MarySmith’sPlace ~ Circle of hell: Cancer Diary #28

Saturday, 27 March: After such a gap, this will be a long post so grab a coffee or a glass of wine and some cake. At the end of my last diary entry on March 10 I still, despite antibiotics, had a hacking cough. On Monday 15 I had more bloods taken at the health centre. The practice nurse thought I felt a bit warm, took my temperature and spoke to the GP who was able to see me after the last patient. Stronger antibiotics and a codeine-based cough syrup prescribed.

Just after 6pm the GP called to say my CRP (C-reactive protein, which can be an infection marker, or indicate inflammation such as in pneumonitis, caused by radiation) was, at 128, much higher than before and wanted me to go straight to the CAU (combined assessment unit) at the hospital. Someone there knew I was coming in. Hah! That person must have gone off duty by the time I turned up, rang the buzzer and waited in the cold for ten minutes before someone came to fetch me.

Admitted at 7pm, nursing staff did the basic observations. Fortunately, I’d had experience of being in the unit before when I had the pulmonary embolism so I knew patients’ drinking water must come from a deep well guarded by multi-headed monsters and had brought some with me. I wasn’t offered any. Everyone on the unit is “very busy”. At midnight, a doctor came to examine me. She prescribed intravenous antibiotics, booked me for an x ray – and said I could have a couple of paracetamol to bring my temperature down.

A cannula was fitted for the IV antibiotic, a Covid test was carried out – then nothing happened for a while until just before 2am two people arrived to take me for the x ray – but the nurse wanted to put in the IV antibiotic first and made them wait. I was still waiting for the paracetamol – they had to check the doctor had written up that I could have it. Finally, roughly two hours after seeing the doctor I got paracetamol to bring down my temperature – and, I hoped, so something about the banging headache I had.

TOP TIPS for being admitted to a “very busy” NHS assessment unit – bring in plenty of drinking water; have a packet of paracetamol hidden in your handbag or trouser pocket; and a wee packet of oatcakes to provide sustenance. Unfortunately, I’d only managed to bring water.

The drip was put up. When it gave the two minute warning bleep that it was about to finish, I pressed the buzzer. After a while, I got up, opened the door and stood in full view of every member of staff until someone finally came to see what I wanted. I was told the drip would finish in a couple of minutes. I asked if she would hear it bleeping or should I press the buzzer? She said she’d hear it. If she did, she was ignoring it – and my buzzer. Again, I opened the door and waited until asked what I wanted. I explained the drip was finished (of which she was well aware) and I was desperate to go to the loo – was told to unplug it at the wall and take the drip stand into the loo. Fine, but that does not stop the bleeping.

For another forty minutes I listened to the bleep and the buzzers buzzing all around before a nurse finally removed the drip, though not before letting me know there were patients with more serious issues than waiting for an IV line to be removed – so that was me told. Well, maybe, it was true, but I’d been coughing constantly for days, was breathless on any exertion, had a high temperature and was exhausted, desperate to sleep. I just wanted it all to stop and told her every minute spent here was making a trip to Switzerland and DIGNITAS more and more appealing. She said it wasn’t a nice thing to say. I wondered if she knew how not nice it felt. She offered me a cup of tea. Said she could probably even find a biscuit.

Early in the morning they moved me into a different room. As I was being pushed along the corridor, sitting on my bed heaped with my belongings, a nursing assistant said she’d managed to find me a breakfast. I told her I loved her. She brought a tray which contained not only breakfast, but a jug of fresh water.

The doctor appeared on the morning round, with the doctor from last night and some students. Said the x ray showed a lung infection (didn’t tell me he’d decided it was community acquired pneumonia – that little nugget came from the DH who was told when he called to find out what was happening) and I’d continue with the IV and oral antibiotics. Said he’d seen my tumour on the X ray (really?) Then followed a squirm-making commentary on how I had to face up to some serious decisions about whether or not I would want to be admitted to an ICU, be put on a ventilator, have ribs broken if I didn’t have a signed DNR … It made me query the seriousness of the infection I have. He assured me it would respond to the treatment – he was talking about the future.

I realised I wasn’t going to get home which meant I was going to have to pull out of the Mining Memories creative writing workshop I was to deliver the next day. I felt so bad at letting people down and so disappointed that the one ‘normal’ working activity since my cancer diagnosis wasn’t going to happen. Spent some time ringing the organiser and my friend, writer Margaret Elphinstone, who I hoped could step in. She did, which was a huge weight off my shoulders. The talk on publishing and marketing has been postponed until April 14, by which time I hope to be able to talk for more than five minutes without coughing.

You, know, I’m not going to give a blow by blow account of the rest of my time in the CAU – one of Dante’s circles of hell. This post could become the length of a novella. I queried the pneumonia diagnosis a few times but, hey, I didn’t do any medical training so what do I know about how long it takes for antibiotics to start to treat an infection. They made not one tiny bit of difference – coughing did not ease, breathlessness increased, for the first time ever my oxygen saturation stats were low and my temperature continued to climb. At least by day two of my incarceration it was taking less than two hours to give me paracetamol to lower my temperature. My CRP (an infection marker or a sign of inflammation) had risen from the 128 which concerned my GP to 200.

I’d fallen out with most of the staff over various issues – like not bringing me something to spit into after using the nebulizer to try to loosen phlegm. Excuse for not providing the container – “Your cough hasn’t been productive.” The timings of the IV antibiotics (I know they weren’t actually doing any good but I harboured a vague hope that if administered as prescribed they might) so one occasion the 4pm dose was going to be at 4.30 but the cannula had ‘tissued’ and had to be removed. The nurse struggled to insert another and after a couple of goes asked a junior doctor who said they’d be along after seeing two patients. It was well over an hour later when the doctor arrived, put in the cannula – but wouldn’t give the antibiotic (nurse’s job) so I waited again. It was finally administered about 7.20pm, over 12 hours after the previous one. I used to think timings of medication mattered, were important. Silly me.

I was suddenly moved to a ward. When a nurse came to give my antibiotic I pointed out it was only three hours since my last dose. They checked and said it showed on the computer it had been raised at 4.20pm – so even though the dose hadn’t been administered then, that’s what showed on the computer.  

