Going Home

I am writing this just after midnight on the plane from Freetown to Heathrow. I have always found that flying is like being in emotional suspended animation. Any excitement, or trepidation, or sadness, there might have been in the departures hall, switches off with the bump of the wheels leaving the runway. In less than 6 hours, normal life will be resumed with the sound of seatbelts being released and overhead lockers being opened, but for now, I am in a different place –  35,000ft above somewhere in North West Africa, feeling calm and clear-headed.

When I saw my boss last Friday, I told him that I had just had  a great two months. He had just presented me with a big hand-woven blanket from his home village, embroidered with my name and thanks from him and his family. I’m not exactly sure why my experience has been so good, but it has worked for me on lot of different levels. Professionally, it has been interesting and challenging; socially it has been fun; and Laszlo’s obvious enjoyment and fearless willingness to get involved during his visit has been great.

One of the things that has surprised me most about my time here has been the way it has brought back stories about things that happened to me in my twenties, when I was a VSO in Uganda. Quite a few people have asked me about those days (including Ugandan VSO’s who are too young to remember them)  and I have talked about the things that happened, including my experiences from the war there.

Many of the people I have met in Sierra Leone have experienced horrors in their lives that I hope I will never even dream of. Some of them will tell their stories freely, but others seem to be struggling to make sense of them. Even my most difficult experiences, of course, are absolutely nothing in comparison, but being here has made me realise how important it is to find a way to tell our stories – all the fragmented bits that add up to a life.

I don’t feel at all pessimistic about what I have seen and experienced. In fact my strongest impression is nothing to do with conflict, trauma or poverty, but about meeting people with a fundamental self-belief that would be the envy of many of us neurotic Brits (speaking for myself here, you understand). A friend of mine once gave me a fridge magnet that said – “Sing as though no one is listening; dance as though no one is watching; live as though heaven is on earth”. It has been my privilege to live and work for a while alongside people who really seem to know how to do that. I know I will never be able to dance like a Sierra Leonian (and don’t worry, I won’t even try) but I do sort of hope a bit of that attitude might have rubbed off.

So that's it from the Freetown Blog, but please forgive me one last self-indulgence. One of the tasks that I would normally have been doing over the past two weeks is writing Christmas cards. It is a bit late for that now, so please accept this home-made one with my very best wishes for the festive season and the coming year.

A festive Freetown surprise

I was lying on my bed under the mosquito net in the dark, sometime after 10pm. It was a very warm night (so no surpise there) and I was glad of the slight breeze blowing in through the open windows. Suddenly a sound started up outside that was as surprising as it was familiar.

Here in Freetown, I am quite used to late night West African music, but  a brass band playing "See Amid the Winter Snow"? It turned out that it was the Freetown Police Band. I was brought up in a small village in Devon and every Christmas the village band would  travel the parish playing carols at the outlying farms. The band often received refreshment at the places they visited. As the evening wore on, and more hospitality was received, the carol playing would increasingly become a triumph of enthusiasm over technique. As you can hear from the attached clip (which I recorded on my ipod recorder), I suspect the same tradition of hospitality operates here.

The Boat Pushing and Other Adventures

We are now back in Freetown after 8 days of travelling down the coast and up-country. We set off last Wednesday with only a vague plan, deciding to travel light without much gear and hope for the best. And the best was, pretty much, what we got.

Our first stop was River Number 2 Beach. Before we left Freetown, I was unsure how easy it would be to get places to stay, but as it happened we were the only visitors there (and that continued to be our experience for the whole week). That evening on the beach we had a good chat with the only other person on the beach - a Bristolian, who first arrived 10 years ago on a government engineering project, and seems have all he wants for a happy life in his beachside house, with his Sierra Leonian wife and the gin bottle in the pocket of his shorts. We could certainly agree with him that as far as the setting is concerned, River Number 2 is hard to fault.

The next morning we crossed the river mouth by boat and walked three miles down the beach to Tokeh Village. Tokeh Beach was the site of the filming for the original Bounty Bar advert in the 1970's and you can see why the chose it -the sand is so white and so soft that it is more like walking on snow than on sand - it even squeaks like powder snow. Tokeh village is a fishing village and when we arrived they were just selling off the night's catch of lobster, makerel and small barracuda.

From Tokeh Beach got some transport a few miles south to Bureh Beach, where we were hoping to find some beach huts to stay in. In the event, we were over optimistic. However, we did find local lads who, from somewhere, found us a tent, which they hired to us, cooked us a supper of fantastic grilled fish, lit us a bonfire, and sat round the fire with us singing Sherbro songs and comparing the quality local gin and Hungarian Brandy (the the words of the songs, we later found out, would be enough to make a rugby team blush!)

 

 

One of the many remarkable things about the Freetown Penninsula is  the way the sand colour changes in just a few miles. The sand at Bureh Beach is a deep golden colour which almost looked like it was glowing in the early morning light.

