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Sunday, 7 November 2010
Views to date
Patient Satisfaction Survey & Ministry of Health
Patient Satisfaction Survey
As agreed, this took place at the health centre on Thursday. My team of community workers (volunteers) were very good although the 9 o’clock start sort of staggered its way from 9.30 to 11.15. The staff were a bit wary but I explained as well as I could before we started so that they knew what to expect.
The results were fascinating and some areas come up in the comments that had not occurred to me at all. The community workers were also very good at placing themselves so that they spoke to as many people as possible – we 48 interview in the end. It was their suggestion to place some of them at the gate so that they could talk to people who were leaving who had completed the episode – my mindset was very much at the health centre.
I have completed the initial report and we have a meeting booked for Tuesday to discuss the findings. I’m sure there are some quick hits we can make that are almost cost neutral that will address several of the issues. E.g. making information about charges on display so that users are aware of the financial commitment before treatment is commenced, and then having itemised receipts that show what people have paid for. Where people have very limited amounts of disposable income or savings it must be quite worrying to enter into a transaction not knowing how much it will cost. Other issues need further consideration and prioritisation by the team - should be very interesting.
Kampala and the Ministry of Health
On Friday I took the Elgon Flyer from Mbale to Kampala. This is an express bus/coach that takes 4 hours and costs 10,000 Uganda shillings UGX (about £3). The coach seats approximately 50 people and provides comparative luxury travel for where we are. There is no air conditioning on the bus but the windows all open so it’s not too bad. AS we started off the conductor walked down the bus thanking people for using he service and hoping they enjoyed ‘flying with them today’. The seats were quite tightly packed as there is a 2 seat row and a 3 seat row on the other side to the bus and it gets a bit hot and sticky where bodies are pressed against each other – but at least each person gets a seat each. The price of the bus is very good considering it cost me 50,000 UGX to get back from the hotel (15 minutes down the road) the other night when I was invited to meet some of the visitors from Wales. As the taxi had been booked for me I thought a price had also been agreed. Big mistake. It’s very difficult to argue about the price where you are at your destination and don’t have any change. A lesson not to be forgotten though – I’ll make sure of the price before I travel anywhere in future.
The trip to Kampala was partly to accompany Vanessa one of the volunteers as she had to go to the dentist – and I thought I would take the opportunity to go to the Ministry of Health to see if I could get copies of the standards and guidelines for health centres so that we can start to put mechanisms in place to show that these are being met. As I had a chance meeting with someone from the Ministry of Health during the previous week I was directed to the Central Pubic Health Laboratory. I found this quite easily and asked to see the person whose name I had been given. When I got there e she spoke to her boss who said that copies of guidelines were kept at the serology office up the road and I was directed up there. I eventually found it after getting a bit lost, so I arrived hot and a bit sweaty having walked nearly 3km in the afternoon sun. When I got to the office it was mostly deserted but I managed to find someone who said they did not really keep any publication there – they were mostly at the public health lab. So – off I walked all the way back again, with the name of a public health doctor to ask for. When I got back to the office I was directed to a person to help who said that they did not keep anything there. After some discussion he said that the clinical guidelines for most services had just been updated and printed and copies of these were available at the main office for the Ministry of Health (close to where I had just walked from). He telephoned and spoke to someone and I heard him agree that I could have 2 copies of this document. As it is a newly updated document that is quite a large book I though great – success at last. It was 4pm by this time so he said I needed to hurry as people would be going home soon, and he told me which office to ask for (who shall remain nameless for the purposes of this blog). So off I walked again trying to go as quickly as possible and wishing I could take a boda. When I arrived I was directed to the appropriate office of a senior person. I explained what I had come for but he was adamant that I could not have any copies of documents. He gave me lots of stories about the documents ending up in Sudan, Kenya and neighbouring countries and the cost that all this incurs. On discussion and reflection on my return I think I missed here that maybe he was asking for money – but not being used to this type of discussion I missed the cues. I explained that the purpose in asking for the document was to work with the organisation I am placed with to help put systems in place to meet the standards – as it is difficult to do this if the standards and guidelines arte not known. He said that they had the documents and were planning to start distribution on Monday. Again I asked if it were possible to have just one copy but he looked me in the eye and flatly refused even though it has been agreed on the telephone that at least one would be available. At this point I had to remind myself that as a representative of another country I needed to put my diplomatic head on, but this took a lot of effort. I was very complimentary about the content of the guidance etc etc as they are good documents – but completely wasted if no one sees them. He admitted that the web page for the ministry is not that good and he said that there internet providers were poor but it didn’t seem to be anyone’s responsibility to do any about this. I left feeling quite frustrated and deflated. Having to walk all the way back into town to meet Vanessa – by now it was nearly 5 pm. I calculated I walked about 15km that day, and the temperature was about 28C.