View from the ward window, somewhat hindered by the blinds – and the window doesn’t open.

The consultant who came in the morning (the one who first told me about my tumour back in July) said she doesn’t think its pneumonia and suspects pneumonitis – in which case antibiotics will do nothing as pneumonitis requires steroids. She orders a CT scan, which I have done at 5.30pm. Next morning the scan report proves her suspicions were correct. I started on steroids – temperature subsided immediately and when there were no further spikes I was allowed to come home. I’m still coughing and am very breathless. I hope it improves soon. If I sit very still and quiet and don’t talk, the coughing isn’t so bad. Maybe the universe is simply trying to make me stop talking!

In case you are reading this and thinking, “She’s a right old ‘Moaning Minnie’, full of complaints and criticisms,” I should say they were validated by various members of staff – nurses and doctors – both on the CAU and on the ward.  

There is some good news – maybe. Although the CT scan was to see if I did have pneumonitis, it obviously showed up the tumour and there has been some reduction in size. I have an appointment with the oncologist on Monday at which I will learn more about what’s actually happening to the cancer – as opposed to the side effucks from the radiotherapy.

I hope my next update will be a lot sooner.

MarySmith’sPlace ~ Cancer Diary 12

Monday, November 23: Last week was what I think of as my ‘medical’ week, starting with the pre-chemo blood check, followed by the pre-chemo assessment and, finally, the chemotherapy session itself on Friday. It’s a sleepless week of worrying about something going wrong to prevent me from allowing them to drip toxins into my body.

This was the last of my prescribed four cycles of chemo. I was asked if I wanted to ‘ring the bell’ but declined. I’m not tempting fate. I did have a happy, school’s out feeling when I came home – which lasted all the way through to Sunday. I should have written my second blog post about being pregnant in Pakistan when the DH was arrested in Afghanistan but couldn’t concentrate.

This is the first time the ‘meh-ness’ has hit so soon, and so hard, after the chemo. Maybe having my flu vaccine this morning hasn’t helped. I don’t think I’ve felt this level of tiredness before. I apologise for not being able to keep up with the blogs I follow at the moment, and not being able to reply to letters and emails. I’ll be back on form before long. I will respond to comments here, though maybe not quite as speedily as usual.

It’s not all doom and gloom and feeling crap. I did manage a couple of walks last week – just as well because since starting treatment I have gained about a stone in weight and feel disgustingly fat and frumpy. With and undiminished appetite, lack of exercise is definitely to blame – and maybe a few more treats than usual. And, today, I’m too tired for Pilates class – when I really need it!

Sandy Hills, Dumfries & Galloway

I have the date for my next scan – Wednesday, December 02 – though as yet have no idea when the results will come through and when I’ll next meet the oncologist to discuss what’s next.  

Some of you may remember back at the start of this, when I was in my ‘I’m-not-going-to-see-Christmas phase, I started blitzing the house, sorting and clearing out photos, letters, books. I’ve calmed down a bit since then. I sold some of my Scottish books to Andrew Wilson at Beltie Books (great coffee and fabulous home-baking as well as books) in Wigtown. Last week he sent me a poem he’s written about me and my books. It’s lovely and made me cry – I still can’t read it aloud all the way through without my voice breaking. I feel so touched by his friendship and his words, which I will treasure, and the knowledge my books will be cherished.

Sadness of second hand books
we had never seen their like before
these books,
they were so wonderful.
she said she could tell us a story
about each book
these ones she was selling;

but each book was itself
a story, of Scotland
no dates and battles, kings and queens
but the story of our people
Blind Harry, Irvine Welsh, Wendy Wood
McDiarmaid, McIlvannie, McCaig

Neil Gunn, every author
that should be known and loved,
and grace the shelves
of every writer on Scotland,
it was a Bard’s collection
yet they filled me with sadness.

they were from a writer
one who penned verses
on Galloway’s Gaelic places
*inflexible tongues could not say them
and memory forgot their meaning
but the Bard remembered

the Bard told their story
and now she was handing the baton
on to me, with her books;
her own battle with cancer
ahead of her, but her books…
her books would carry our story forward.
                                                                        Andrew Wilson

* words from Mary Smith’s poem “Lost in Translation”

MarySmith’sPlace – Afghan adventures #23 a bit about party politics – Afghan style

By now I had spent nearly two months in Jaghoray and it was almost the end of August. It was almost time to move on, if I was to reach the other clinics before winter. Jon, the project co-ordinator returned to Qolijou and I went to discuss travel plans. The idea was for me to spend some time in each, helping with any admin tasks, stock taking and generally being there to sort any other problems. Jon would return to Pakistan to collect the money and essential supplies the clinics needed before winter closed the road. We would meet at the clinic in Lal-sar-Jangal and return to Pakistan together.

IMG_0006 (Custom)

My room in the clinic

 

At the hospital, one of the translators greeted me, adding, ‘Have you come to visit your landlord’s mother?’ I was mystified until I found Rosanna setting up the x ray equipment for Gul Agha’s mother who was lying, grey faced, clutching at her stomach.

IMG_0008 (Custom)

The x ray room where they were able to see where the fragments of metal had gone in

Chi shud? – What happened?’ I asked, appalled at her appearance. Her only answer was to groan and grab my hand. The translator explained, ‘Hisb-i-Islami attacked Gul Agha’s house in Sangsuragh. His mother was standing behind the gate when a rocket went through it. She is really lucky to be alive but we think pieces of metal have lodged in her stomach.’

 

‘What about the rest of the family, Latifa, Gul Agha ….?’

‘Latifa was slightly injured in her leg, nothing serious. Gul Agha is all right but they captured his brother Hazrat.’

Fatima and Sughra (Custom)

Gul Agha’s mother and Sughra

Gul Agha appeared then – a miniature Rambo, weighed down by his bandoliers, Kalashnikov in hand – but when he spoke to his mother, his expression softened until he looked like any other young boy, stricken with fear for his mum.  I expressed my sympathy and concern and asked if I could visit Latifa at home.  ‘Yes, of course, she will be happy to see you. I have to go now.’  The smile slipped and he looked grim again. ‘I have to do something to get Hazrat back.’