We found that as we travelled down the coast, we were continually meeting up with the brothers and cousins of people we had previously been with and began to suspect that word was travelling ahead of us  that there were two white guys on the way in need of assistance (mobile phones are a wonderful invention). From Bureh Beach, we were offered a boat trip across to the Banana Islands (which was our destination anyway). The starting price was $100, but we eventually settled on $30, and it seemed everyone was happy. And so it was that we arrived at the Islands, which are just three miles off shore from the Peninsula.

 

 In the early 19th Century, the Banana Islands were used as a base by the Royal Navy in an effort to stop the slave trade, which was continuing at that time despite legislation in the UK to abolish it. The islands are now a place of complete quiet and peace, with only about 1000 inhabitants, but the traces of their military past are there to see, including a number of half buried cannons, one of which clearly shows a foundry mark of 1813.

We stayed 2 nights on the Islands and it was one of the most relaxing places I have ever visited. Before we left Freetown, I picked up a novel that was lying around in the house in anticipation of getting a bit of time to read on the beach. It was Jane Austen's 'Mansfield Park', and you might think that such a novel of 19th Century England would have little connection with the Banana Islands. However, as I read it, I discovered that it was written between the years of 1811 and 1813 - exactly the years when the Royal Navy was here on the Islands. One of the characters in the novel is a naval captain (and Jane Austen herself had two brothers in the navy), so it is not impossible that she had a fair awareness of what was going on here. One of the significant aspects of the first part of the novel is the prolonged absence of Sir Thomas Bertram, who travels to  Antigua to  attend to financial difficulties on his estate - problems  we can assume were probably caused by the loss of the supply of cheap labour resulting from the efforts of the Navy here and elsewhere along the West African coast. It all brought home to me just how closely tied the history of this part of the world is to the great events of the 18th and 19th Century in the UK and Europe. The same events have had repercussions down the generations here and many argue they were a significant factor in the events that recently tore Sierra Leone apart.

During our second day on the islands, we were shown a boat, which had just been completed after 9 months of manual labour and was due to be launched the following day. The site where the boat was built was in the middle of Dublin Village, and getting it to the water involved pushing it several hundred metres down to the beach. We were invited to the ceremony, and duly turned up next morning at the appointed hour. The ceremony began with us all being asked to gather round the boat and recite the Apostles' Creed; then sing Now Thank We All Our God ("first verse only"); then The Doxology; then we had the tossing of Kola Nuts to seek the blessing of the ancestors; the sprinkling of palm oil and palm wine; the throwing of food  into the boat (which was eagerly grabbed by the children). Then, amid much chanting and general hilarity, the Boat Pushing began, and we joined in.

 

When the boat eventually got in to the water, it floated with perfect balance, but that was not enough to stop us being alarmed when it was decided that the maiden voyage of the boat should be the one that took us back to the mainland. If I look nervous in the photo below, and as if I have just grabbed one of the only two available life jackets, it's because I was, and I did.

 

Our arrival point back on the mainland was Kent Beach, at the slave wharf where John Prescott madea speech on the 200th Anniversary of the abolition of slavery ("from such an idyllic place, so vile a trade").  It was yet another stunning place that we had to tear ourselves away from after only one night to travel up-country.

The day we left Kent, we travelled up to Mile 91 to meet with my VSO friend Jayne, and the following day, travelled on north on a dusty 8 hour round trip to visit the Bumbuna Falls. As you can see from the photo below, the road, particularly the last bit, was not all easy going.

When we parked the car, we couldn't actually see the Falls, but could hear a rumbling, more like a jet plane accelerating down a runway than a waterfall, and when we got down the path in front of the Falls, the sound was almost too deep to be audible - more like being thumped on the chest by the force of the water. The driver of the vehicle we hired to get there had lived in Sierra Leone all his life without seeing the Falls and was as mesmerised as we were.

By the end of our trip we were pretty comprehensively dust covered. The sort of dust which, I fear, will not get extracted from every orifice until long after I get back to Cardiff!.

And so, it's back to  noisy, dirty old Freetown. I arrived back this afternoon, to a phone message from my boss, saying he has a lot of things he needs to finish by Friday and really needs my help. I find that I am really pleased about that - to be busy and involved right up until my last day is how I would want it. So tomorrow, Laszlo will be off to negotiate Freetown on his own. Hopefully, we will meet up again tomorrow evening..

Institute for Healthcare Improvement

Over the past 20 years, I have been involved in a lot of different health service quality improvement projects and my experience has generally been that they promise more than they offer. It was therefore surprising for me to find that the IHI approach to quality improvement that is guiding the 1000 Lives patient Safety Campaign in Wales has sustained my enthusiasm for so long.