I confess I cursed to myself as I walked back up the road again but by the time I got back to town I had walked it off. I think it has made me realise that when I get back to my job in Wales I need to be mindful that we do not create these types of situations for people who need information to try to be able to deliver good quality services.
The hotel we stayed in is very popular with backpackers and volunteers travelling through. It was by no means luxurious but is was clean and felt quite safe. We had a family room with 3 beds and use of a shared shower and facilities which cost 45,000 UGX (about £15). When we got back to the hotel there was an event going on across the road. As our room had access to a veranda above the shop fronts http://www.pbase.com/bmcmorrow/image/63364464 we went out to look and had a good view of the African drummers and dancers – it was loud but very good. Thankfully they packed up at 11pm. We were afraid ait was going to go on all night. I tried to take some photos but it was too dark.
We had a good look around the craft stalls on Saturday morning, I have some good ides now for Christmas presents to bring back, but I think it will be better to get these on a stopover on the way back to the airport when I leave.
We got the 12 o’clock bus back which left at 11.45. Apparently once they have sold enough tickets for the bus to leave it just goes. The bus makes a couple of very quick stops on the journey back. Forget MacDonald’s as fast food. The stops are at pre arranged places and the locals rush up to the windows to compete to sell chicken on sticks, chicken kebabs, roasted banana, and water or fanta.
Then the conductor on the bus comes around with napkins and a rubbish bag. It’s a shame but most of the local people throw their rubbish out of the windows of the bus and don’t make use of the rubbish bag.
There is also a stop for a ‘short call’ – This is along a deserted strip of road with high buses and tall grass – almost everyone piles ff the bush and disappears into the buses etc reappearing a few minutes later. I didn’t partake but apparently it is agreed that the men go one way and the women go the other. As we stopped a bus stopped on the other side of the road as well. I have to say the men were particularly bothered that they were in full view of the bus on the other side of the road!
A little tipple
When I was looking around the supermarket in Kampala on Friday I saw a little carton of whiskey made in India – the kind of carton that kids have for fruit juice – certainly not what we see at home.
Wednesday, 3 November 2010
Patient Satisfaction Surveys and VIP visitors
Ground breaking developments
I’m quite excited today (sad I know, but it’s still good). Tomorrow we will be undertaking a patient satisfaction survey at the health centre. I happened to be talking to someone from the Ministry of Health this afternoon and asked him if he knew of any other patient satisfaction surveys in Uganda. He said that he only knew of one that took place in a leading hospital in Kampala that is led by an Irishman. So we may not be the very first in Uganda but I think we are still on the cutting edge.
I have developed a template of questions to be asked. This has been derived from some of the Ministry of Health documentation and some are a common sense approach to the quality of healthcare, - information for patients & checking they have understood, privacy, infection control, cleanliness etc etc. The team that will be asking the questions are community healthcare workers attached to Salem. If I asked any questions I’m sure I would frighten everyone away.