The x ray showed the fragments of metal had missed the major intestines and, although she would be in hospital for some time and suffer a great deal of pain, Fatima would make a full recovery.

Jon and I left immediately for the village. In neighbouring village of Kat-i-Sang people tried to dissuade us from continuing, insisting that it was too dangerous. We carried on, wondering if we were being naive in our assumption that reports of any incident were always lavishly embellished. Gul Agha had said it was all right to visit, we reassured ourselves.

Sughra spotted our approach, running to meet us so, before going to visit Latifa, we first had call at Baqul’s house. We answered queries about Fatima’s condition. I also explained I would soon be leaving, although I would be back before winter. I asked her mum for permission to take Sughra to the bazaar for a shopping expedition with me and Jon the next day. We took our leave and headed towards Gul Agha’s house.

About twenty yards from our destination we were taken completely by surprise as a dozen armed mujahideen leapt from the trees and surrounded us, Kalashnikovs pointing menacingly at us. Obediently, we froze.

Another would-be Tarzan jumped from the branches, rushed towards us, and suddenly threw his arms around Jon in a huge bear hug. They indulged in a bit of back slapping and hugging and went through the necessary enquiries about each other’s health then the muj indicated with a grin, that we could proceed. ‘Who was that?’  I asked.

Jon shrugged. ‘No idea, don’t remember ever meeting him before. Seems he knows me, though.’

Latifa was delighted to have visitors and, once assured that her mother was all right, embarked with relish on the story of the attack. She didn’t seem particularly concerned about the fate of her little brother, positive that Gul Agha would soon secure his release. Her own injury, which was nothing more than a slight scratch on her leg, was proudly displayed.

IMG_0002 (Custom)

 Latifa with her sister-in-law, Gul Agha’s wife and their first baby 

I asked about the people hiding in the trees.  ‘Oh,’ Latifa replied, ‘they are guarding the house in case they try to attack us again. They are from Hisb-i-Islami.’

I was confused. ‘I thought it was Hisb-i-Islami who attacked you?  Gul Agha is with Nasre.’

Latifa nodded. ‘Yes, it was people from Hisb-i-Islami who fired on the house but they are strangers. These guards are Hisbi, but they are from our village. They don’t want any more fighting.’

Gul Agha and baby (Custom)

Gul Agha in proud daddy mode

I was surprised, and heartened, to hear that village loyalties took priority over those of the Party. Much later, on my return to Jaghoray I was astonished to learn that Latifa was engaged to be married to a man from Hisb-i-Islami – the same man who had taken her brother prisoner. Gul Agha (who had succeeded in getting Hazrat freed – I think without blood being shed) was hoping to put an end to Hisbi by joining the two political parties in marriage. Latifa, who had always made clear her views against marriage, was not in favour of her brother’s political manoeuvring and had objected strenuously, but unsuccessfully. Shakespeare, I thought, could have done something with this storyline.

Back at Hussain’s clinic everyone was excitedly embroidering their version of events in Sangsuragh. These now included details of the enemy storming the house and being mowed down mercilessly by Gul Agha, from his stand at the top of the stairs. When Hussain heard of our plan to take Sughra to the bazaar the next day, he immediately informed me that it was impossible, that it was too dangerous for me to go to Sangsuragh to collect Sughra.

I did rather enjoy watching his expression when I told him I had not only already been there already today, I had visited Gul Agha’s house too.

IMG_0001 (Custom)

Me, Jon and Ismail, Hussain’s field assistant. Jon was tickling Ismail so he wouldn’t stand all solemn and unsmiling.

MarySmith’sPlace – Afghan adventures #22 with fighting and kidnappings

Now we were living on the building site work on the new clinic was speeding up and patients seemed unconcerned about the makeshift consulting room. I still spent part of the day writing out case notes and prescriptions. It was good practice for my language skills and could listen to the gossip – even if I did still need Hussain to translate much of it.

Much of the talk was about the fighting which had recently taken place. From what people were saying it had been more than the usual inter-party skirmish and several days of heavy fighting had resulted in casualties, both dead and injured, on both sides.

We decided to visit the Qolijou hospital.

IMG_0012 (Custom)

Qolijou Hospital from the mountain behind. Built at a time Soviet air strikes were a possibility, it’s well camouflaged

The grounds were swarming with mujahideen and a weary Rosanna was in the outpatient department.

IMG_0024 (Custom)

A group of mujahideen posing for their photo – they don’t usually point their guns at each other!

She and the translators had been kept busy patching up the wounded. The stranger with her introduced himself as the “prisoner doctor”. He was an Egyptian surgeon, brought to the hospital to operate on one of Nasre’s men, critically injured in the fighting. I had heard of four foreigners who the Nasre Party had kidnapped a year earlier. They had been sent by an Islamic Arabic organisation to work on a programme it was funding in a Pushtoon area.

IMG_0003 (Custom)

The ward in the hospital

En route they, three doctors and a teacher had been taken hostage. No one seemed to say with certainty what Nasre hoped to gain by this, nor even if negotiations were taking place. Some said Nasre wanted money, others believed the Party was demanding the organisation should build and supply a hospital for Nasre in Hazara Jat. Until meeting the Egyptian doctor I’d never known whether to believe the story or not.

IMG_0005 (Custom)

What can happen if picking up a landmine. This lad lost his sight and a hand.

We went to the staff room for tea and he was allowed to speak with us in English (there were enough Nasre spies amongst the Translators to report back if any attempt was made to pass on messages to the outside world). ‘Mostly our days are spent in a mountain cave, hobbled by leg chains so we don’t try to escape,’ he told us. ‘They took our watches and radios. Otherwise, we are well enough treated.’

IMG_0004 (Custom) (2)

A bit luckier, only part of his hand gone after playing with a bomb

I’d hear one of the men had tried to escape and been shot but didn’t like to ask. The hostages had no idea if negotiations were taking place or what their fate might be, and that, along with their enforced inactivity, was the most difficult thing to bear. ‘We would be happy to use our skills but are not allowed. Only when mujahideen were in need of treatment are we asked for our medical knowledge.’

