Walking for taps and toilets

Last year, the magnificent Emma walked 100km from London to Brighton in memory of her grandmother, and in support of Parkinson’s UK.  She walked through the day and night, suffered horrendous blisters, still looked fabulous when she crossed the finishing line after 23 hours and 18 minutes, and raised a staggering £1727 for a cause close to her heart.  I found this truly inspirational.  This year, I raise my glass to you Emma, and announce that I’m taking on the challenge too.  100Km, day and night, from London (Richmond) to Brighton Racecourse, over the May bank holiday weekend (24^th-25^th May).  I’ll be walking for established global clean water and improved sanitation charity, WaterAid.

On this very blog, I documented my summer 2013 in Ghana, researching the use of untreated wastewater in the capital city Accra.  In Ghana, an estimated 4000 children die of diarrhoeal disease each year.  All but perhaps the tiniest fraction of these could be prevented with the provision of clean water and improved sanitation facilities.  Here’s an extract of an entry I wrote this summer, but never posted.  The sense of injustice I felt… the words could never really convey.

I used to work at a crèche to earn money in the Summer holidays.  There was a rigid routine, and I found it a little monotonous – help them to wash their hands, give them a snack, change their nappies (washing your hands before and after every child), supervise play, help them to wash their hands, wash your hands, give them lunch, change their nappies (washing your hands before and after every child), put them to bed, wake them up, change their nappies (wash your hands), wash their hands, give them a snack…. wash hands, nappies, wash hands, food, wash hands, nappies, wash hands, food, hands, nappies, hands … wash hands wash hands wash hands wash hands.  My day was dominated by a constant search for flannels, filling buckets with warm soapy water, briskly rubbing sticky fingers.  I washed my own hands seemingly continuously – sometimes more than 50 times a day.  Even now, as a medical student, with the stages of the Ayeliffe hand-washing technique and the 5 points of patient contact at which it should be employed branded for all eternity in my sub-conscious, never has hand-washing been such a big part of my life as when I worked with all those little children.  Its boring and time-consuming.  And it saves lives.

Children die of diarrhoea, in large numbers.  Children still die of diarrhoea in large numbers.  Please just think about that for a moment.  Let it really sink in.  Diarrhoea, yes, diarrhoea, that cramping discomfort, those loose watery stools that most of us consider an occasional nuisance (even a fair trade-off for a dirty kebab or an exotic holiday perhaps) kills over seven hundred thousand children every year.  I’m not talking about cholera, typhoid or something equally distant or tropical (although children do die of these too).  The majority of diarrhoea deaths are due to the same old culprits, the common or garden viruses and bacteria send children and adults all over the world running for the toilet every day, which you’ve almost certainly been infected with and will be infected with again.  Children are still dying of diarrhoea that is just diarrhoea.  This is intolerable.

Diarrhoea is transmitted by the “faeco-oral” route; ingesting pathogens from someone else’s excrement; poo by mouth.  We consider toilets and sewage management systems an inelegant and unspeakable given, but the truth is that 2.5 billion people globally do not have access to a safe, clean and private toilet.  And globally, nearly 2000 children a day die because of it.  Trapped in a viscious cycle, dirty water spreads diarrhoea, further contaminating the available water supplies, leading to further spread, more disease, more death.

For everyone forced to rely on unsafe drinking water, for anyone who lacks a toilet, and for all those who have been harmed by pathogens spread by poor sanitation practices – this one is for you.  If you feel moved to donate to WaterAid in support of this wild endeavour it would mean the world to me, and you can do so over on my WaterAid fundraising page.  And you are positively welcomed, encouraged – indeed begged – to read all about my training, my progress, my thoughts, and my little life, right here on Where’s Viv.

No dog-sleds in Ghana

I think it was one of the books that made its way to our home via those colourful and enticing Scholastic catalogues that they distributed at Junior School.  I don’t remember choosing it or buying it, but I remember sitting on the futon on our upstairs landing and reading the true story of Balto in one sitting.  Maybe its the double-whammy of brave animals and sick children, but something about the story has always moved me in a way I can’t logically explain.  Just thinking about it can make me well up; I can’t recount the story out loud without a lump forming in my throat.

