It’s Sunday again, one month in. It’s been raining steadily for the last four hrs. Gonna be a bog fest! I need to go to town for some spuds and a soccer ball. Not looking forward to tackling the black, sticky and extremely slippery excuse for a road!

It’s Sunday again, one month in. It’s been raining steadily for the last four hrs. Gonna be a bog fest! I need to go to town for some spuds and a soccer ball. Not looking forward to tackling the black, sticky and extremely slippery excuse for a road!

This week’s been quite a challenge but all in all good.

On Monday we tried to go a new way by car to Nyawech but after three hours of driving we were in sight of the village yet unable to go any further. For around 10 km the trip across the plains of waist-high grass was similar to doing 10 km in a tinny [tin boat] with three meter high waves. The ground had two to three metre high mounds every five meters so it was up-and-down all the way and I got incredibly seasick. The top of the mounds was firm but the dips between them were quite boggy. The team was becoming more and more alarmed and wanting to turn back in fear of getting stuck. I made them continue three times before deciding that getting stuck and spending the night in whoop whoop was really a possibility.

The fact that we had a sickly patient and small child with us, who needed to get home, and the fact that we had missed last week's clinic due to security issues, were spurring me on. But with the tukuls of Nyawech in sight I decided that the patient could walk that far and we in turn should turn back and return next week by boat. I gave the poor patient, a lady with metastatic breast CA [cancer] my water bottle and a packet of biscuits from the emergency box, and watched her walk off into the waist high grass, a plastic bag of belongings on her head and child holding her hand beside her.

There's nothing we can do for her. We are trying to arrange a mastectomy purely for quality of life purposes as her breast is fungating with purulent ooze and stinks. Due to the lack of surgical services we are trying to send her to Nasir in South Sudan. MSF has a hospital and surgeon there. We send him a few patients, like a gunshot patient with shattered tib/fib [lower leg bones] this week, but we really could send a boatload each week if they could have us!

This week among my travels I found three pediatric surgical cases that require intervention but only one relatively urgent case. I’ve taken photos that I sent on a disk to Addis with my monthly statistics as it is too big to email. Anyway, I’m hoping they can find a surgeon willing to help these kids but in the scheme of things, I doubt it will happen.

The semi-urgent patient is a seven-year-old boy with a cyst like growth coming out of his bottom eye lid. It has grown in three months and is fungating upwards, disturbing his vision. There's also a one-month-old baby with thumb and fingers fused together that will require plastics at some stage and a five-month-old girl with a closed vagina.

We also had a lady who had been shot in the butt, the bullet lodged in her abdomen. She was carried for three days to reach us but had peritonitis and was transferred to Gambella but with no surgeon there, I don’t think she’ll make it. Also a five-day-old boy with neonatal tetanus, the poor bub convulsing at the slightest stimulation of voice or light. He won’t make it either.

My first twins came back for follow up and while the one we were treating is doing well the other is severely malnourished and was readmitted into the program.

The team is doing really well and has settled into the new dynamics and taken on board my changes. I got sick this week and several came to see me to say they were “sorry” that I’m sick. Bless their cotton socks!

I got stuck in both legs by a bamboo spike the first week I arrived, no drama really. However after 10 hours in the heat in wet, muddy gumboots, the old wounds festered and got infected. Amazing really but it can happen so quickly! Anyway I got sick as a dog on Tuesday: high fever and joint pain (malaria check negative), started antibiotics and then became sooooo nauseated! Spent Thursday at home with leg in the air, worked like a dog on Friday with over 200 patients and then after mefloquine combined with two lots of antibiotics became almost beside myself with nausea. So with the help of omeprazole and maxalon things are better today. I think maybe the mefloquine has something to do with it as I’ve been having some olfactory delusions for a week, woke up smelling bacon and eggs, swore I could smell electrical smoke, and the smell/taste of antibiotics is ever present. Oh yes, not to mention thinking I had three '3's in Yahtzee only to find one of them was a 2! Anyway, all the other expats are on doxycyclin because of the Mefloquine side effects so I may have to change delusions for diahorrea - ha!

The expat team here is a great bunch. Suzanna the Austrian doc is very down to earth and caring. She loves birds and wildlife and is always up at the crack of dawn marveling at the flocks of birds immigrating to this area through her trusty binoculars. This week there are huge flocks of spurwings, huge birds with black and brown wings and a white undercarriage. Thousands of them. She’s really looked out for me with my leg, doing dressings and making me porridge so I could tolerate the drugs. She keeps telling me she doesn’t have any cotton socks! After I’ve earnt some $$$ when I get back she’s going to come over and we will travel New Zealand together, which will be fun!

The PC [project coordinator] Jean Baptiste is a young Frenchie from Brittany, with a midwife background. He is a really kind and caring guy (not SO good looking but then again he IS French) and fantastic with the national staff. He leads by example and doesn’t ask them to do anything he won’t do himself. He’s often right beside them lugging boxes or sweating it out doing stuff. He is also funny and the number one Yahtzee fan (and the current champion of Ethiopia with a very beatable score of 495).

Yesterday we were cleaning the health center from top to bottom, literally scrubbing years of dried sputum and grime off every wall, bed and floor when I was being stupid, demonstrating throwing water to rinse the wall (straight up into the air) to one of the national staff. He threw a bucket of water at me and started a war! It was great and the expats and national staff all got a new lease of life with the cleaning and scrubbing!