Mental health : new initiatives

July 26, 2010

Mental health is one of the big issues in Africa. There are millions of people living in trauma: Aids orphans, war victims, battered women and abused children, let alone the clinically mentally ill. Post war Liberia was reckoned to have 40% of the population suffering trauma . Lyn Westman has worked accross West Africa to offer training , help and teaching to people on how to manage mental health. She is a trained Psychologist and psychiatric nurse ( Liberia only has one Psychologist ) and pastor. Lyn’s strategy has been to work with the churches to train them to look after people, and to teach social workers ( in Togo), the police, prison wardens and the army. Over 400 hundred officials have receive this effective knowledge, and surely attitudes to the mentally ill are changing too.

The Togo government tasked Lyn and her team of 3 to care for 50 children directly, and work closely with social services, police and army to build a stronger system. Now Lyn is linking all the West African churches and officials and raising awareness and treatment for the ill. This is the beginning of better mental healthcare system in W Africa and its all down to Lyn and her work.

She teaches children about avoiding abuse, self esteem , boundaries, emotions, what is right and wrong and positivity. The adults too benefit from this, and a 4 stage analysis of care  : Awareness , personal care, informal care and primary care. Everyone is empowered to be aware of the issues and the whole social structure is being raised.

Agricultural project in the bush

July 22, 2010

Up country, in the middle of nowhere, somewhere near Ghana, is an instructive agricultural project run by Ken Wineback, agricultural projects director for Mercyships. Ken has brought together 3 Togoan NGO’s to train young people in new organic agricultural techniques. The results are astonishing.

Classically the local poeple would slash and clear the land and plant Corn or Cassava. Trouble is in many areas the soil is relatively poor, the heat scorches off the water and when it rains the soil is washed away. Farmers are forced to use fertilizer to replenish the nutrients and carry water continuously . But, Ken has worked out (testing this technique in Texas- equally hot)  that the soil has microbes at different levels that break down and convert organic matter, so he promotes minimal digging and turning of the soil  (retaining moisture and microbes) , covering the soil with the cut grasses and vegetation ( to retain moisture, nutrients and provide a protective mulsh to keep down weeds) and planting Corn and Beans in alternate measure in simple protective holes.

The effect is dramatic- against a control group of traditional Corn farming on an adjacent strip, the organic Corn not only is three times higher, but also requires less watering, no fertilizing and yields a good crop, as opposed to virtually none. The weeds are less and the alternation with Beans means that nitrogen is naturally returned to the soil. The dozen farmers on this project have all graduated with flying colours and are now primed to spread the word and train others in the technique. To celebrate their work, we all enjoyed a delicious lunch of rice, fresh corn on the fire, and spicey chicken prepared under a mango tree .

Further along the road is an animal farm project, breeding rabbits, goats and hens.  Fed on local shrubs and animal feed, the rabbits are fat, beautiful and selling fast at 4,000 sefas ( about £5) each –  good money. Adjacent are Moringo trees that provide unbeatable nutritional value ( vitamins, calcium,high energy ) from thier leaves and feed animals and humans alike. So powerful is Moringo as a food supplement  we all should be eating it to boost our systems ( especially the old).

Togo has enormous potential for agriculture, its luschious, wet and with much good soil. With appropriate husbandry and organic techniques there is more than enough land  to create a thriving agricultural economy.Spread the word.

Maize farmers take a break

Palliative care : Putting on a brave face

July 21, 2010

Harriet is a palliative care nurse.  She provides medical and phsychological care to the incurable. Everyday she visits a woman in her 40’s who has a large facial cancer for 18 years that is now killing her. Her family have left her, neighbours and friends have shunned her and she is tended by her elderly father who works to provide for them.  Until Harriet and her team came to visit her this woman was alone. Now they clean her tumour, give her medicine to stop the pain, provide social contact and emotional care. This womans life has changed from sadness to happiness, from exclusion to inclusion from despair to acceptance. By visiting her everyday, the locals also recongised she did matter, that it is worth caring for someone, that you can interact and treat the ill and they are to be valued. Harriet has changed perceptions and turned this woman’s life around.

When she leaves in 3 weeks, Harriet worries about her other patients . Togo has no pallilative care , no drugs for the dying, or the social acceptance that they need care and inclusion. People are expected to be strong, to put on a brave face, whatever they are going through, there is no one they can tell thier agonies, worries and fears to. But the Mercyships team are sowing the seeds of a new approach that is significant in reducing suffering.

It’s a tough job for a young woman, Harriet ( 28) often feels inadequate, but she does feel she’s getting somewhere with individuals, thier families and among the day volunteers in Togo who see this work in action, sheds a light on what the dying are going through and changing attitudes.