Balto was a huskie dog, a lead dog for a sledging team.  In the deepest Alaskan winter, an outbreak of the deadly infection diphtheria broke out in the remote town of Nome.  Diptheria is a particularly nasty breed of throat infection – its toxins cause a web-like membrane to form across the throat, covering the airway, choking and suffocating the victim to death.  Diptheria is now included in the childhood vaccination programme in the UK, but even back in the bad old days, a potentially life-saving antitoxin was available.  But the antitoxin batch in Nome was long expired, and insufficient in any case.  The cases, and mortalities stacked up.  The infection was spreading, and children were dying.  As word of the outbreak spread, antitoxin stocks were released from the Anchorage, but in the harsh winter the only safe way to transport them to Nome in time to save lives was by dog-sledge, in a feat known as the Nome Serum Run.  I forget how many brave teams formed the chain that was planned to race the antitoxin across the state.  Balto was the lead dog of one of these teams.  They set out in the midst of a terrible storm, so severe that their driver, Gunnar Kaasen, was at times unable to see any of the dogs.  Navigational and logistical difficulties led them to complete not only their own leg, but also the following two legs of the trip, in almost complete darkness and in agonising cold.  The dogs, led by Balto, battled on until they reached Nome, where their frost-bitten and snow-blinded driver is said to have uttered the words “Damn fine dog,” before collapsing in the snow.  The antitoxin was delivered, lives were saved.  Balto became a national hero.  His statue still stands in New York’s Central Park.

We can’t be sure if the child in the isolation room had diphtheria, though the signs all pointed towards it.  We can’t know for sure because the (relatively simple) lab tests needed to confirm the diagnosis weren’t available.  Neither was antitoxin.  Neither was money to send for antitoxin.  Or money to send him to another hospital- for an expert opinion, for supportive care, for a cure, for hope.  He died, of a vaccine-preventable, treatable infectious disease, in the year 2013.

On a year of bugs

Tomorrow it will be one week since I finally submitted my masters thesis.  It will also be one year since the journey really started – that first night in Peckham sleeping in a sleeping bag on a rickety single bed, my one bag of belongings spread out on the floor around me; the first walk through Burgess Park to Camberwell Road, buying crazy pink leggings at the East Street Market; the first time I caught the 63 bus to King’s Cross and was dismayed at how long it took; a first night out with cider in the White Horse; my first attempt at cooking plantains.  Then those first-day-of-school nerves, deciding what to wear, worrying that everyone else seems to know each other already, then meeting Phil (my first fellow microbiologist!), then Catherine, Adam, Mark, Naomi, Chantelle, Nenna and all the others, biology-nerd jokes (“I wish that I was DNA helicase…”), free sandwiches.

Last September, I didn’t know what “molecular biology” was, never mind “genomics”, “quorum sensing”, “slip-strand miss-pairing”, “sub-genomic RNA” (actually still don’t know what that last one means).  I hadn’t done an essay-based exam since school.  I wasn’t used to learning by lectures.  I had never done a gram stain, or a catalase test, or streaked a plate for single colonies, or put up a peptone water.  It is fair to say that I was pretty far out of my comfort zone.  I didn’t tell many people at the time, but during that first term I went to see my personal tutor to ask about whether I could consider changing onto one of the public health courses- not because I didn’t want to do microbiology, but because I felt that there was a very real possibility that I wouldn’t pass my exams.  I felt that I was slipping behind already.  He calmly told me to wait until the after the mid-term exams before making any major life decisions.  Wise words.  Bit by bit, microbiology became a bit less scary, then it even started to seem like quite good fun – the moustache sketches and blue-tac dinosaur models that we would find on our lab bench, the endless jokes about “very small rods”, foozball tournaments during “incubation periods”, revision sessions with endless quantities of pizza and Doritos.

I forgave Peckham for the long commute, and began to fall in love with London.  I learned to love the buses.  My commute, which took me first on a morning walk past the Burgess Park duck pond, then over Waterloo bridge on the 168 bus, could make me smile no matter how stressed out I was.  People seem to have a tendency to congregate in London, and I was able to reconnect with some amazing old friends of mine; the happiness that this brought me cannot easily be expressed in words.  I lived in the same city as my older sister for the first time in nearly 10 years (the morning that I showed up for lectures with HP smeared across my face attests to some of the perks of this!), I was also able to see my aunt Penny and cousin Laurence more regularly than I ever have in my life.  I made new friends, wonderful new friends, too.

As I write this, I don’t feel sad or emotional that its over.  What’s left is happiness, fond memories, an overwhelming gratitude for an amazing opportunity.  And perhaps a smouldering, glowing love for microbes, and a desire to understand more about their tiny little world, the infections they cause, how we can kill them, how we can work with them.  I said many times over the last year “I don’t want to be ‘A microbiologist.’”  I couldn’t see myself peering down a microscope all day.  During my thesis-writing-pits-of-hell weeks I would watch enviously as my housemates donned scrubs and stethoscopes and headed off to be real medical students, wishing I could join them.  My return to medicine couldn’t come quickly enough….