Following this last battle one seriously injured mujahid was brought to the surgeon who explained he could do nothing in the cave, the man required urgent surgery. Nasre commanders decided to bring patient and doctor, along with what looked like half their fighting force to guard the prisoner, to Qolijou where the necessary operation had been carried out. The surgeon was being allowed to remain twenty four hours in the hospital to care for the patient during the intensive, post- operative phase, and then he was to be returned to his mountain prison. ‘I hope,’ he added, ‘they will bring me back after ten days to reverse the colostomy. In the meantime, I shall try to convince Nasre to allow me, and my colleagues, to work here more often. We could do many surgical procedures, and teach the translators how to carry out the more simple operations. So much could be done for the people.’

IMG_0007 (Custom)

The hospital pharmacy

Unfortunately, the patient died less than a week later so, sadly, the “prisoner doctor” never returned to Qolijou. The hostages were, I heard, finally released, after about two years in captivity.

IMG_0008 (Custom)

The X ray room

I wish I’d known the outcome sooner. It may have had me less anxious when my husband, Jon, the programme co-ordinator was kidnapped in Jaghoray a couple of years later. I was six months pregnant in Quetta, Pakistan when I received the news. As I was thirty-six and considered rather old to be having a first baby – elderly primagravida, as they put it – it had been agreed (reluctantly in my case) I shouldn’t accompany him on a tour of the clinics in case anything happened. As it was I had no idea if they would demand money, keep him for months or years, or shoot him. He did get back to Pakistan before the birth of our son – but that’s a story for another time.

MarySmith’sPlace – Afghan adventures #21 – in which we go camping.

IMG_0005 (Custom)

When we arrived home, everyone trooped out to welcome me and I felt extraordinarily glad to be back, although there was an air of suppressed excitement about Hussain which made me wonder what was afoot.

Ali Baba and Ismail vied with each other telling me tales of the recent fighting. Throughout my stay in Malestan I had never heard a shot fired in anger, nor heard of any fighting. The three Parties in that district seemed content to maintain a peaceful status quo – or perhaps they shared Mubarak’s apathy for anything troublesome.

While I was unpacking Hussain asked, ‘Well, Mum, what did you think of Malestan?’  Before I could open my mouth, he proceeded to answer the question himself, ‘The people are not as educated as Jaghoray people, and of course they are much poorer.’

I replied, ‘Well, I admit Jaghoray is more prosperous but Malestan is peaceful – and the women are much more free, which I liked.’

Hussain snorted.  ‘Free? Free to work all day in the fields! Is that what you call freedom?  Our women don’t need to be field workers. Their husbands can provide for them; they are free to stay at home.’ I was still trying to formulate a suitable reply, hampered by my knowledge that in the UK in the 1950s and 60s some men did not want their wives to take jobs outside the home because it reflected badly on their ability to provide for their families, but Hussain had moved on.

‘I’m very worried about how slowly the work is going on the new clinic. Sometimes when I go there to check only one man is working, the rest have gone to do some other job. They know that we are too busy to supervise them. I think we have to move in now, and then they will work faster. What do you think?’

‘I think you’re mad. How can we move in? The roof isn’t on yet. Where would we sleep, where would Baqul cook, how could you run the clinic?  There isn’t even a latrine!’

‘We can build a latrine in a few hours and we can live and work in tents.’ He flapped his hand about airily, all problems solved. I knew there was no point in arguing.

‘When were you thinking of moving?’

He gave me one of his most engaging grins, ‘Tomorrow.’

I began walking towards the door. ‘Where are you going? Don’t be angry.’

At the door, I turned, ‘I’m going to ask Baqul for hot water for a bath – it sounds like I might not have the chance of one for a while.’

It was actually two more days before the move was made – two days of frenzied activity, begging tents, hiring transport and packing all the equipment, furnishings and medicines.  A large notice on the door stated normal clinic timings would be kept at the Mazar Bibi clinic.  It seemed a bit hard on Latifa who was scheduled to have her ears syringed the day we moved. She now faced a three hour walk to reach the new clinic.

Slide42 (Custom)

Saying goodbye to friends in the village was painful. Sughra spent the morning in tears. We all knew we would not see each other for a long time, despite the fact I would only be an hour’s drive away. For them, that meant a six hour round trip on foot – not possible for a social visit – and I understood that Hussain would be unwilling to bring me back to Sangsuragh very often. He could barely conceal his delight at leaving the village and moving into his own home territory.

Slide02 (Custom)

I have absolutely no idea what Hussain and and I are doing – obviously looking at something fascinating!

Excited as a boy scout on his first camping trip, he was eager to show me our new quarters.  One tent contained the medicines and was to serve as the consulting room. A smaller tent accommodated Baqul, his collection of pots, pans and other culinary equipment.  He was already busy, fussing over a primus stove outside his ‘kitchen’. The third, largest tent was our living and sleeping quarters and I was surprised, and delighted, to discover it was luxuriously different from my notions of roughing it under canvas. The well flattened earth floor had been covered by our brightly striped gilims, mattresses and cushions were arranged invitingly around the canvas walls.  A central flap converted the large living space into two sleeping rooms. The gas lamps hung from hooks, and even my bookcase had been set in place. Very ‘days of the Raj-ish’.

Slide34 (Custom)

Hard at work. The new clinic starts to take shape

The temporary latrine was a hundred yards up the mountain, offering a great view of the surrounding countryside.

Slide09 (Custom)

Temporary latrine

Slide08 (Custom)

Interior view

Baqul, by some feat of magic on his primus stove, provided a feast. After dinner we sat outside watching the moon rise from behind the mountain and tried naming the stars. The Milky Way was a broad band of white sweeping across the sky, and it was astonishing to see how many stars could be seen in Orion, which at home I picked out by his belt. Occasionally we would glimpse a shooting star. Jawad explained that everyone in the world has his or her own star in the sky and when that person dies his star falls down. I told how we wish on a falling star.

We sat talking late into the night. When we could stifle our yawns no longer we retired to bed. Ali Baba, Ismail and Jawad shared one room. Hussain shared mine, explaining that he thought I might be afraid to sleep by myself. I suspected the real reason was that there wasn’t a great deal of room left once the other three laid out their sleeping bags and blankets.