These workers are also used to giving health promotion talks and using drama to covey important health messages in the community. I did some training with them this morning; it was so refreshing that the areas that I said I wanted to cover were areas that they also thought were important. I could really see a spark of enthusiasm in their eyes. The enthusiasm and obvious understanding for what we are trying to achieve also came through in their questions and comments on some of the questions. They will be talking to as many people as possible tomorrow using a conversation approach to try to ascertain their views on the experience of using the service. Once we have all the information I will produce a report for the project coordinator and the Board. One of the health workers also suggested we ask similar questions to the staff so that we gain their feelings on the quality of the service. May be this will be stage 2.
I hope it all goes as I expect it to and we don’t hit any unforeseen snags.
More later......
Feet feast
I think I have recovered from having my feet eaten. Thank God for antihistamine tablets. I only brought 2 with me – so I took one on Monday and the relief was amazing I suppose I wonder why I didn’t take one before. I used antihistamine and hydrocortisone cream but they didn’t really do much. It’s amazing how much better you feel when you haven’t got burning itches.
Ambassador visit 17th November.
The pathology laboratory is coming on well. It has been all hands on deck for the past week or so. I think we are on track for completion by next week when the German Ambassador to Uganda comes for the official opening, although there is still a lot to do.
I have some photos but will post later (they take ages to upload about 5 mins each).
We have agreed a programme for the day and I have been nominated to be Master of Ceremonies!!! This is a real honour – from what I gather the main challenge is to keep people to time on the programme – in Uganda that is no small feat. The programme is not at all as it would be in the UK it goes something like this: (I’m not completely sure of all the titles and roles by it goes in ascending order and it is very important not to leave anyone out who should be present)
1. Tour of facilities
2. National anthems
3. Address by Local Commissioner 1 – village level commissioner.
4. Address by Salem Project Coordinator / Medical Director.
5. Address by Salem Board Chairman
6. Address by representatives of funders
7. Address by District Health Officer
8. Address by Chief Administrative Officer – head of district council
9. Address by Local Commissioner 5 – representative of the Ministry at district level
10. Address by Regional District Commissioner
11. Address & opening by the Ambassador.
We need to cover all of this in less than 3 hours, so I shall have to think of some careful strategies for moving people on, as some of these people are well known for their love of public speaking. I’m looking forward to the challenge J.
Sunday, 31 October 2010
Climate change and experiences to make you think
Tree Planting and Climate Change
On Thursday I went to the official launch of the project for tree planting as part of the measures to address climate change. The project is part funded by Wales and so John Griffiths AM (Counsel General) was there to represent the First Minister, there were also lots of dignitaries and representatives of the tree planting groups from Uganda. The project has given a commitment to plant a million trees over the next years of the project. One of the things that has surprised me in hearing the discussions around this topic is how many examples the local farmers can give without any prompting that changes are occurring to the seasons and the climate on the equator. There used to be very clear and predictable wet and dry seasons. At the end of October we should be entering the dry seasons and it should quite hot and dry. Since I have been here it has rained every day to a greater or lesser extent. On Friday night I found it quite cold in bed because it had been cloudy for 2 days and so there had not been any sun to warm the ground and the air (although compared to back home its probably still very warm).
Listening to the presentations by the groups involved in the project I can now see the importance of planting trees (although I confess before I came to Uganda I could not really see the immediate relevance).
At the beginning of this year in the Bududa district (in the hills not far from here) there was a large landslide and there were many fatalities and loss of homes. This happened because people had relocated themselves and built their houses on the hillside and in doing so had removed quite large areas of forestation. It had been predicted that a landslide would occur but as ever no one really thinks it will happen to them. The displace families have been living in tents in a refugee camp since the landslide. The Ugandan Government are trying to relocate people to other less densely populated parts of Uganda but this is met with some resistance because the people to not have any support networks, family history or other links to these areas. It also doesn’t seem to be helped by the fact that they are relocated to the new area in a tent and provided with a small amount of money to start building a house. One of the discussions I overheard was that it would seem better for the Government to commence a building programme and provide basic housing in preparation for the relocation so that at least they have some kind of basic permanent structure with which to commence their new lives (also the tents they are providing to live in are not cheap tents so there is a double expenditure).
It was also reported that the mud slides are continuing to happen although on a much smaller scale and there had been 2 this week.