But on only my second day back in hospital I found myself sneaking off into the cosy intrigue of the lab, all crystal violet stains and worn chairs, and blood smears dyed a variety of pretty colours, shiny new microscopes and ancient centrifuges, friendly people in white coats and a fuzzy telling broadcasting Ghana v Zambia.  It was my first time there, but it felt like home.

Cabbage

My levels of general lab incompetence peaked recently when I managed to set fire to the bench, the alcohol burner, three of my fingers, and my nice glittery zebra print T-shirt (should have been wearing a lab coat and gloves, what?).  The lab staff were rather more sympathetic to me than I really deserved, and only laughed at me a little bit as I sat for 90 mins unable to continue with my practical work and trying instead to type up my results one handed while the other one rested numb on a block of ice.  Lifting it off the ice for more than a few seconds released the kind of throbbing shocks of agony that reassures you that this is only a surface burn – the nerve endings are clearly all intact.

We have reached the final phase of our field work.  The final domain is market sampling, zipping between stall holders with our clip board and cold box, collecting a lettuce and a cabbage from each.  10 lettuces and 10 cabbages neatly placed in zip-lock sandwich bags, in exchange for a fair price and a small gift pack of toilet roll and soap as a little thank you for the additional trouble of answering our questions about storage duration, nearest toilet facilities, and so forth.  Back at the lab, I pour half a litre of the special salt water into each bag and shake it about, trying to wash whatever may be on the surface off into the liquid so that I can filter it and watch it grow into one of those little blue dots.  Sitting around in salt water for hours makes lettuce look rather limp and unappealing.  The cabbage, however, is more resilient and seems to suffer no ill effects.  So everyone in the lab – from technicians, to secretaries, to managers, to security guards- has been eating a very cabbage-heavy diet for the last week or two.  I myself have not been very adventurous so far.  Cabbage and noodle soup and a spicy cabbage and tomato stew have been my only efforts so far, but with 5 and a half cabbages taking up a full shelf in the (shared) fridge, I feel I should stir myself from my usual kitchen-based laziness tomorrow and perhaps try out Claire’s suggestion for cabbage rolls.  I will update you on the results.

Fun factoids gleaned from my weekend trip to Kumasi

Kumasi, Ghana’s 2^nd city, the regional capital of the Ashanti region, the ancient royal capital of the Ashanti state, and described by one of my friends as “like Accra, but condensed into a much smaller space.”  Also my destination of a choice for a little weekend-exploring.  Here is what I learned:

• A popular urban myth in Ghana holds that the consumption of large numbers of sweets gives you thrush (vaginal candidiasis).  Lollipops will never be the same.
• VIP and VVIP coach companies, although having very similar names, are not the same.  Nor do they depart from the same location.
• Opening times to see the Okomfo Anokye sword at the site where it has been stuck in the ground for the past 300 years, are guidelines only, however Okomfo Anokye hospital where it is located is a rather fine attraction in itself.
• The Ashanti kings used a drum that sounds (remarkably convincing) like the roar of a lion in order to frighten off attackers.
• One of the Ashanti clans has a fire-breathing dog as its totem symbol.  The dog is white with black spots and is remarkably Dalmatian-looking.
• Unfortunately the Prempreh II Jubilee Museum museum neither allows photography, nor sells any postcards of the Dalmatian totem.  Disappointment.
• The feet of an Ashanti King must never touch the ground.
• The incubation temperature of crocodile eggs determines the sex of the offspring.  (Actually I knew this one already, but I think it is worth repeating)
• The Manhyia palace contains a fridge that has been fully functional for the last 62 years.  Unfortunately I forget the make.
• It also houses the “pipe of peace”, which was smoked following the settlement of disagreements, as a symbol of unity.
• Also the only place during 8 weeks in Ghana that I have seen post-cards for sale.  If you want one, let me know your address!
• People in Kumasi just don’t shake it like their Accra counterparts.
• Taking the more expensive (and, as everyone tells you, safer) VIP coach is no guarantee that you will not suffer a tire blow-out and ensuing delay on the return journey (fortunately at low speed).