My interest has continued since I have been here, as it soon became clear to me that the challenges of connecting front line clinical staff with other organisational levels, and making change and improvement sustainable, are faced here just as much as they are anywhere else (as my VSO friend and erstwhile Matron from the Royal London puts it: " the thing is Tim, it's the same old shit, just a very different scale!")

Last month, I made contact with IHI and discovered that they have been working on a large scale project for child health improvement in Ghana. They have been supporting the testing of small scale change ideas to discover which ones result in measurable improvement and are now spreading and scaling up successful ideas. This is probably even more radical in a developing country context than in the UK, as donor-led development projects tend to be very long on high level strategy and very short on how to actually go about sustainable implementation.

Over the past two weeks, it has been great  to put Dr Kargbo, the Director of Reproductive and Child Health in Sierra Leone, into direct contact with Nana Twum-Danso, who is leading the IHI project in Ghana. I have been talking to Dr Kargbo about the IHI approach for a while and he was interested to find out more.  It now sounds like the IHI is very positive about the potential to support progress in Sierra Leone - an opportunity to work on health service improvement across the full spectrum from the very top of the UN Development Index to the very bottom. It may be that it takes a while before anything comes of it, if it ever does, but if I have done anything to help it come about, I will be well pleased.

First day of the holiday

As it happened, the rendezvous at the airport went without a hitch. After an evening beer with the Kenyan VSO's,  I had a comfortable and low stress helipcopter trip over to the aiport  with windows, seats and even ear protectors. Laszlo's flight was more or less on time and I booked a room at the airport hotel (not so grand) so all in all the whole thing was pretty straightforward.

Yesterday morning we had a leisurely breakfast before strolling down to the water taxi jetty at the beach. The sailing schedules depend on flight arrivals so we weren't exactly what time we would leave, but the beach makes a pretty good waiting area. Soon after we got there, some local lads identified Laszlo as in need of some intensive football coaching (they obviously spotted that I was a lost cause in that department). So Laszlo spent his first morning in Sierra Leone engaged in a vigorous game of footie.

When the boat arrived, a team pic was requested with 'Laz', and I was happy to oblige.

  

Getting to the airport

Freetown has the third largest natural harbour in the World. The city itself is on one side of the harbour, while the airport is way over on the other (think Penarth to Western Super Mare). This is not great if you need to get to the airport as the transport options are not very inspiring - rusty old car ferry, rusty old helicopter, or small water taxi  (a bit hairy if it is dark or rough). However, things are looking up - a new helicopter has recently come into service, which has glass in the windows and individual seats; and a new foot passenger ferry started three days ago.

This is all of particular interest to me today, as I need to get over to the airport tonight to meet Laszlo. I have ruled out the car ferry, as even getting to the terminal at the Freetown end can take hours. The passenger ferry fare is half the cost of the helicopter, so about an hour ago, I phoned the ferry office to find out about their schedule and booking arrangements. They just said I should turn up around 2300 tonight and they should be leaving around 2330. This would probably be fine, but it is such a new service that it is difficult to tell whether it is reliable and  I found myself considering a worst case scenario which involved me stuck at midnight in the City Centre, and Laszlo at Lungi airport, facing the scrum in Arrivals on his own. So I have decided to go by helicopter, which leaves from much nearer to where I live. I just hope that I get the one with the windows, and the seats.

Tying things up at work

It's my last few days at work now, and I'm trying to finish things off and spend time talking to others about their plans for next year. One of the things that keeps surprising me is when I find people with great skills who just need a bit of support to help focus their efforts. There is one man, Dennis, in the department who is Rwandan and initially came to Sierra Leone to help with monitoring elections. He later had to leave SL because of the war, but subsequently had to leave Rwanda for the same reason and returned here. He has been working in the Ministry for a while, though without a salaried contract.

Dennis is fantastic on Microsoft Access and Excel. By sitting down with him and talking about the sort of questions we need the staff headcount database to answer, he is well able (far more able than me) to generate the reports required.Some of the answers are shocking, but they really help the Ministry to state its case to the Government and to donors.

One of the issues we have picked up is that around 50% of the newly qualified Enrolled nurses appointed this year did not take up their posts. It is not difficult to see why when you understand that transport to get to their base could easily be $10, and basic accommodation could be $50 per month, and compare that with the salary scales:

Grade	Monthly salary
14	$  359	«Consultant
13	$  276
12	$  195	«Medical Specialist
11	$  151
10	$  90
9	$  69	«Medical Officer
8	$  52
7	$  40	«Nursing Sister
6	$  28
5	$  22	«SRN
4	$ 18	«SEN
3	$  16
2	$  14
1	$  12	«Nursing Aide

The only way anyone is able to keep functioning at work at all is through making informal charges for basic services. But with general poverty rates as high as they are, that means that many people simply cannot afford to access basic health services at all.