The Teacher/ Student group from Wales that visited this week visited the refugee camp and seemed to be stunned by what they found. The people at the camp said that they had not had any food for the past 3 days and they were not expecting to have any until abut 6 days. They has despatched whoever they could off to the neighbouring villages to try to get some food, and some had returned with rice and beans. However each of these is not much good without firewood, as the main method of cooking is a charcoal burner – and they did not have any firewood. Hence the need for the trees.
On another visit where there was an established tree planting project in the village, the locals reported that their crops of vegetable such as aubergines were doing very well as they were growing in the shade/ shelter of the trees. Without this shelter the sun is too fierce and the smaller plants just do not survive.
The main problem now for the locals growing crops is the unpredictability of the weather, they are finding it wet when it should be dry, the dry seasons are also longer leading some drought conditions. So the need for our combined efforts to address climate change is clearly much more urgent.
Nose and Feet
My nose has stopped running for the past two days although I still feel a bit under the weather. It’s only a cold but interestingly here it is most definitely ‘flu’. When talking to people no one talks about not feeling very well or anything like that – the language is very much 'are you sick’? People also turn up for work and say ‘I have malaria today’ and then disappear off to the health centre for medication. I was surprised to learn that the common course of treatment is tablets morning and evening for 3 days. I thought it would be for much longer.
My feet seem to have been a feast for something over the past 2 days and I am covered in bites which really really itch. I haven’t worked out yet if the DEET spray makes them itch more or whether there is something around that is not affected by the spray. When the weather is a warmer as it has been today it’s a nightmare to walk anywhere as the shoes/sandals rub the bites. I have got cream which helps a bit but I need to work this one out fairly quickly as I can’t do this for very long!
Experiences to make you think.
I had one of my first experiences that really shook me on Thursday evening. It was just about getting dark when a motorbike pulled up outside the health centre with 3 young men on the back. The one at the back got off and then I could clearly see that the one in the middle was supported by the body of one who was driving the bike. He was literally draped across his back with the side of his head resting on the nape of the driver’s neck. His nose was bleeding and he had quite bad facial injures. He also had a rough bandage on his left foot – both feet were just dangling as he was astride the motor bike. He was barely conscious and could not raise his head. The friends explained that he had come of a motorbike. The staff at the health centre explained that he required investigations that could not be provided here and they needed to go to the district hospital in Mbale. I could not understand the conversation and don’t know what was said but it seemed to take an eternity (about 15 – 20 minutes) before they could persuade the 3rd young man to get back on the bike to drive to Mbale. I asked whether the ambulance at Salem could be used to take him to the hospital, but the staff said this could only be done if he could pay for the petrol.
It wasn’t until much later that it occurred to me that I could have volunteered to pay for the petrol, it just didn’t think of it at the time and then felt quite guilty. The main thing is this is not just a single occurrence as these things happen every day here. It seems so hard to turn people away but they were absolutely right as he seemed to have serious inquires and they also don’t have the right drugs here for a head injury. We take so much for granted at home.
On a lighter note the group from Wales invited me to join them for dinner at the local hotel for their last night. It was a pleasant and there were people from PONT and the schools with which the Welsh schools are partnered. The minibus on the way back was the venue for some lusty singing of dubious quality. It was great. It was a very clear night last night and we stopped along the lane where it’s dark just before the entrance to the compound to have a look at the stars. This was one of the very few times that I have seen many many more stars than I can see at home. It made me want to learn them all or have an ‘app’ to recognise them – it really was stunning.
They have all gone home today – best wishes to any of them who might read this – we might meet again soon.
Wednesday, 27 October 2010
Regulation in Uganda and an Update on the Beer
Regulation of Healthcare in Uganda
Denis (the Project Coordinator for Salem) took me to the District Offices in Mbale this morning. I asked him to arrange and introduction for me in an attempt to understand their inspection system. The building and the set up reminded me of the Temple of Peace in Cathays when it was Bro Taf Health Authority; not because they are exactly the same but there are many similarities. The district office is a single story building with several offices to either side of the board room/library. The District Health Officer is a public health doctor. I spoke at some length with the public health nurse who does a lot of in service training for health workers and is also involved in the ‘inspections’. If I have understood it correctly inspections here are not known as such, they are visits linked to the supervision framework.
