I am Gambian: Call me Kumba

Dear friend,

Yesterday, after a week-long unfortunate hiatus, I finally got a chance to go out to the field with the vaccination team once again. I love going out to the field because not only is there a bit of patient contact but the team I get to work with are such awesome people! The team is headed by four Nigerian paediatricians (total co-incidence that they're all Nigerian, lol), two of whom have been especially kind to me. My time in the lab has been riddled with at best a disinterest and at worst a feeling of my presence being merely 'tolerated.' (I admit it's probably just my one-sided perception and they don't mean to be!) The field team, however, made up of a handful of Gambian nurses, fieldworkers and a community 'witness' (= respected member of the community who oversees the clinical trial to make sure there is no 'dodgy' business) have shown me a generosity of spirit that has really touched me.

They treat me like their daughter -- as part of a real family. They have even endowed me with a Gambian name! From the Wolof tribe. The title of my next book? lol 'I am Gambian: Call me Kumba' Yes, my Gambian name is Kumba. And I LOVE it. (Say it with my last name and it sounds like it's meant to be!) The community 'witness' has been teaching me some Wolof as well, so now when mums and bubs sit down in front of me I can say the basics of 'Hi, how are you?' and even introduce myself (as Kumba, of course!). When I arrived there yesterday after being away for relatively so long, everyone greeted me with big smiles and even bigger handshakes, saying how much they had missed me. :) So going out to the field in Fajikunda was a most welcomed day out.

Let me stop for a moment and give you a bit of background of what actually happens on one of these days out in the field. The TB vaccine team are currently conducting a clinical trial on a new TB vaccine that has been shown to be effective in adults, however, not yet trialed in infants. So the team here are aiming to recruit about 300 infants, some of whom will get this new TB vaccine while others get a different meningitis vaccine (because it would be unethical to not give them anything). As mums and bubs come to the clinic to see nurses for whatever reason (either sickness, or medicines, or for their routine childhood vaccinations) they are told about the study and sent home with information for them to discuss with their husbands. Then they are followed up and, if they agree to participate, are screened to see if they meet the inclusion criteria. Hence, on one of these days out in the field, we could be screening, following-up, vaccinating, treating (if anyone is sick), or all of the above. And, on an important side-note, each of these babies need blood samples taken -- but more on that later.

The first couple of times I went out to the field I mostly sat back and watched. One of the Nigerian paediatricians I mentioned above is a young, newly qualified paediatrician who arrived here in The Gambia a day before I did so initially the two of us together did our fair share of 'learning.' It's a pretty crazy, full-on day, with only two small 'offices' (5m x 3m partitioned areas) to do all the business required! And as per the culture/work environment here, having an organized, methodical approach is a very very foreign concept for the locals. The Nigerian doctors, on the other hand, are all about efficiency (I had heard of, and now seen first-hand, just how hard-working Nigerians are!). And I have learnt a lot from watching the inevitable frustrations that arise and the compromises that have to be made by both parties to get the job done.

Besides getting to spend time with my awesome de facto African family, lol, the other grand upside of going out to the field is that I have been practicing taking blood samples from babies. The unbelievable thing is that here it is done mostly by the nurses. Yes the doctors can do it if they need to, but in the interest of convenience and saving time, the nurses do most of the blood-taking. Back home, any kind of procedure (invasive or not!) on children/babies is highly guarded, performed only by consultant specialists or their senior trainees. Junior doctors, let alone medical students, are kept far far away, and know to stay away lest they want to incur the wrath of their bosses and the stressed out parents.

Here?? A completely different story! They've been encouraging me to get amongst it, give it a go, and get all the practice I need. The mums don't mind either, in part because in their eyes I am a Western doctor and in part because healthcare here is still quite traditional (i.e paternalistic) so for the most part people sit quietly in perfect cooperation with whatever needs to be done. Plus, when basic healthcare is a luxury, not a fact of life, patients don't seem to question much.

In my first week here I had a chance to have a couple attempts, both of which didn't go too well. Granted, I had no idea what I was doing. Taking blood from babies is seemingly impossible in the best of circumstances, but with little black babies? With very very dark skin? And no veins that you can see? To quote one of the Nigerian doctors: 'Sometimes you see a vague hint of a vein, sometimes you don't. Most of the time it feels like you're imagining it, so you convince yourself it's there and then just go for it. No fear.'

And yesterday? A success rate of seven out of eleven, baby! All first attempts too! Seven out of eleven!!

There was one baby who's vein I couldn't even imagine I saw so I let the nurses go instead. After four failed attempts by two different nurses, they called over the young Nigerian paediatrician who, in a matter of seconds, oh-so slickly got the needle in, first pop. And I gotta say, it was pretty hot. (A bit of an ambiguous statement, but I'll leave you to take from it what you will, lol.)

So yesterday was another good day. And I treated myself to an ice-cream sundae after dinner as a self-pat on the back.

Always,

-A