The lives of others (part 1)

Non-residents don’t usually venture into the maze-like network of muddy sawdust tracks and precarious make-shift structures that make up the Old Fadama slums.  For a while, we idly observe from the perimeter road while we wait for our guide.  Columns of people, trucks and motorbikes surge in either direction through a haze of petrol fumes, displays of brightly-coloured flip-flops juxtaposed with open drains filled with stagnant black water and the smell of sewage.  The light begins to fall, the air seems to thicken, our guide arrives, and into the heart of the slums  we go..

The structures we pass are reminiscent of Quentin Blake illustrations, improbably leaning and irregular.  The occasional two-storey contraption is particularly arresting, as if kept upright by imagination alone.  Despite the criss-cross of naked wires snaking overhead, many stalls are lit by oil lamps only, casting a dancing, dream-like aura over the arrays of sweet wrappers, toothbrushes, kenke and fruits laid out in front of them.  Their flickering does not reach the ground however.  I stumble repeatedly over rocks, ditches and kid goats as I hurry to keep pace with my supervisor and our guide, clipboard and camera clutched close to my chest.  I nearly collide with a line of young women stretching out across the track, over-spill from the nearby mosque kneeling in prayer in the dirt street.  Motorbikes weave precariously through the ceaseless human traffic; a naked toddler bounces past holding his mothers hand, heading for the bucket showers; a goat stands over her kids as they snooze next to an open fire; and the ground becomes springy with sawdust and sewage underfoot as we head further and further into the slums.

The sky is black now.  Round a corner, a rubbish dump two men high and stretching for as far as can be seen by the scattered fires ripping through it, silhouettes skeletal cattle against flames and refuse.  The air, thick with burning plastics, is suffocating.  The rice stall here is lit by a single kerosene lamp, but trade is brisk, and the stall-holder barely looks up or skips a beat as he hands us our salad sample and answers the necessary questions, continuing to serve up rice, salad and chicken at top speed to a growing line of customers while behind him his brother stirs a cauldron-sized pan of fried rice.

Where I am used to hearing shouts of “Obruni” or “White lady” as I walk by, here I am met instead by the occasional yelp of surprise.  In the darkness I appear no different until I am just a couple of steps away.  Children follow me, touching my arms, standing on tip-toes to stroke my hair, giggling madly when I say “Hello.”  One little boy simply stares at me with wide-eyed horror.  On we walk, past the mosques, the endless stalls, the benches filled with people keenly watching WFF wrestling matches on tiny fuzzy screens, a single computer on a coffee table serving as the local internet cafe, more goats, more cattle, more people, more life.  I sneak the odd side-ways glance through open doorways into faded rooms filled with lamp-light and voices.  The place fascinates me, and I find myself wanting to see and know more.

After 2 hours and 10 samples, we head for the car, my head buzzing, already resolving to enrol on a photography course once I get back to Exeter.

Water in a bag

I love you Ghana, but we’re going to have to agree to disagree on this one.  Environmental friendliness aside, I am of the opinion that liquids belong in solid containers.  Even with a sturdy receptacle like a glass or bottle, I frequently manage to miss my mouth in the drinking process.  The little plastic bags which drinking water is usually sold in here are simply not designed for uncoordinated individuals like myself.  Its practically discrimination.

My problem with water in plastic bags is not limited to embarrassment caused by inability to drink water in social situations.  My lab work unfortunately also involves the handling of dozens of bags of water.  In my little cubicle, I sit surrounded by bags and bags of water in various shades of brown, some with lettuce leaves poking out, some without.  Much of this water contains untreated or partially treated sewage- and of course it was one of these delightful samples that I managed to spill all over my feet (and the bench, the floor, pipettes, and various other bits of crucial equipment) this afternoon.  Luckily managed to chuck a bit of kitchen towel and some spirit on it and clean away the worst before anyone noticed (fingers crossed for no cholera).  Today was our first day of full-scale, all-out, big-daddy, real-deal study time.  21 samples of soil, water and lettuce transformed over 6 hours into 87 damp white discs of filter paper on 44 beautiful shiny smooth agar plates, and my breath is held for blue blobs in all the right places (and none in the wrong ones) tomorrow.

We’re going to scale back a bit tomorrow, take fewer samples and conduct fewer duplicates (we need to make sure the lab manager doesn’t have to stay 2 hours behind waiting for me to finish again!).  Yes I need to be faster, neater, slicker; yes I made some silly errors; but I’m also proud of the work I managed to accomplish today.  It wasn’t perfect but it was a solid start, and I’m sitting home tonight with a smile on my face knowing that I managed it all myself.  This is the baseline, and I know that I can do it.  Bring it on!