The supervision framework set out by the Ministry of Health (MoH) describes how the MoH provides supervision to the district in the way that they perform their functions. In turn the district health officials provide supervision to the clinicians in the health care providers in their performance in delivering healthcare services. When an ‘inspection’ takes place there is a visit by quite a large team of people with varying expertise and the district health officials who undertake the supervision. They identify areas of commendations and areas for improvement and then sit down and discus with the healthcare provider how they can put together a plan to address areas for action.
The framework against which performance is monitored is derived from policy and standards documents issued by the MoH. Rather than having cross cutting standards which are relevant to all areas these have been produced in relation to work streams and funding i.e. malaria treatment, injection safety and waste management, TB & HIV management, prevention of mother to child transmission of HIV, anaemia, rabies surveillance, reproductive health and education for parents on sexuality and HIV/AIDS prevention. This means that policies are focussed on these areas rather than on generic factors such as infection control, record keeping, risk management etc etc.
I explained the 3 tier approach (patient experience, organisational, board) to inspection in Wales to the District Health Officer who was very keen to explore ways that they could use this, recognising that board members generally know very little about the performance of organisations and the need for better information at this level to inform decision making. He seemed to think I might be coming back at a later date to do some more work with him on this – I explained that is a debate to be had at another level!!
I have lots of work to do back at base now that I understand a bit better how the system works and what is meant to be in place.
Feeling grotty
I’ve got a horrible cold at the moment. It started 2 days ago and my nose is just pouring. The worst bit is the sneezing and when it runs down the back of your throat and makes you feel sick. Ugggg. Still it should be better in a few days. It was interesting last night as I was on my over to the new path lab with the head of the lab to do a monitoring site visit – as work is progressing very well. I said not to come too close as I was ‘full of germs’; his response was ‘yes but its self limiting’. Even though I was feeling a bit sorry for myself it made me think of the other diseases around here that are dealt with on a daily basis and are much worse and put it in a perspective which made me feel quite selfish I suppose.
Update on the local brew
I gave you a description previously of the beer brewed in the local villages but had trouble with the images taken by one of my housemates. I have copied the text from before but added in the images as I have managed to save them now – I think you’ll see what I mean.
We haven’t been back for any more even though we had a few offers....
The beer story with pictures -
One of the staff here who lives on site said that he had to go back to his home town on Friday and promised to bring back some of the local beer that is brewed in the villages for us to try. When he returned he invited us all over for a taste. This sounded great so off we trotted to next door for a sample. ‘We’ is Misha and Sarah (my German housemates) and I.
The local beer is brewed from millet, a very small hard grain. The brew is ready to drink after about 7 days of fermenting. We were advised that it can be taken with either hot water or cold water, but that people who drank it with cold water get drunk very quickly.
The beer is poured from a large canister into a clay pot and this is topped up with either the hot or cold water – we all opted for hot.
Each person is then supplied with a very long drinking straw. The ones we had were about 4 – 5 feet in length, so that you can sit in your chair and sip the beer from the pot. The end of the straw is covered in a tea bag like filter so that the solids in the bottom of the pot don’t get sucked up into the straw. Traditionally the mouth piece is made from a turkey quill, but the ones we had were made from plastic (I think).
The beer was not quite what I was expecting a beer to look like. It was thick grey brown liquid (a bit like cement) and had a slightly chocolaty, gritty, sharp flavour. We did not really drink very much and I hope we didn’t offend our host but it was very different to what we are used to as a beer.
Our host told us that back in the villages, when a person has had enough to drink, they are not expected to say anything but to quietly remove themselves and go off on their way. He said they often look around and wonder where people have gone. He also said that once the brew has been drunk the millet in the bottom is eaten in areas where they are short of food.
