many goats as cars going along it and there aren’t that many of either of them . 

The street has a lining of trees along one side but theres almost no other green thing anywhere, just sand and gray dirt that is used to make the small houses on the streets that run back from the road on one side, while on the other theres a scattering of  wooden tables boxes and plastic buckets making tiny stalls and shacks behind the trees with the odd person lounging about.  Just before the hospital, the sandy unsealed side road is all bumps and  potholes, theres a ragged worksite where a new Mosque is in the early stages of construction and opposite a tin shed that acts a a substitute for the time being in this part of town. In a noter place one can see the four tall thin minarets of a more substantial mosque, but we cannot approach it. Everything here is in the "Red Zone" : Out of Bounds apart from the Hospital and the compound. Theres a sort of middle eastern appearance to everything,what with sand everywhere and the Muslim women and girls walking with large and tiny pots and packages balanced on their heads which are always covered, and the men with long flowing gowns and round caps. Its hot and dry most of the time but as it’s the rainy season there is rain from time to time, which so far seems to arrive in brief heavy thundery downpours heralded by strong winds that send sand and litter flying along the road and up into the air as people rush about looking for shelter. At night after rain its cooler, some say cold but I wouldn’t, and its easier to sleep but otherwise in my MSF room, I lie on the thin sheet and perspire all night long. Being the wet season its also malaria season so I sleep under the net and take doxycycline. Paradise : yeah, right!

So I think if you were driving through here you would quickly forget it. Quiet sleepy, dusty Muslim town with nothing happening, no restaurants, no shops to speak of, no sights, you would definitely forget it.

Unless of course you came to the hospital....

Family Members waiting in the hospital grounds

The Kiss Point

We went past this on the way out of Abuja. But this is not my photo as we are forbidden to take photos outside the MSF Compound

On Thursday I finally made it to the MSF Project  in the town of Jahun, in the northern state of Jigaw.  It was a 9 hour drive in the standard issue Toyota Landcruiser, MSF flag fluttering off a short pole on the front right side, and a load of supplies and one other passenger returning from a visit to Abuja. The road was sealed all the way but reduced from 10 smooth lanes exiting Abuja to 2 patched and potholed ones by the time we were in Jigawa State, said to be the poorest in the country.

As expected it was a long tedious drive, with incessant slowing and stopping and starting for road blocks, pot-holes and congestion. The security checks were mostly cursory and we were waved though after a glance into the vehicle by a uniformed soldier with a rifle over his shoulder. At the half way point, the so-called Kiss point,  we stopped at a smoky dark restaurant, had a cold drink and a little food and waited for the arrival of an identical vehicle from the other direction – the drivers swapped, so they could return to their base, and we continued north with a new driver. Usually its the passengers who swap and the driver and vehicle from each end of the route go back the way they had just come but this time a vehicle also needed to be swapped.

I amused myself by counting Petrol stations : they’re everywhere, forecourts mostly empty, many unfinished, half done and abandoned with the unburied diesel and petrol holding tanks rusting nearby , while just along the road a bit  further new ones  are being built – I saw 8 in a row in one town, and 3 more further along. Hard to understand what its all about as theres a standard price for petrol, the only reason for preferring one place to another is the likelihood that at some, the pumps dispense less than what they Register, or that the fuel has been contaminated either accidentally or deliberately  to make a bit more profit. One interesting addtion  to the forecourt services provided in Nigeria that hasn’t hit Australia yet instead of car wash and rest rooms and minimart is the MiniMosque for travellers – some rather cute. Of mosques, there are many, everywhere, again some quite lovely.

We continued on across a relatively flat and massive fertile plain then detoured into Kano for milk – incredible fithy congestion everywhere, infrastructure almost non-existent on the roads we took , a totally uninspiring place that is one of the centers of “unrest” shall we say – and one can imagine part of the reason is the perception that Nigeria’s massive wealth neither trickles down – to the poor – or up – to the North of the country. Ordinarily Kano is out of bounds for MSF.

East of Kano, entering Jigawa the countryside was less densely populated, and for once I saw more rural scenes of village life , there was less rubbish on the roadside and I saw kids playing, donkeys wandering about on their own, cattle, not just the dirty white ones common further south but massive horned brown and black ones pulling heavy wooden carts with kids piled on, it was greener, and the fields of crops and maize looked better organized. Did people look happier here? I was told theres less unrest in this state so maybe they are, despite their poverty.