So you see what I mean about the scale of the challenges here.When you work with people who have seen services decline through the years of conflict, and are still struggling to get things moving back in the right direction, you can only admire the tenacity that keeps them going.I'm starting to wonder how all this might make me view the problems and constraints of the Health Service in Wales on my return...

St George's Cathedral

Travelling into the city centre for pleasure has not been high on my priority list until now, but yesterday, Jayne, Becky and I (VSO colleagues) took off into town to explore. As well as the government wharf and market area, we visited St George's Anglican Cathedral. Walking through the door into the whitewashed nave was like suddenly being back in Britain, a world apart from the streets outside. But on closer examination, the memorials that line the walls give glimpses of the unique  history and geography that have shaped this place. I was so taken with some of the inscriptions that I wrote them down on a scrap of paper. One of the first plaques I came across was at the back of the building, just inside the door:
 

Sacred to the memory of Robert Corley, RAC Corps, who survived the Battle of Waterloo and perished in this unhealthy climate, June 16th 1837, in the 39th year of his age.

There was a programme on the BBC World Service recently about the digital recording and broadcasting of  life stories, and their significance for bringing closure and communicating about traumatic events to future generations. Walking down the side aisle, it occurred to me how digital stories are only the latest way of doing something that memorial inscriptions have been trying to do for generations. Another plaque records words that appear to have been written by angry, grieving parents, far away in Britain, telling the story of their son's death:

This memorial was erected at the desire of the afflicted parents of John Mansfield, mate aboard HMS The Scout, in token of their untimely and irreparable loss from the effects of a season sickly beyond example, in a climate pre-eminently fatal to the health and life of Europeans. 

May 6th 1833.

Some of the memorials read like references addressed to St Peter, leaving no good deed undeclared, but others choose their words with care, leaving stories untold. Half way down the  south aisle, there is a small memorial stone, high on the wall.163 years on, I wonder about the circumstances of his life, and the grief he left behind.

To the memory of William McCauley, his manliness and generosity, the true friend of the poor in this colony. He died on 24th September 1846, aged 38 years. 

This stone was erected by a friend who loved him well.

A request from VSO

VSO London has been in touch today, wanting feedback on my experience of being here. The demand for health managers is greater than their ability to recruit and they are looking for case studies to use for publicity and advice for others who might be considering applying. As with a lot of things here, I find it difficult to comment without sounding contradictory: it is one of the most challenging things I have ever done, but being here does not feel like a hardship; I feel like I'm working as part of a team with my Sierra Leonian colleagues, but I am not sure whether I have made any difference at all; daily life in Freetown is exhausting and frustrating, but nearly every day I have experiences that make me laugh and put a spring in my step. However, I'm aware that such ramblings might not be of much use to VSO, so I have tried to answert their questions as best I can:

· What expectations/preconceptions did you have of Sierra Leone before you arrived and how far have they been met or challenged?
Before I arrived, the only things I really knew about SL were that there had been a war here; that it was very poor; and had the highest infant mortality rates in the World. All that is true, but so is the huge optimism and commitment to work for change among my colleagues, the easygoing friendliness of the people and the stunning coastline and scenery.I think that living in Freetown is probably tougher than I expected, though it is a vibrant and fascinating place.

· When you arrived in Sierra Leone, what was the situation in its hospitals? What challenges were they facing?
My job is working in the Ministry of Health, so I’m not based directly in a hospital. However, I have spent some time with the hospital manager at the teaching hospital in Freetown, who did a health management Master’s degree in the UK . Many of the challenges are recognisable to a UK HS manager, but the scale of the problems and the constraints on resolving them are of a completely different magnitude.

· What does your day-to-day work involve?
I share an office with my boss, which has been great for learning fast about the range of challenges and priorities he faces. SL has recently published a health sector strategic plan and there is now a huge amount of work in progress to bring the plan to life and set operational objectives. During my time here we have been analysing HR data; preparing for next years operational plan; and thinking through the HR implications of the proposed establishment of the Health Service Commission. (see blog 18th Nov).

· What positive changes have you seen as a result of your work?
It is difficult to say whether I have had any impact in such a short space of time, but people tell me they have appreciated having some more energy around to get on with the practicalities. Today, my boss and I were discussing a problem together and he commented that “two heads are better than one”. He is a very committed and experienced man, and I take that as a great compliment on the way we have worked together.

· Looking back at your work, what are you most proud of?
I am proud to have been seen as a valued colleague by senior people in the Ministry of Health for whom I have great respect (See blog 20th Nov).

· Can you tell me about any skills you have gained or enhanced as a result of volunteering? For example, would you say you're a better leader/communicator/decision maker / influencer/problem solver/strategic thinker/innovator etc?
Since I have been here, I have sat in many meetings having to work from first principles to consider questions like ‘what is going on here?’; ‘what behavior would be most useful in this setting?’. ‘What contribution would be most useful to get where we want to go? ’. ‘How might my presence and behavior be impacting on others?’ These are issues we confront daily in all management settings, but we make assumptions when operating in a familiar cultural context that we probably shouldn’t. Working outside your cultural comfort zone really brings these issues to the surface and tests your skills of perception and judgement.