We have had offers to go over and finish the container for the last couple of nights but have very politely declined. I wonder if they really like it that much – they seem very keen to give it away!
Sunday, 24 October 2010
Gardens, Visitors and We and They
Working with the Agriculture Team
On Friday I spent the day with Aida and Tony from the agriculture team at Salem. Aida is in charge of the gardens where they grow vegetables that are used by the guest house, the children’s home and for the staff lunch. Some of the vegetables are also sold off.
We harvested a large bin full of aubergines (egg plants as they call them here). We also picked greens for the staff lunch.
Then we went over to the medicine garden where they grow Artemisia which is harvested and dried to make tea as a relief and preventative for malaria. They also grow aloe vera, hibiscus, lemon grass, and several others - I can’t remember all the names.
We looked at the bee hives from a distance as the bees are not particularly approachable in the heat of the day. They harvest the honey as sell locally.
One of the things that really surprised me was the G nuts. At home I know these as money nuts or peanuts. The monkey nuts that I know of are found in beige shells that are cracked to reveal nuts in a burgundy coloured coating. Everyone laughed at me when I said I thought these grow on trees and were nuts from a kind of pod – a bit like peas I suppose. They are G nuts here because they come from the ground. The stem of the plant is pulled up to expose the nut shells as a type of tuber that grows in the ground. I don’t have a picture now but will get one. The g nuts are an important part of the harvest and diet here and most small people grow some on their small plots of land. They are not eaten straight away but are slowly roasted over a charcoal fire with a small amount of salt, and then very often ground to make a sauce that is eaten with matooke (boiled green bananas). We experimented to roast them with a small bit of sugar – really nice, especially when there are no other sweet treats around.
Welsh Visitors
A group of teachers and students from Rhondda Cynon Taf arrived on Friday evening. It’s amazing that I come all this way and meet people who live 5 minutes down the road from me in Pencoed and Llanharry. The saying ‘it's a small world’ is quite significant. They had arranged a bus tour to some ancient rock paintings on Saturday and invited me along, and I gratefully accepted. The paintings are at a place called Nyero near Kumi http://whc.unesco.org/en/tentativelists/914/ . One of the village elders acted as guide and showed us around.
He said that the rock paintings were one of the first ever rock paintings completed about 7000 years ago, but I’m not sure about this.
The concentric circles are meant to symbolise the sun god and I think they are not too dissimilar to the Egyptian icons for Ra the sun god – which is not that far from here. You can also see on the paintings a boat on the river with people in it. The paintings were reportedly done with the sap from the cactus plant whose sap is quite rubbery, and is mixed with blood to give the red colouring.
As we walked between the rocks there was a large spider and web overour heads. it was 5 - 6 inches in diameter. We didnt hang around!
It was a beautiful setting and it’s a shame that it has been vandalised and spoiled over the years.
There are also some rock paintings quite close to where we are at Salem – I’d like to cycle to see those one weekend as well http://kampala.usembassy.gov/pr_09212010.html .
I thought you might also like to see what the ‘loo’ was like – a very nicely decorated pit latrine (you have to make sure you carry a supply of your own tissues).
There is also an official visit through PONT (as mentioned in earlier blog), by officials from Welsh Assembly Government as part of the Wales for Africa agenda. The focus of the visit is tree planting and climate change. I was invited to the Mount Elgon Hotel http://www.mountelgonhotel.com/ in Mbale where they are staying to have dinner on Saturday night. It was a good opportunity to summarise what I have done at Salem to date and to explain my findings and the objectives that I am working to over the 8 week placement. I hope they think they have made a good investment in me.
From left to right is Patrick (from the hotel) Jon Townley (Wales for Africa WAG) John Griffiths AM http://www.assemblywales.org/memhome/mem-profile/mem-newport_east.htm, Elin, Me, Sarah, and John Harrington (on placement).
This poem was in a book in the volunteers house giving tips on Ugandan culture. I thought I would share it – I like it.
We and They
Rudyard Kipling
Father, Mother and me
Sister and Aunties say
All of the people like us are We,
And everyone else is They.