Hussain had been right – our presence certainly ensured the building work sped up considerably. Before long there was a roof on the consulting room, though patients had been arriving long before it was on – and another over the bathroom.

MarySmith’sPlace -Afghan adventures #19 #Health #Leprosy

IMG_0024 (Custom)

Malestan clinic – this was taken the previous year

Mubarak’s clinic was a shambles. The premises, rented from a local farmer, consisted of several dreary rooms round a central courtyard. I suspected if just one of the posters Mubarak had stuck on the walls to brighten the place up was removed, not only the plaster, but the whole wall would crumble.

IMG_0022 (Custom)

Mubarak in his consulting room

Peeping through a doorway into the medicine store, my heart sank. Medicines were heaped on narrow shelves in total disarray. The floor was almost entirely covered by cardboard boxes, some of which had been torn open allowing plastic drip bottles and crepe bandages to spill onto the dusty floor.

My face must have registered my feelings because Mubarak spoke apologetically, ‘We have so little space it is a big problem for us to find a place for everything.  When we move to the new clinic it will be much better.’

‘When will the new clinic be ready? Wasn’t it supposed to be finished ages ago?’

‘Well, maybe after a few months. The problem is, the builders are also farmers, and now they have to work on their land. When the harvest is finished they will be able to carry on building. Maybe you should wait until we move before doing the stocktake. I can give you a list of the things we need. Already we need more supplies.’

I shook my head. ‘No, I think it’s better to find out what you have in stock here, so we know what you will need when you move.’ Mubarak gave a nod, which I guessed was non-committal and suggested I go and have tea while he saw the last of the day’s patients.

IMG_0023 (Custom)

Baba and Khala, the couple who worked as watchman and cook/cleaner

Outside the living room my eye was caught by something stacked against the wall. Under a canvas covering was this year’s medicine supplies, not yet unpacked, although Mubarak was crying for more. Inside, I half expected to find last year’s unpacked boxes hidden under a table. Instead I found Khala, waiting to introduce me to two of her friends from the village.

IMG_0025 (Custom)

Taking tea after dinner in the living room at the clinic.

When Mubarak joined us I assumed the women would leave immediately, or at least cover their faces and turn away from him as they would in Jaghoray. They did neither, greeting him warmly. One of the women patted a place near her and he sat down, taking the glass of tea she poured and laughing at some comment made by the other woman. I nearly choked. These women from Malestan were indeed very free.

As a leprosy patient Mubarak had gone to Karachi for treatment, later training as a leprosy technician. He’d worked in Pakistan until asked if he would return to Afghanistan to open a treatment centre in his own area. He admitted he’d been apprehensive about coming home. ‘The Russians were still trying to win control of the country, but more than that, I was afraid the community would not accept me because of the leprosy.’ In fact, people were so desperate for any kind of medical services to be provided they hailed Mubarak as a conquering hero.

IMG_0021 (Custom)

Mubarak and his field assistant

At the end of the day Mubarak drove me to the house he shared with his mother, about half an hour’s drive away. The clinic guest room where I would have slept was currently occupied by Nasiba, a young woman with leprosy who had come from the north of Hazara Jat.

Her nose was depressed and she had huge, suppurating ulcers on the soles of both feet.  Another, on her side, had been caused by an accurately thrown stone. When still a child, she had been thrown out of her village when it was discovered she had leprosy. For the next ten to twelve years she had kept on walking, sleeping rough when she could not find shelter, begging for food. Sometimes people had been kind and given her food, discarded items of clothing, permission to sleep with the cow or goats for a night. Often, though, she was driven off by people terrified she might pass on her disease. Eventually she had been directed to Mubarak’s clinic.

He had started Nasiba on medication and each day he dressed her ulcers, which were slowly healing. Later, he would arrange for her to travel to Pakistan, to the leprosy centre in Karachi, where she would undergo reconstructive surgery on her nose. For now, though, she was content and happier than she could ever remember.

As we drove to Mubarak’s house I noted near the river everything was green and fresh with poplar trees in abundance. Things were later than in Jaghoray. There, the wheat had already been threshed but here it was only now being harvested.

The house was at the top of a steep incline, at the foot of which was the site for the clinic. It was a two storeyed house: the ground floor was used for the storage of animal fodder and wood and sleeping accommodation for a cow and some sheep. Two flights of stairs led to two front doors both of which were painted bright blue. The window sills were full of red geraniums. Mubarak’s mother was waiting for us; an elderly woman whose face was wrinkled like a walnut but who was still sprightly and welcomed me cheerfully. I was grateful she did not throw anything at me.

The three of us ate together. Mubarak laughed when I said I’d been surprised about the women talking to him. ‘Jaghoray women have no freedom. Malestan is different. Women here can talk to men when they meet. In the clinic we can even give women injections in the buttock.’  This was a concept of freedom I hadn’t previously contemplated.

IMG_0011 (Custom)

Who couldn’t fall in love with such a landscape?

 

MarySmith’sPlace – Afghan Adventures #13 #Babies

Although Hussain didn’t encourage house visits he could never bring himself to refuse, even though experience was teaching him the messenger’s ‘emergency’ was probably nothing worse than an indigestion attack. But there was always the fear that perhaps, this time, it really was a crisis.

Slide13 (Custom)

Shortly before dinner, one evening, a man arrived at the clinic to say that his wife was in labour and the ‘baby did not want to come out’. This threw us both into a panic. When visiting Rosanna, I had examined quite a number of women in various stages of pregnancy, but never had anything to do with actually delivering a baby. Before hurrying after the expectant father, we thumbed through the obstetrics books, trying to memorise relevant chapters.

When we were ushered into the house, none of the three women in the room looked pregnant, and for a brief, wonderful moment I thought the baby had been born. Instead, I was ushered behind a curtain and there lay our patient, looking a lot more calm and in control than either of us. I examined her, calling through the curtain to Hussain that as far as I could tell the baby was the right way round and the head was well down. ‘Ask how many babies she’s had.’

Hussain translated the question and the woman, smilingly held up three fingers. ‘Well, ask what problems she had with the other deliveries.’

Back came the reply, ‘No problems and all are alive and healthy.’ Mum-to-be smiled complacently. A strong contraction came and went. She nodded encouragingly at me.