· How far would you recommend volunteering to others?
I’m lucky to have been part of the Welsh Assembly scheme, as my two month placement has always been understood primarily as a learning opportunity. I think that anyone doing this sort of thing should be under no illusion that that it is going to be easy. It is not like an extended holiday, or an external management consultancy. You will be right in amongst it. So don’t do it if you aren’t prepared to be challenged on pretty much every level. But if you are, then I think the experience is hard to beat.

Learning Krio (small, small)

Last Thursday I had a barb, although I wasn't aware of the fact at the time. I only realised the next morning, when I arrived at the office with my shorn head, to be greeted by the comment "Eh, nice barb, Tim!" (It's obvious when you think about it - what else would a barber do?)

Alhough English is the main spoken language in the office, many conversations soon move into Krio and exchanges on the street, with the neighbours or in the taxi are almost always in Krio. According to my Bradt Guide, the language started as a trading language for tens of thousands of freed slaves across West Africa, Europeans and other merchants, and uniquely blends words from different sources. There are many recognisable words from English, but the grammar and vocabulary make it a language in its own right.

People sometimes comment that I should know more Krio by now, and I wish I did,  because judging from the laughter, conversations in Krio have the best jokes. As it is, I can manage greetings: "Ow di bodi?" ("How are you?"); reply: "A tel God tenke" ("Can't complain"). Given my short time here, I'm never going to be fluent, but I have realised that just trying will often crack a smile on even the most serious face.

A Sunday stroll - via Leicester and Gloucester

Today Becky (VSO colleague) and I have been for a great walk in the hills behind Freetown. We had been told where the route began, so just decided to take a taxi up there (near the American Embassy) and see if we could find our way. As it happened, it was easy - a very quiet and shady lane winding through Krio villages back down towards the city.

The villages in the area were originally set up by Christian missionaries as communities for freed slaves and some of the sights had a hint of English village about them. In the village of Leicester (below), we passed the Anglican church, complete with stained glass windows, from which a packed congregation, in their Sunday best, was giving a hearty rendition of 'All Things Bright and Beautiful'.

On a day like today, it is hard to imagine the hardships the early settlers endured, both freed slaves and missionaries. Of the 70 adult missionaries sent out by the CMS from 1804, by 1824 38 had died in the harsh conditions of climate and disease they found here

In addition to the British heritage of the missionaries, there are also signs of the US  heritage of the freed slaves. Many of the house designs are reminiscent of the US, where many of the returnees would have previously worked as domestic staff.

 

Although it is quite high above the city, it was still hot, and we stopped off for a welcome cold 'soft' at a roadside shop, before the urban sounds and smells started to rise up through the trees  to meet us.

 

 

On arriving back among the hot throng, we jumped straight in a minibus taxi. For 40p and in 40minutes we were on the beach and able to cool our feet and have a beer.

 

And here is one last picture. It adds nothing at all to the flow of the narrative and I am only including it because I can..

A shocking lunch

It is Friday again and I was disappointed this morning when Dr Sandi turned up in a rather conventional shirt on the very day I took in my camera to catch the Friday dress code. Even Margaret and Hannah were not quite as colourfully dressed as usual (yes, I know the white guy looks a bit out of place, but he is trying).

Shortly after this photograph was taken, Dr Sandi produced, as he sometimes does, a big plate of fried  chicken from under his desk and he and I sat down to eat it and to chat.

I have often thought to myself how little people mention the war here. In the six weeks we have shared an office, the subject has rarely been raised, except in the most general terms. I knew he had been in Sierra Leone until 2001, when he went to London to study for a year, but had assumed that prior to that he had been working in the Ministry in Freetown. But as we chewed our chicken bones and swigged our coke, he told me things that shocked me more than anything I have heard since I arived, telling the story in such matter of fact terms that he might have been telling about what he did last weekend.

In 1997, he was posted as Medical Superintendent of the Government hospital in the Eastern town of Kenema (see  A Long Way Gone - Memoirs of a boy soldier for a feel for the war in the Eastern Region). He stayed there for the next four years, trying to keep the hospital functioning. On one occasion, he and  one other doctor received 1200 maimed and injured in 24 hours, triaging and treating as best they could, and spending 12hours per day, 6 days per week in theatre. There were very frequent attacks on the town, and he was a target for capture by the militia - a surgeon would have been particularly valuable to the rebels in the bush.