Unloading at Jahun Hospital

PLEASE NOTE : INTERNET CONNECTIONS HERE ARE VERY INTERMITTENT AND CAN BE EXCELLENT FOR 5 MINUTES THEN NON-EXISTANT FOR 24 HOURS. I WILL UPDTE ASAP BUT THERE MAY BE DELAYS.  

Cleared at last

A Local Paper

I am still in Abuja, a week after arriving, but I have finally been cleared to go up north and start work.
Before the local team leader was happy to send me, I had to see a Cardiologist about my Blood Pressure and the one I saw yesterday had no major concerns about my heart but he added some extra medicine to my pill regime.

So now I take   16 Steroid tablets
                           2 BP tablets
                           1 new BP tablet
                           1 cholesterol tablet
                           1 aspirin
                           1 malaria prevention tablet

or, as my father used to say, enough to have a ball bearing in every joint! My eye is no worse but no better, that I can discern so far - if I look straight ahead with both eyes open everything seems normal but if I close my left eye, everything below the tip of my nose disappears, except for things way out to my right.

Theres a kind of irony in their concern about my blood pressure, wanting to make sure its OK before sending me close to the heart of Boko Haram territory, while the Ebola epidemic silently and slowly builds up its head of pressure in the crowded suburbs of Nigerias massive cities. At the Private Hopsital I went to yesterday there were hastily photocopied notices pinned up all around the Public spaces inside and outside advising that a Press Report that two people had died there a day ago of Ebola were LIES, and that no person with Ebola had EVER been admitted to the Hospital. The feeling is that before long those notices will have to go...

The Dr I am replacing arrived back here yesterday afternoon so today I can learn a little from her about what to expect up there. She said she enjoyed the work but she looked exhausted, and from what she's already told me I can easily see why. But the great thing I have learned is that I will not be on call every night as I was in Aweil last year, so there will be time for catch-up sleep after what I think will be long and busy days.

Transport will not be available to take me for two more days, when some others are also going up, so I shall hang about the house and do some reading.

The Interested Blogger Guide to Eye Diseases

Approaching Abuja, the Capital of Nigeria

Yesterday I was supposed to be leaving Abuja and going on a seven hour journey by road to the place where I will be working in Jigawa State, but instead I returned to the Eye Hospital. I was there all morning and underwent a fascinating battery of tests, that confirmed the Specialists opinion of the night before, that what I am suffering from is called Non Arteritic Anterior Ischaemic Optic Neuropathy. Reading about it today I discover the incidence of this disease in people over 50 is about 1 case per 40,000 so I  am feeling a bit unlucky.

The exact aetiology of this condition is still not properly understood, but it is more common in people with high blood pressure - which I have, though it has been treated - and diabetes, which I don't have. The one thing agreed on is that it almost only occurs in people born with a smaller eye and especially a smaller optic disc, which is the place where all the nerve fibers of the retina converge and form a bundle that exits  the back of the eye like a cable through a circular space in the eye coverings to enter the brain behind it. If that disc is relatively small,  ( the so-called Disc at Risk)  fibers are more tightly packed together, along with their accompanying blood vessels and this crowding is thought to predispose these blood vessels to blockages,the event that precipitates the retinal damage and the loss of vision. There is also controversy about whether there is any effective treatment, and the prognosis, both in the short term and longer. My other eye - what the Opthalmologists charmingly call the "companion" eye - also has a "disc at risk" because genetics have determined what sort of eyes I was born with. Larger eyes don't get off scott free however - they are more prone to Retinal Detachment, which was what I thought I had and which is much more common (1 in 5000 over age 50 ) and also to Glaucoma.

There is some evidence that high dose steroids administered early in the course of the disease improves the likelihood of recovery of at least some of the lost sight, so that is what we have decided to do.

Now I will show you the test results and explain what they mean. The Eye Hopsital gave me hard copies of all their reports and I have taken photos of them, so the images are not good quality. The first image is close enough to what a normal Visual Field study should look like. The black area just below the 9 o,clock  position is the normal "blind spot. All the other grey dots mark out where I can see.