‘What’s different about this time from the other times?  Why does she feel that the baby won’t come out?’ I asked, instinctively holding the woman’s hand as another contraction began.

There was a longer discussion on Hussain’s side of the curtain then he called, ‘You can come out now.’ As I emerged from behind the curtain he continued, ‘The woman says this time is like all the rest only her husband thought that as there is now a doctor in the village he should call us. We don’t need to stay, the women will help her and we are only minutes away if they do have a problem.’

I didn’t feel I wanted to be only minutes away from a delivery problem. Hussain glanced at me. ‘If I had a vehicle then we could take her to Qolijou,’ he said. I had to agree. Back at the clinic we resumed our study of the obstetrics book. Less than hour later the husband re-appeared to tell us that a healthy son had been born and both baby and mother were fine.  Hussain and I whooped with relief that we were not going to have to practise our non-existent midwifery skills after all.

Soon after this episode I did get a chance to participate at a delivery, fortunately under Rosanna’s experienced supervision. I’d gone to spend a couple of hours at Qolijou while Hussain attended to some work in the bazaar. ‘Come on,’ she said when I arrived. ‘You’re going to see a baby born this afternoon.’ She was just about to examine the very young woman who had been brought in early in the morning. It was her first baby and the girl looked petrified. Her contractions had begun the previous evening but when, mid-morning, they had stopped the family decided to hire a jeep and bring her to Qolijou. Rosanna had started a drip to induce labour again but the contractions were still very weak and infrequent. ‘It’s going to be some time yet,’ she said.

Slide05 (Custom)

A trip in this kind of jeep on these roads was almost guaranteed to kick start a labour!

 

Suggesting the family take the girl for a drive in the jeep she added to me, ‘Driving for half an hour on these roads should get things going nicely.’ Sure enough, when the little group – panic stricken wife, bemused husband, mother-in-law and confused looking aunt – returned the contractions were stronger and more frequent.

Although she had delivered countless babies Rosanna admitted she was slightly worried about this one. I found her in the delivery room, sitting on the floor, poring over her own obstetrics book. The husband was becoming increasingly nervous, making moves towards the door, but Rosanna encouraged him to make himself useful by gently massaging his wife.  Normally the husband is nowhere around for the delivery of an Afghan baby and the two women attendants at first looked shocked, then amused.

Hussain arrived to collect me but there was no way I was going anywhere until the baby arrived. He went off to take a nap.

It grew dark and lamps were lit. When Rosanna next examined the girl she said triumphantly to the father-to-be, ‘Your baby is on the way. Look, you can see the head – so much hair!  Now, you help your wife to push, encourage her.’

She turned to me. ‘When the baby arrives I’ll give it to you, don’t let the women get hold of it until I have finished. I’ll tell you how to tie the cord.’

As the woman pushed to bring her baby into the world Rosanna was there with her, pushing with all her might, puffing and blowing and panting until I began wondering which one of them would deliver first. Suddenly, the baby was there, yelling a protest at its arrival.   Rosanna told me how to tie the cord – giving me the chance to feel that I was actually doing something useful. As I tended to the baby girl, so beautiful but so slippery, I was overcome by awe at the miracle of new life coming into the world.

The father was totally bowled over by it all, the only father in Jaghoray if not all of Hazara Jat who had actually witnessed the birth of his child.

Only the mother seemed totally disinterested and we were afraid that she wasn’t happy because her baby was a girl and not a boy. Rosanna questioned the husband about this but after he had spoken lovingly to his young wife we saw her smile and he said, ‘O khush ast lekin kheley khasta shud – She is happy, but very tired.’ When the baby had been cleaned she was taken over by the two older women, impatient for their turn to participate and they expertly swaddled the child, binding her with a band of beautifully embroidered cloth.

The beaming father took his baby in his arms and invited Rosanna to choose a name and, after some thought, she decided on Gulzeba, meaning Beautiful Flower.

The only time the father lost his composure was when, the afterbirth having come away cleanly, Rosanna began to stitch up a small tear. He spoke excitedly to Iqbal who translated, ‘He is afraid that if you sew her up they will have difficulties in the future.’ When Rosanna explained what she was doing, promising that this was not a new form of family planning technique he relaxed again, looking rather sheepish. Rosanna and I returned to her room where we celebrated with a pot of tea and a biscuit.

On the way back to our clinic, I gave Hussain a graphic account of the birth to which he replied, ‘So now you can deliver all the babies in the village.’

I looked at him, aghast, ‘Not on my own, I can’t – send them to Rosanna.’

Slide29 (Custom)

The bridge of terror from a different angle

MarySmith’sPlace – Afghan adventures #11

A shorter post this weekbecause I’ve been running around like a headless chicken with the book launch. Plus, I felt this particular story needed to be told on its own.

DSCF1071 (Custom)

One day, Rosanna was awaiting my arrival at the field hospital with great impatience. A young woman had been brought to the hospital after a wall of her house had collapsed, burying her completely in mud and rubble.  She couldn’t move her legs and Rosanna needed another woman to help her lift and examine the girl. She was afraid the girl’s mother-in-law could not understand the need for minimal movement to avoid further damage and, although any one of the Translators could have done it, the women would not allow a man to be present for the examination.

Together we undressed her carefully. When at last her tunban – baggy trousers – were removed, we discovered the village women had administered their own form of first aid. From waist to thigh, back and front, between her legs, the girl had been plastered with a homemade compress of cow dung and mud which, dried to a hard crust, took forever to clean off. It was clear as we soaked and sponged the girl could feel nothing from below the waist. There was no response, no flicker of movement.

 

Rosanna was pessimistic, but held some hope that after the initial trauma had passed the girl might recover the use of her legs. She inserted a catheter, teaching the mother-in-law how to empty the urine bag and promised to visit her at home the following week. She carefully explained the girl must be kept flat on her back, not moved in any way, until her visit. The family agreed.

Slide05 (Custom)

Not easy to keep someone lying flat and immobile on roads like these.

She asked me to go with her on the house visit a week later. As we bounced over the potholed, boulder-strewn road I winced at the thought of how it must have been for the family trying to keep the young girl immobilised on their return home. As she examined her patient, Rosanna’s face reflected a mixture of anger and compassion.