He explained how his extended family, originally from that area, had been scattered by the conflict, and how his brother had been killed in an ambush. At one point he was offered evacuation from Kenema, but the offer did not extend to his wife and sons, so the decision to stay was not difficult. As a contingency, in case they found themselves alone, he gave each of his teenaged sons 100,000leones and told them that if ever there was an attack, they should on no account go home, but should run into the bush and go to a prearranged place where he would find them. I asked him if they had ever had to use the rendezvous point. "Many, many times", he said.

When we got up to go back to our desks, he said "Tim, those were bitter times. One day when I retire, I will write a book". That makes me feel better for writing this, because I haven't asked his permission to share his story. It would have seemed trite to finish our conversation by asking "do you mind if I write about this in my blog?" I just hope that if he ever does read it, he will understand the sense of respect with which I wrote it.

Working hard

I really wasn't expecting to be working quite as intensively as I have been. This is great, as I feel like I am in among it, though it is also tiring. It is now clear that the formation of the Health Service Commission is a contentious issue, and not all government departments are as enthusiastic about it as the Ministry of Health. Last Saturday there was a special meeting in the Ministry to consider how to stengthen the case and a lot of the work I have been doing with my boss was central to the discussion, which was good to know (I was supposed to be there, but was unable to attend for reasons previously explained).

One thing that is very much in my mind now is the fact that I have less than 3 weeks of working time left here. Bloke flies in, works hard, flies out, leaves no trace, doesn't seem like a good recipe for sustainable development on the face of it. However, I have come to the conclusion that just being here, showing a bit of enthusiasm, helping to get some work out the door and giving positive feedback on the commitment of good people who keep going under constraints that, frankly, would make most of us give up in despair, is not such a bad thing.

And I am, of course, a very small cog in a wheel: DFID is sending in Technical Assistants in the New Year, and the Office of Tony Blair also has a consultant here supporting the Ministry,  so there are others giving support and continuity. 

So I'm not beating myself up about whether I am doing any good or not and for the next 2 weeks I will keep grafting. After that, Laszlo arrives and we will be heading down the Freetown penninsula. And there will be photographs of tropical beaches, oh yes, there will.

Freetown Sounds

One thing I haven't mentioned much so far, and which you obviously can't get through a picture, is what this place sounds like. It is rarely quiet and often loud; sometimes very loud.

The sounds of the morning generally start around 5am, when the pans and buckets start clattering in the kitchen next door. The building is very close to ours so you can easily hear the morning greetings and conversations as people get up to start the day. Early yesterday morning, the conversation was punctuated by a sound that I first thought was the croak of an old person with a bad throat, but then realised was a goat. Later in the day, the household had a big family meal and, for some reason, I can no longer hear the goat.

By about 7am, cars have begun moving along the lane outside. They travel very slowly and the creak and crack of suspension being tested to its limits is generally louder than the sound of the car engine itself.   This is all very calm compared to the roaring engines, hooting and shouting that you get up on Wilkinson Road.

During the day, there is sometimes quite a bit of amplified music in the area around the house. There is a small and very poor looking compound out the back that is a major contributor. On one occasion, the music stopped and was followed by that jingle you get when Microsoft Windows closes down. It shouldn't still surprise me, but it does, when I realise that someone in that tiny, poor, house, has got  laptop, and has been downloading music. You might think that a power cut would be a relief under such circumstances. However, if the power does go down, you get the additional sound of various diesel generators.

In the evenings we frequently get another sound which is very common in this football-obsessed country: Beside our house is a long tin shed that is quiet for most of the day, but if you look inside, you will see 3 large TV screens in front of rows of wooden benches. When you hear them turn on the sets in the evenings for the pre-match commentary, you just have to brace yourself for the eruption. Watching football on TV is not done half heartedly here.

There is just one other night sound that I need to mention: If you are Disney fan, you may remember that in the film "101 Dalmations", there is a bit where all the dogs bark to eachother to communicate that the puppies  have been stolen. Well there must be a lot of puppy theft here (there are certainly a lot of dogs). Sometimes you can hear it start far away over the hill, and then approach like a wave until you are surrounded by howling and barking before it passes off in the other direction.

The odd thing is that noise that would drive me mad in Cardiff is somehow less of a wind-up here. It may be that I'm still in the honeymoon period. If so, I just hope it lasts until December!

On communicating by email

I've got the runs. Apologies if that is too much information, but I did say I would use my blog to keep people udpated with my movements (bad joke, sorry). It's nothing serious, I think; it is usually self-limiting within 4  days, and prevalence is about 50%, so I would have been lucky to avoid it. But for today, I have decided to allow myself to lounge round the house, groaning gently.

There is something about feeling off colour that makes you want cool; and Lucozade; and home. It brings back a lot of memories for me about my various tropical illnesses as a young VSO. In those days there was no prospect of emailing or skyping for a bit of instant sympathy. Communicating with home involved air mail - usually an aerogram - a single piece of paper that folded to make its own envelope. It took around 3 weeks for my letters to get home, and a similar time for the response to get back in the other direction. I wrote most weeks and got used to the experience of receiving letters responding to things that I had written 6 weeks and several letters before.

