price of cigarettes...

The "Framework Convention on Tobacco Control" gained wide press and international support when it became the WHO's first (and only) legally-binding treaty of its kind. During my internship, at the non-communicable disease department in Geneva (where tobacco control is kind of important!) it was upheld as one of the organisation's greatest successes. I do not disagree.

So how and why are the cigarette companies here allowed to get away with selling 3 cigarettes for 100 CFA (that's less than 13p) and throw in an extra mint for free?

I have seen no evidence of anti-smoking advice or campaigns since arriving. It's back to the era of smelling of smoke when you come back from a restaurant, bar or club. The doctors in hosptial rarely take "un histoire du tabagisme". Many, if not a majority, of patients I have seen so far at clinic have presented with a cough, weight loss, fatigue etc - TB? yes, probably epidemiologically, but when will lung cancer also be one of the top differentials?

elective students everywhere...

Je ne croyais pas! Including myself, there are 25 students here in the ID department of this hospital. 23 of them are French and one American girl who actually studies Public Health. Most of the french students came in 2s or 3s and had no idea that other students would be here. I wonder how many other students from Newcastle have found the same thing arriving at their hospitals?

My post a couple of months ago reflected a little on the impact of the migration of students between healthcare systems. Here I am - seeing it first hand. In the wards upstairs, each students looks after one or two patients. They see them every morning and depending on their stage of medical school, try and write in the notes what they think needs to be done. After that they check the medications and investigations (if the family can afford them) by the one doctor that is looking after all 16 patients on that ward. Ishmael, the doctor, is always under time pressure. Therefore the students are helping, but what happens if we miss something. Has this department become reliant on the number of stagiares (elective students)? Actually, I think not, since I know that at other times of the year there are far fewer, if any stagiares. but maybe more doctors take annual leave holiday now?

Some good things manifest themselves too because of the number of students. We have lessons every tues, weds and thurs mornings all together. This is either led by one of the doctors or the students themselves. (I am hoping that I don't have to embarass myself doing one!) Some of the doctors are also really good taking the time to explain things and teach the students, but to the detriment of which patient's care?

Beefburgers and fries à Dakar!!

So last week I was staying with this Senegalese lady called Sineta who runs a bed&breakfast ici. From the website it looked pretty authenitic senegalese, with lovely african room decorations and drumming lessons available etc. Dinner was included in the very reasonable price so I thought, "that'll suit me just fine- easy".

It turns out Sineta is originally Senegalese but has lived in Louisiana, US for most of life. So instead of eating the local food and learning traditional drumming rhythms, I've been eating Beefburgers, lasagne, noodles; and greasy french toast for breakfast and listening to her son's rap music! ahhhh! As many of you know I was vegetarian for the last year and half, or so, all this meat has been quite a shock to the system!

There's more... she's quite a character. Although Sineta has lived in Senegal for the last 12 years, she cannot speak either French or Wolof (the local language). She refuses to learn, complaining that everyone knows how to speak English, they are just to lazy too to try. ummm... slightly hypercritical? Instead, the other day... I was on the back of her scooter wearing un casket but she wasn't. As we came up to this big roundabout a gendarmarie walked out and held his hand to stop us. He tried to fine Sineta 3000CFA ($6) for driving a scooter without a helmet. She started shouting and swearing back at him, in english! So he just walked over and took her key right out of the ignition! it was classic. Amazingly, and I still don't know how she managed to do it (and I haven't heard the end of it since) she managed to sweet-talk her way out of paying the fine.

I have dozen more stories like this to describes this lady's attitude. Suffice to say, it was pretty tiring. Yesterday evening, however I moved to a new appartement. Anna, a US/English journalist who works for IRIN, is going on holiday for nearly 3 weeks so I am looking after her cats while she is away. It couldn't be more convenient for the hospital, being just around the corner and Anna is really friendly. So things are looking up for the next few weeks...

Arrivée au Sénégal

Wow, it's been a tough couple of days! My flight was delayed some 2 hours, then by the time my baggage had arrived, negotiated the taxi price and eventually found the appartment (not straight forward!), it was already 4:30am. After just a couple of hours sleep I had to leave in search of the hospital to meet my supervisor at 9am at the hospital.

One of the main things I have established since arriving is I CANNOT speak french when I'm tired! Oo la la, c'est tellement difficile! Although I'm sure it will get easier, but it's going to be challening and exhausting.

Hopital de Fann, where I will be working for 6 weeks, is one of the main government hospitals in Dakar, and has the only infectious disease department in the city. It has quite a juxtaposition of resources. I am sitting in an air-conditioned room with 12 brand new flat screen Windows XP computers, where the doctors and students have continual access to the internet. Just off the same corridor, there is 'les soins intesifs' (intensive care) where 8 patients are fighting for their lives. There is no ventilation machine, and only a couple of oxygen cyclinders. The beds are dirty and there is an overwhelming smell of urine in the heat of the day. The patients' families have to buy everything from medication to bed sheets. Gloves and masks are reused by the doctors, and in short supply.

Five of the seven patients currently in inetnsive care have tetanus. An infection that is completely preventable by a vaccination programme. The 14 year old boy who arrived this morning, already has developed severe rigidity, trismus and spasms and increasing breathlessness. What was his exposure to tetanus? Circumcision, 15 days ago.

So far, it's been exhausting speaking and trying to understand french all the time. I'd be lying if i said I was enjoying it! I've become this quiet little girl in the corner who doesn't really speak. Although I can understand a lot more that I can speak. When someone asks me a question I'm just embaressed by my inability to make comprehensive sentences!! It's really quite frustrating because the medicine is fascinating, with signs of such advanced disease that one would never see en Angleterre, but I'm concentrating so much on understanding the french I'm kind of ignoring the medicine at the moment. Therefore, many of the doctors must think that medical students in England are stupid and know nothing!

(hopefully more updates to come... sorry, i don't think my English is very "couramment" because i'm kind of thinking in French!)

WHO Internship

Desolée tout le monde... i didn't get a chance to update my blog while I was in Switzerland but I have many things that I would like to share about my experience at WHO... but also now is not the time. Suffice to say that I am really glad of the experience and insight into global public health and the activities of such a large organisation. I will try to update this blog when I have more time and a head that is not half thinking in french, comme actuellement!