Indicating we should move to another room, out of earshot of the girl, she asked through Iqbal the translator what they done. The girl’s mother-in-law said, ‘We couldn’t do nothing. She couldn’t move, couldn’t walk. We had to try something.’

‘What did they do?’ Rosanna asked again.

After a few moments, Iqbal translated, ‘They waited for two or three days but when she showed no improvement they called in a local healer. He manipulated the girl’s spine. They say it made no difference.’

To me, Rosanna muttered, ‘It made a difference all right. He’s inflicted such damage, there’s no longer the slightest hope she’ll ever walk again.’

She was eighteen and had been married for just one month. Her husband had gone to Iran to earn enough money to allow them to build their own house.

He would know nothing of the tragedy until he returned, perhaps after one or even two years. Custom does not allow bad news to be sent to a person who is far from home. Many a migrant worker has returned home, money for the family in his pocket, to a tearful reunion with loved ones. All too often they are tears of sorrow as he learns that, in his absence, his mother died or his brother was killed in action. His hard earned savings may well have to be spent on ceremonies to commemorate a death rather than provide for his family.

The return journey was subdued. Everyone’s thoughts were with that young girl. She had not uttered one word of complaint.  I wondered if, when alone, she raged and cried out, as I wanted to do on her behalf, or if she calmly accepted what life had dealt her?

MarySmith’sPlace – Afghan adventures (8)

The morning of the clinic opening Ali Baba had to lock the door to prevent eager patients from disrupting breakfast.

Too nervous to eat, Hussain checked for the hundredth time that all was ready. He’d asked me to sit with him in the clinic, write the prescriptions and make notes of things which needed to be changed. It would also be a good way to improve my Dari.

Hussain gave the signal for Ali Baba to open the door. Immediately, half a dozen men pushed and shoved each other into the consulting room, all talking at once. Using some pretty persuasive shoving himself Ali Baba eventually succeeded in evicting five of them and the victorious winner sat on the floor, beaming happily.

Hussain urged him to sit on the folding metal chair provided for patients. He, himself, was ensconced in a chair more appropriate to his exalted position.  It was a monstrous wooden armchair of peculiar design and proportions, “crafted” by the village carpenter to Hussain’s specifications. In fact, he very quickly realised it was totally out of place in the clinic and swapped it for a folding chair, which must have been less intimidating for patients.

The examining couch was of equally generous size, and so high that patients required the help of a chair to enable them to reach it. It became a useful diagnostic aid and Hussain often had to hide a smile as a patient who had been complaining of dreadful, incapacitating pains and weakness all over his body would suddenly leap with remarkable agility onto the examining couch.

An average of between forty and fifty patients arrived each day during the first week. This left little time for other work – accounts, reports, supervising the building work at the new clinic. As yet Hussain did not have any leprosy patients on his register but that would soon change.  He would inherit all patients living in Jaghoray who, until now, had been receiving treatment from the leprosy clinic in neighbouring Malestan.

Slide01 (Custom)

Hussain at work in his clinic

Many of the patients who came in the first weeks came mostly out of curiosity, wanting to see the foreign “doctor”. I tried in vain to persuade people to stop calling me doctor. Others came because, at last, they had a health service on their doorstep – one which dispensed free medicine. The clinic’s primary aim was to control leprosy in the area but because of the stigma attached to the disease we knew the people would not be happy about a clinic opening only for leprosy patients. We needed to keep people on our side if we were to be able to trace and treat everyone who had leprosy and could do that by prescribing medication they needed.

One major problem was that many of the patients, who showed up in the early weeks, had an obsession for medicines.  Injections were number one on the list of preferred treatments, considered to be the most effective (if it hurts it must be doing some good?), next in favour were syrups followed by multi-coloured capsules. Antibiotics in the form of plain white tablets such as Penicillin V were not thought to be of much use and aspirin or paracetamol were not even considered to be medicinal.

Hussain valiantly resisted prescribing unnecessary medicines but he was going to have to fight hard to win that battle. His entire reputation as a “good” doctor rested, not on effective health care, but on the amount of drugs he prescribed. In such a close-knit community, holding on to such principles in the face of plummeting popularity was going to be tough – especially for someone like Hussain, whose ego needed constant boosting. Occasionally patients became angry and abusive if not given a prescription, as though Hussain was denying them something that was rightfully theirs.

The days slid by quickly. I no longer reached automatically reaching for a light switch when dusk fell. I’d stopped trying to flush the latrine. I did wish it was possible to flush if only to hide my embarrassing pink poo. Some months before, while working in Karachi, I contracted tuberculosis and had been taking treatment (including Rifampicin, responsible for the pretty poo) ever since. I kind of knew that after nine months of regular treatment – and I was very good at “eating my medicine” every day – it was safe for me to stop. However, I also knew I should wait until I could have bloods checked in a laboratory so I was waiting until that could happen.

Unfortunately, I’d found I was sharing my room with things that went bite in the night. These proved to be tiny mites which lived in the mud walls. Ali Baba sprayed my room thoroughly with an insecticide lethal to all insects – and, presumably mankind, as it had long been banned in the west. Even by bedtime fumes still lingered but I did get a good night’s sleep. After two nights, though, the invaders returned in force to feast on foreign flesh and only if the room was sprayed every other day did we prevent the little horrors from enjoying me for their midnight snacks.

A constant battle also had to be fought against the horrendous flies which swarmed in the moment a window was opened. Baqul would organise fly eviction crusades. Everyone used their patou – the large shawl worn or carried by all the men, required for keeping warm, carrying shopping, wiping noses and a hundred other uses including fly evictions. Each member of staff charged around the room flapping their patou wildly at the flies until, unsettled and giddy, the flies would eventually find their way out of the windows.

The alternative, rather gruesome, method was to add some black Baygon powder to a saucer of water.  The flies found this concoction delicious and would swoop down to gorge, only to be seen moments later struggling in their final death throes. A saucer full of a couple of dozen dead or dying flies floating in black slime was a revolting, but horribly fascinating, sight.

Slide06 (Custom)

Threshing wheat – a timeless image and much nicer than flies in their death throes!