Today, in my fragile state, I think email is The Best. But, although I know it is a cliche, there was something about a letter that I suspect has gone for good. In 1982, I remember the first letter that arrived from my Dad and thinking how I had never really seen his hand-writing before, apart from his signature, or a note to the Vet or the AI man. But looking at it, I could imagine him coming in from the farm, cleaning himself up, and sitting down to write to me. It was probably only the usual news of family and village and weather, but  the collection of blue and red envelopes that grew month by month was like having a physical bit of home there with me. You just don't get that with email.

Comparing notes

In my previous experience of VSO in Uganda, the organisation was very strongly British. Almost all of the volunteers were British; the Country Director  was British; as was his Assistant (me). There were Ugandans on the staff, but they worked as secretaries, drivers and junior support staff. Twenty five years on, the staff in the VSO office here are all Sierra Leonian, with the exception of the Country Director, who is Eritrean. But more remarkable is the fact that the British Volunteers are significantly in the minority, as the majority are from other African countries. For me, the presence of 4 Ugandan VSO's here, sharing their very considerable skills, is the most remarkable of all. For some reason I can't quite explain, that makes me want to cheer.

One effect of this internationalism is happy events like the one that took place in our house last night. In the picture below, there is (from L-R), a Kenyan VSO who works up-country and was staying with us overnight; my Kenyan VSO housemate, who did his accountancy training in India, and has also worked as a aVSO in Indonesia; our Sierra Leonian nieghbour (and boyfriend of the photographer); me; and a VSO ex-publican and business-woman from North Yorkshire. It was a good reminder for me of thedimensions and diversity of Africa - Freetown is closer to London than to Nairobi.We were discussing and comparing the bizarreness of local cultural practices (and you have to admit, the scenes on St Mary Street on a Saturday night must get a pretty high bizarreness rating as a cultural practice!)

During the course of the evening, there was a spectacular rainstorm, and another topic of conversation was the question of just how heavy the rain would have to be before it is reasonable for a Manchester United fan to walk home under an Arsenal umbrella (Answer: there is no rain of sufficient intensity for this even to be considered as an option).

Street life

I spend quite a bit of time on the street, at least it feels like it. Last night, for the first time, I actually wondered whether I was ever going to get home. To catch a taxi when it's busy you really need to have your wits about you. They often just swing by the crowd waiting on the pavement and you have to call out where you want to go. Sometimes it also helps to offer a fare that is slightly over the odds, say 1000le (16p), rather than the standard 800le(13p). When it gets dark, the task gets trickier, as the lack of streetlights makes it diffiicult to see which vehicles are taxis and which are just cars crawling along in the traffic.

The good thing is that there is no extra hassle for a white guy, but there is no extra preference either, at least not much. After about 40 minutes on the kerbside last night, a woman who had been standing next to me, called out very insistently in Krio to a passing taxi. As he pulled up, she grabbed my arm and bundled me in, without a word to me. As we drove off, the taxi driver was chuckling when he said "So, how do you like our Freetown, brother?" He then took me right to the end of my road for the standard fare. When things like that happen, the frustration just tends to evaporate.

Despite all the exotic chaos of the streets, when you look at the street signs themselves, the names are more than slightly resonant of their British colonial history. There is, unsurprisingly, given Freetown’s origins as a home for freed slaves, both a street and an area called Wilberforce (if you want to go there, you need to call out "Ba-foss!, Ba-foss!"). There is also a Liverpool Street, Gloucester Street, Victoria Street, Regent Street and an area called Aberdeen ("Abba! Dabba! Dabba!"). You can just imagine the colonial administration meeting to discuss naming the streets: Given the strength of the British desire to limit French colonial influence in West Africa, the naming of Waterloo Street and Wellington Street probably had unanimous support!

However, there is one area of Freetown on the hill above where I live that bucks the colonial naming theme: It is called “Bottom Mango”. I have rather been hoping that, somewhere in Freetown, there is also an area called “Top Banana”. Unfortunately, this does not seem to be the case.

Mile 91

It has been good to get out of Freetown this weekend. We left early yesterday morning and chartered a taxi across the city to a place where we could pick up a minibus taxi. You can't rely on exactly when they will leave, because they just wait until they fill up, but we weren't sitting in the sun too long before there was a full load (which is a about 5 people more than I would judge as a full load). On the way, we noticed that every time we stopped a remarkably similar looking lad appeared outside and pulled the side door open to let people in and out. It was only when we saw vans coming the other way with passengers tucked  among the luggage on the roof that we realised how he was managing it. In contrast to the hot traffic jam that is Freetown, the main road up-country is a joy. If only the standard of the vehicles could match it..