Visual Field Study Left Eye

This is the bad eye. One quadrant is completely blacked out. The Blind spot is in the opposite corner

Visual Field Left Eye

This colour photo below of the inside of my left eye is more or less normal. The Optic disc is the yellow area in the middle and  I am told it is small. A big one is only about a third wider. You can see blood vessels radiating out from it but the nerves are not visible:

The Left Eye

This is the optic disc of the right eye, the bad one. The disc is swollen and pale with indistinct margins and there are smudges of red caused by blood leaking from damaged vessels and causing localised tissue reaction that results in the swelling and further exacerbates the difficulty blood has in getting out of the Disc.

Right Eye

Finally they injected Fluoroscein into the vein on my arm and took more photos. They showed exactly where the blood is flowing and confirmed that it was leaking out of the vessels of the disc in my right eye.

The Good eye : distinct vessels at the Disc, no leaking

Vessels at the disc obscured by blood leaking out ( the thick white patch)

I was totally reassured by the Professionalism and concern that everyone at the eye Hospital showed me, and decided there was no need to seek a second opinion from someone back in Australia, something I had been thinking I might do, initially. Ive been warned to keep a close eye on my Blood Pressure and next month when the steroid course is finished I will start taking Aspirin for its anti-clotting effects. It seems Aspirin is the universal Panacea with more and more evidence appearing of its positive health benefits, almost for everyone.  With luck, the swelling will reduce and some of the nerves recover and the defect get smaller. However I am probably going to have to live with at least some vision loss and  hope this doesn't happen again.

Now I am waiting for permission from Paris to head off to work on Monday. MSF has a rule that if any Ex-Pat develops a problem in the field the advisors in Paris have to be notified and decide what should be done. I cant see why they wouldn't let me carry on - better late than never.

Ebola: the least of my worries

Abuja is in the centre but where I will be working is in Jigawa State in the north

The flying time to Nigeria from Sydney  was just on 24 hours with a three hour stopover at Hong Kong and another three hour stop over in Addis Ababa. The contrast between the two international Airports could hardly be greater, as HK was massive, clean and brilliantly organized and there was a huge range of  Duty Free shops – which didn’t interest me – and food places – which did. I enjoyed Tandoori cooked Lamb Chops with Naan bread and yoghurt, a couple of Coke Zeros and the free wifi.

The Bolle International Airport  building in  Addis looks quite impressive from the outside, a sloping three story glass frontage facing the tarmac but inside the vast halls there was almost nothing to do. There were far too few seats for the numbers of people milling round in transit, there were two tiny toilets with long queues, the Loudspeaker system was unintelligible, forget WiFi -  Internet wasn’t even available at the Internet Kiosk where the woman said it had been down since yesterday,  the Duty Free shops stocked only cigarettes and a limited range of spirits and their staff were slumped in their chairs half asleep. I managed to get some money changed into Birr, and bought a weak Cappucino and had one of the three greasy old chocolate croissants that were on offer.

The last leg to Abuja was only four hours and I had two empty seats beside me. There was a lot of cloud and I only had  glimpses of the land below until we were approaching the airport. The landscape was green and crisscrossed by a network of dirt paths and tracks between the scattered huts and family compounds, and then rough roads appeared, and closer to the city freeways which were only half finished, partly sealed, overpasses unconnected to crossroads. Clearing customs and finding the waiting driver with his MSF teeshirt didn’t take long and soon I was at the MSF accommodation, being shown my room, and after a little food, catching up on sleep. It was around 3pm local time but about 1am Wednesday back in Australia. 

In the morning we left the Compound and were driven to the MSF headquarters for rounds of introductions and debriefings. Ordinarily the extremist attacks by Boko Haram would have been our main concern, as there have been many but this week Ebola was the main topic of discussion and everyone is very worried about it. There is growing fear that a tsunami of cases is about to spread outwards from Lagos, because even though there have only been two cases, in the past Ebola has only occurred in small easily isolated rural communities - but now it has managed to infiltrate one of the most massive chaotic and crowded cities in the world where identifying and isolating  new cases will probably prove to be impossible, such is the poor state of the Public health system in this country, its lack of preparedness and the highly mobile population. Theres a feeling we are on the edge of a cliff and are going to go over in the next few weeks...

Later in the day I discovered I was standing on the edge of a cliff of my own, when a vague blurriness of my vision that I had noticed on the plane the day before seemed not to be getting better, as I had expected it would after a decent sleep. In fact when I crudely tested my vision there seemed to be a serious problem with my right eye - and when I finally managed to do some reading on the internet as all patients do these days I concluded I might be suffering a retinal detachment, an eye emergency that requires urgent surgery to prevent progression to complete blindness in the affected eye. 