MarySmith’sPlace – Settling in #Afghanistan (7)

In a hired jeep, on a road worse than the one I had previously decided had to be the very worst, we drove to Qolijou hospital to collect the medical supplies.

Slide05 (Custom)

It might not be much to look at but a Russian jeep could go literally anywhere, on any road surface, on any incline. A true workhorse.

Over a fast flowing river was a rickety wooden bridge festooned in a Heath Robinson-ish way with an irrigation system of hollowed tree trunks taking water to the nearby fields. I closed my eyes until we had safely negotiated the sharp bend onto terra firma, leaving the bridge swaying gently behind us. Weeks later, when Hussain was learning to drive, he entrusted me with the task of switching off the cassette while he ventured over the bridge. The abrupt silence was broken only by the sounds of fearful, heavy breathing – his, not mine. I stopped breathing until we were safely across.

Slide20 (Custom)

I’m not sure if this photo demonstrates quite how terrifying this bridge was to cross. It would be absolutely fine as a footbridge – to drive a jeep over it….

The translators – or tarjuman, a title which in Jaghoray had become synonymous with doctor, appeared en masse to meet us and I struggled to remember names and faces as introductions were made. I was rescued by Rosanna, an Italian nurse, teaching a basic health care course at the hospital, who bore me off to her room so we could have tea on by ourselves. She gave a potted history of the political intrigue amongst the translators.

When Medecins sans Frontiers (MSF), fed up with interference from the political parties who wanted to control, not support the work, had withdrawn from the hospital the translators had carried on by themselves – as doctors. During the ten years of Soviet occupation, Afghanistan’s infrastructure was in tatters, particularly in rural areas where there was no electricity, no running water, no sanitation and almost non-existent health services. Their money finished and medicines all but exhausted the translators approached Dr Pfau at the Leprosy Control Centre in Karachi for assistance. She agreed to help on the understanding it was a temporary measure until they could find a more permanent source of funding. Rosanna, who had many years’ experience working in Iran, was asked to teach a course to increase the level of the translators’ medical knowledge.

Although the translators had promised to continue to search for a long term solution, they had made no approach to any other organisation, confident, according to Rosanna, in their assumption that, having begun to help them there was a moral obligation to continue to do so. Their demands for salary increases, new equipment and greater volumes of medicines were escalating. It was becoming increasingly difficult to justify the vast amounts of cash required for the field hospital, especially with Hussain’s clinic scheduled to open. Also, an enterprising and dynamic woman, Dr Sima, whose husband had been killed in Kabul, was planning to build a hospital a few miles away.

Some of the tarjuman, more perceptive than the others, had decided to jump before they were pushed. They had secured funding from an American organisation to establish a new clinic at Angoori, the large bazaar a three hour drive from Qolijou. Building was already in progress but, in the meantime, the renegade translators wanted to continue with the medical course. Rosanna regaled me with tales of the very unfriendly rivalry between the two groups in class. ‘The people who will be left in Qolijou are with Nasre and will make trouble when they know we are going to stop funding. Don’t get involved in any discussions with them about funding,’ she warned as I took my leave to help pack the jeep with Hussain’s supplies. It was good to talk to another woman and to know she was there, not so far away even though I suspected in the real world we would never become friends.

When the medicines and other medical supplies had been stacked in towering piles all around the house the mammoth task of checking everything, compiling stock registers and preparing to open the clinic began. The following days were frantically busy, not helped by Hussain’s temper tantrums. For some reason he was permanently on the defensive, convinced that his clinic was being deprived of vital medicines, without which he could not possibly work properly.

Keeping their heads down, out of the line of fire, Ismail and Ali Baba carried on unpacking and counting while Hussain rushed from box to box, peering anxiously at packing lists, muttering darkly. Even when he had to admit everything on the list had arrived, more or less intact, he was scarcely mollified. Everyone’s nerve ends were totally frazzled and on the evening before the clinic’s opening we were exhausted, but everything was ready.

For me, the day’s major achievement had been meeting a woman. Wandering outside for a break in the afternoon I came across a young girl with her small sister playing a game with pebbles, throwing them in the air and catching them on the back of her hand before they reached the ground – similar to the game of Jacks I played as a child. I knew this was Sughra, Baqul’s daughter and she lived in the small house only yards from ours. Instead of scurrying away, as on previous occasions, she smiled shyly, though the smaller child buried her face in her sister’s lap, casting occasional, terrified glances at me.

Speaking too rapidly for me to understand, she pointed towards her home and I guessed it was an invitation to visit. She sped off clutching her sister to her chest like she was some kind of oversized doll, turning once or twice to beckon. Baqul’s wife, Fatima, met me at the door and launched full speed into the greeting ritual, going so fast that I was barely able to respond to half of the ‘How are you, your family, your health, your happiness?’ liturgy. When she ran out of steam we stood beaming at each other. She offered tea. I declined, explaining that there was too much work to be done but promised to come again. Finally, after refusing tea the requisite three times – though I’m sure it was more than that – I was allowed to return to the clinic.

Cleaning wheat (Custom)

Taken a few weeks after my arrival when the wheat had been harvested. It was the women’s job to sift through it removing stones and dirt. Tedious, but an opportunity to catch up on all the gossip.

I felt guilty that I had done nothing to improve my Dari since my arrival in Afghanistan. Ali Baba and Ismail always wanted to practice their English and Hussain always spoke to me in English. Although pleased the few words I had said to Fatima had been understood I was puzzled that what she had said had been almost unintelligible to me. I asked Hussain why Fatima and Sughra sounded as though they were speaking something quite different from the Dari I had learned. He laughed.  ‘In your country does everyone sound the same when speaking English?’ I thought of Glaswegian and the Doric and had to agree.

Hussain continued, ‘Here, the people speak a dialect, Hazaragi. The pronunciation is very different to how people from Kabul speak. There are also many words used only in Hazara Jat. The women have never been to school so they only speak Hazaragi though they can understand proper Dari.’ I wasn’t sure if I would ever be able to speak proper Dari. However, Baqul explained, very slowly, that his wife wanted me to visit her again soon, to think that her home was mine. I hoped further contact with Fatima and Sughra would let me meet more of the women of the village, who had so far remained elusive.