As you can see below, the welcoming committee were out to meet us at Mile 91. Jayne, the VSO we were visiting, has only been there for 2 weeks and the arrival of 3 more white faces was a big deal for some.

Jayne works for the Sierra Leone Youth Empowerment Organisation, which is doing great work with young people. This area was very badly affected during the war, when much of the fighting was done by young people. We also met several of the other staff, some of whom have been working in the organisation since its inception 10 years ago.

I'm now back in Freetown and feel I can set the city in a bit better context than before. The weekend was a tiring one in some ways, but it was also energising for me, just observing the way people get on with life when they don't have any of the 'essentials' we take for granted. On the way back we were in a car sized taxi, and paid for an extra seat, so that were only three of us in the back. As you can see, the guys in the front could not afford such luxuries.

Having a bit more space, I was able to take some pics of the roadside scenes as we drove by. There was just one view that was alarming, and I really, really hope some artistic wag was just having a laugh, though I can't be sure..

White Man's Grave

It was not for nothing that in the 19th Century, the area that is now Sierra Leone was known as the “White Man’s Grave”. A traveller to the area at the time wrote: “When you have made up your mind to go to West Africa, the very best thing you can do is to get it unmade and go to Scotland instead; but if your intelligence is not strong enough to do so, abstain from exposing yourself to the direct rays of the sun, take 4 grains of quinine every day ....and get an introduction to the Wesleyans; they are the only people on the Gold coast who have got a hearse with feathers“.( ref)

Things are not quite like that now of course, but compared to my experience of East Africa, this is certainly not a place to take a cavalier attitude to health and hygiene (especially while you are still getting the hang of bathing in a bucket, which, incidentally, I am now excellent at). In East Africa, moquito nets were often regarded as optional, but here they are definitely not. It may be that I am acting on the cautious side (being here for such a short time, I really don’t want to waste any of it being ill) but every morning before I leave the house, I check that I have mosquito repellent (useful for when you get diverted to an outdoor bar for a sundowner on the way home – like every night), drinking water, antiseptic wash and sunblock.

This weekend I am off up-country to Mile 91 (no prizes for guessing how far it is from Freetown) to visit a VSO who lives there. I am going with two other VSO friends, one of whom is an Australian nurse working in the office of the CNO. The other is also a nurse lecturer at the Teaching Hospital, whose previous job was Matron of the Emergency Unit at the Royal London. Considering the total number of qualified nurses in the whole of the country, I think my health care risks for the trip will be pretty well managed!

I have been asked to go easy on the beach shots, so this is my health related picture for the day - my mosquito netted bed. Just be relieved that I have spared you the shot of me demonstrating my bucket bath technique.

Never a dull moment

The office gossip can be high quality here. The Ministers office is just up the corridor and the news that is now on the link below has been been flying around  as a possibility for a while. The President launched the Health Sector Strategic plan this morning and, remarkably, all seemed to go off without a hitch.

 Reuters, Africa - top news

At first sight.the headline might look dramatic, but when you think about it (for those of us who have been around the UK NHS for a while) it's not like we have never come across a situation where a contract has been favourably awarded to a relative, is it? The dominant view round here seems to be that sacking and arrest is not such a disproportionate reaction. Maybe we have something to learn...

Just like Wales (in some ways)

Every Monday morning there is an 8.15 meeting of the Directors in the Ministry of Health (which I and two VSO colleagues get to go along to) where the issues for the week are discussed. This week is busy: on Tuesday the President opened a telemedicine facility at the Connaught Hospital, and tomorrow he is attending the launch of the Health Sector Strategic Plan, so there was a lot talk about.
   

Immediately after the meeting I was asked to go with my boss to a meeting at the office of the Cabinet Secretary about the formation of the Health Service Commission. Although I was only there as an observer, this was definitely a jacket and tie job, as we sat around a very shiny table while my boss and colleagues were roundly berated for the quality of ministerial briefings and recommendations. In the car on the way back to the office, I told them how similar it all was to Wales, so we all had a good laugh about that!    
 

As it is shaping up, my job is about helping my boss at a practical level to get on top of his huge agenda. It is proving a lot easier to help than I feared before I started, although that is probably more to do with his skill in knowing how to work with me, rather than the reverse. He did his medical training in the Ukraine, a Masters Degree at the LSE, was in Sierra Leone during the war and has more life experience than I will ever get.  
   

There are loads of things I would love to photograph here – at work, on the way to work, around home. But you have to be very sensitive about using a camera, particularly away from the beach. So though I am now in city work mode, here are some more gratuitous beach shots, this time of Lakka beach. Getting there requires a bit of walking and taxi hopping, but I got there in about an hour last Sunday, at a total cost for the round trip of about 70p. The sand here is very yellow and, once again, the whole scene is stunning.