And They live over the sea
While we live over the way.
But – would you believe it?
They look upon WE
As only a sort of They!
We eat pork and beef
With cow-horn-handled knives.
They who gobble Their rice off a leaf
Are horrified out of Their lives;
While They who live up a tree,
Feast on grubs and clay,
(Isn’t it scandalous?) We look upon
As a simply disgusting They!
We eat kitcheny food.
We have doors that latch.
They drink milk or blood
Under an open thatch.
We have Doctors to fee
They have Wizards to pay.
And (impudent heathen!)
They look upon We
As a quite impossible They!
All good people agree
And all good people say,
All nice people, like Us, are We
And everyone else is They:
But if you cross over the sea,
Instead of over the way,
You may end (by think of it!)
Looking on WE
As only a sort of They!
Thursday, 21 October 2010
Local Beer & Our Lodgers
The ‘local brew’
One of the staff here who lives on site said that he had to go back to his home town on Friday and promised to bring back some of the local beer that is brewed in the villages for us to try. When he returned he invited us all over for a taste. This sounded great so off we trotted to next door for a sample. ‘We’ is Misha and Sarah (my German housemates) and I.
The local beer is brewed from millet, a very small hard grain. The brew is ready to drink after about 7 days of fermenting. We were advised that it can be taken with either hot water or cold water, but that people who drank it with cold water get drunk very quickly.
The beer is poured from a large canister into a clay pot and this is topped up with either the hot or cold water – we all opted for hot. Each person is then supplied with a very long drinking straw. The ones we had were about 4 – 5 feet in length, so that you can sit in your chair and sip the beer from the pot. The end of the straw is covered in a tea bag like filter so that the solids in the bottom of the pot don’t get sucked up into the straw. Traditionally the mouth piece is made from a turkey quill, but the ones we had were made from plastic (I think).
We did take some photos on Misha’s camera but unfortunately I could not load them onto my laptop.
The beer was not quite what I was expecting a beer to look like. It was thick grey brown liquid (a bit like cement) and had a slightly chocolaty, gritty, sharp flavour. We did not really drink very much and I hope we didn’t offend our host but it was very different to what we are used to as a beer.
Our host told us that back in the villages, when a person has had enough to drink, they are not expected to say anything but to quietly remove themselves and go off on their way. He said they often look around and wonder where people have gone. He also said that once the brew has been drunk the millet in the bottom is eaten in areas where they are short of food.
We have had offers to go over and finish the container for the last couple of nights but have very politely declined. I wonder if they really like it that much – they seem very keen to give it away!
Our Lodgers.
The volunteer’s house has a concrete base and is a construction with wood cladding. There are four bedrooms, a kitchen, shower room and sitting area. There are currently three of us living in the house but I thought I would explain that we are not alone.
We have lots of spider’s webs around the lights and in the corners of the ceilings, but we don’t attempt to get rid of these because they eventually catch the mosquitoes and other flying creatures.
In the roof above the kitchen we have some creatures that make a high pitched squeak. We think they might be bats but are really not sure. We can hear them moving around a bit but we don’t see them and they make more noise in the day time.
We have quite a lot of lizards about 4 inches long with very big bulging eyes. They are very shy and quickly disappear if you manage to see one. We think it is these that leave a trail of droppings each morning on the worktop in the kitchen.
I haven’t seen any snakes yet but Misha keeps a blanket at the foot of her door to make sure she doesn’t get one in her room. The staff here have said that there are quite of lot of snakes in the long grass by the school of nursing. There is a better internet signal up there and we previously toyed with idea of sitting on the bench up there at night to be able to get the signal – but you won’t catch me up there now I know this. Apparently they are bright green but ‘only a bit poisonous’. There was also one in the office the other day which caused a bit of a fuss. Having looked then up on the internet there are several green species of snake so I’m not sure exactly what it is. Most likely a green tree snake.
The green snake isn’t the only one that is seen around here; a short while ago there was a very large snake (probably a python or a boa) found in the guest house – glad I wasn’t around then.
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