Its a disconcerting feeling to realise you might need expertise thats unavailable , that I might go blind in one eye and probably no be able to operate, and also unpleasant is the feeling that I might be going to have to let  MSF down - or more importantly the women I was coming to support - if indeed I did have a retinal detachment.

I felt badly and didn't want to make a fuss but realised I had to do something straight away, because arrangements had already been made for me to head north to the project in a small country town 7 hours drive away, leaving first thing in the morning. I spoke to the Head of Mission, who was a GP from Burkina Fasso and asked her to look into my eye but she was reluctant - she said we had to find a specialist eye doctor to look at it, and so began ringing around. By now it was 6pm, and it took a couple of hours for her to find a Private Clinic way over on the other side of the city, called the Eye Foundation Hospital.  We went there and it appeared to be closed...but in the end, after paying 20,000 Nira - a vast sum for this place - the clinic was opened and the eye doctor came and examined me.

He said there was no sign of retinal detachment, much to my relief but raised some other worrying possibilities that will have to be investigated further. He thinks I have suffered an acute vascular event causing ischemic optic neuritis, but he is not certain yet so in the morning I will be going back for more tests.  Terrorists and ebola haven't been on my mind much at all today, but once this eye thing is sorted they may be. The newspapers and TV is full of shocking pictures of blown up cars and the wreckage from various terror attacks in many places around he country, but so far none in Jigawa state where I hope to eventually arrive and get to work.

Catching Up

Waitui "Marina" Geothermal activity is producing the steam that rises out of the beach on the other side of the wharf

In the morning Aseri came out in his dinghy and he was delighted to receive the fish which I had covered with a wet cloth to keep it cool. Later he returned with the Customs officials and Quarantine, the paper work was done and after paying a couple of hundred more dollars in fees and charges I was cleared back in to Fiji. I had been gone six days. The loveliest memory I will have of the trip was that last day, sailing in towards the Somosomo strait with the sun rising behind me, Taveuni to port, and then an entire day with the wind strong and in from a favourable quarter. I remembered I had told myself on the way out, close hauled or motor-sailing and hating it, that I would have my reward on the way back,  and so it proved to be. I saw two dolphin fish - mahi-mahi -  leap from the water, and dozens of tiny flying fish.


I realised I had made it back in time to possibly salvage my mission to Nigeria. I needed to get my Passport to MSF in Sydney so they could obtain the Visa, a process they said could take up to three weeks, which was all the time left till the start of the gap they wanted me to fill. I had a chat to Jolene at the Waitui Marina and she reassured me that  they could care for Sapphire right there, even offering to bring her to the mooring closest to their wharf, so almost on the spur of the moment I decided to go back to Sydney so there would be no delays with the Visa process. Aseri promised to eradicate the ants while I was away, and the next day I flew to Nadi, and on Wednesday I arrived back in Sydney.

MSF took my passport and I had several meetings and briefings with them about the mission to a place called Jahun in northern Nigeria. I had to get a medical check up, make sure my Vaccinations were up to date and that was about it, so I phoned Amber at the Locum Agency and as usual she came up with some work for me - in Gladstone, Queensland, for two weeks starting Monday 14th. I flew there on Sunday and would return on the weekend before my monday departure for Nigeria.

As it turned out, my Visa was obtained and the Passport returned in just one week, and then MSF changed the date of my departure by a week, meaning after Gladstone there was a week to fill. The Locum was quiet and relatively uneventful so I decided to visit my daughters, grandkids and friends back in New Zealand after the Locum. Ordinarily, returning from Fiji I would have made a stopover there, but I skipped it this time in the interests of getting the Visa - but now I had it, I could pop back and see them all. It was a busy trip but it was great to see them all again, and on my return to Sydney took a further trip up north to catch up with Alex and Jeri in the beautiful isolated country inland from Taree.

I returned Saturday, did all my repacking and watched the Super Rugby final on TV, hoping the Crusaders would beat the Waratahs yet again, but it was not to be. A dubious infringement by Richie McCaw in the last few seconds of the game gave the Waratahs an opportunity to kick a difficult penalty and instead of losing by two, to  win by one, and Bernard Foley did it! A great game for sure!

July had been an amazingly busy month!