Down in the depths

July 21, 2010

In the hull of the Africa Mercy dwells a distinctive and brilliant species of man. The engineer. Above board, we enjoy high quality facilities with aircon, lighting, hot water, lavatories, electicity and these computers. But below deck its another world- almost unbearably hot, unbelieveably noisy and seeingly dangerous. However, the team of engineers who keep the engines functioning  have adapted well to this life, led by Michael Z the chief engineer. Michael  takes on a dozen local boys from Lome to teach them the basics of engine maintenance and cleaning- for which they will recieve a certificate on leaving. The rest of the crew are old time professionals from companies like NedLloyd.

As Doctors and nurses undertake medical procedures above ground, Michael is doing just as complex a job below- I was quite taken back by the number of engines, compressors , filtres and generators required to keep the ship working- hundreds of dials, levers, pipes and computer screens check pressures, energy and flow. 10,000 litres of diesel are required each day to keep this ship functioning and it all flows through here, including a sophisticated sewage system. For the nerdy among you, the ship has 4 main engines and two shaft gear boxes, room for 1m cubic litres of fuel and 6 generators. Some of the items were made by FRISCH 30 years ago and due for replacement for the next 30. It throbs down there !

In August the ship leaves for Durban where it will be refitted with new generators and systems- they will rip out the side and remove what appear to be immovable generators, upgrade the airconditioning and enable the ship to reduce its fuel consumption by at least 20% and Nitrous oxide emissions. We’ll have a greener, more efficient Africa Mercy and a much quieter ship all round. This all needs a lot of money, do, please, visit mercyshipsuk.org website if you’d like to contribute .

The ship’s hospital

July 20, 2010

Bringing a large hospital ship to Togo boosts the country’s healthcare capacity considerably. Among a population of 6m , there are two hospitals, mainly accessed by those with money. If you’re poor, you get very little. With 6 operating theatres the crew can get through 3,500 eye surgeries, 3,000 face and tumour operations ,10,000 dental operations and hundreds of VVF ( Fistula ) ops, over the last 6 months. Not to mention club foot , physiotherapyand sustainable training for local dentists,health workers,agricultural/ nutritionists/eye medics and advice to the Togonese health ministry.

Mercyships runs a complex and wide ranging team, extending to 450 volunteer medical , engineering , support, administrative staff from around the world ( US,UK, Dutch esp) and 200 local ship volunteers, who are learning about medical , engineering and housekeeping tasks. The ship is effectively a floating town with the infrastructure to support it.

With such an array of requirements mercyships are on constant look out for skilled medics- especially surgeons and anaesthetists, without whom its a show stopper. Bill Martin ( Head of Hospital) took us around the various operations and patient ward decks. It was quite clear that this is a highly efficient operation, with dozens of people focused on specific tasks- ensuring patient comfort and a high volume of operations. There’s a grat deal of high tech equipment CT scanners, Cytology scanners- that can send results for analysis in Bristol, Sheffield or Mitchigan over night. Sadly many of the patients tumours have turned cancerous and the cytology scan flags this up and these cannot be helped in the medium term.

The ship sails for South Africa in August and the wind down has begun – many of the Dr’s and Nurses I spoke to expressed enormous regret at leaving patients and the volume of need in Togo, but realistically the convalescent time required for many of the proceedures precludes further surgery . It’s also quite clear that once a patient has been operated on and recovered, there is no further support from them in the country, should a relapse occur. Everyone is painfully aware of this, but recognise that at least most have been cured, or been given more than a fighting chance to live a productive life.

Patient in Ships hospital

Screening on the quay and passing on skills

July 19, 2010

Just below the ship are the initial screening tents- brought from Alaska, tough and insulated, with airconditioning. A team of nurses, physicians and Opthalmologists work to assess the needs of the waiting hopefuls and attend to the outpatients. The screening nurse has a tough job, assessing hundreds of people a day- one every 90 seconds- to assess what help Mercyships can help provide. Sadly only 12% can receive treatment due to limitation of surgery, timing and the patients condition.

For many this is a tragic place, where they learn of terminal problems, inoperable conditions and surgical limitations, so there is a support team in place to comfort the rejected. For the lucky few, its the start of a new life- new sight, new face,ability to walk unimpeded and the end of Fistual torment .

This year Mercyships have learned to correct club feet in young children without the need for invasive surgery- gradually manipulating the feet joints into normal formation. For very young children under 30 months this is relatively simple, and for older children a short tendon cut and manipulation over 6 months with braces and adjustments does the trick. With regular  therapy from the occupational therapy team this technique is working well -Local physicians are also being taught how to change club feet abmormalities without surgery , and retain the skills locally after Mercyships leave in August. Local  physicians are also trained for eye cataract removal ( 15 minutes a time) with simple tools to sustain the good work.

Arriving in Togo

July 19, 2010

One of the big differences between landing  at night in a western city and an African one  is the relative darkness . Its not that there are significantly fewer people, its just street , house and industrial lighting are lacking. But on the ground its lively, thousands of people are milling around ; street sellers,  family businesses, music bars and petrol bottle vendors orchestrate a lively spectacle illuminated by tiny parrafin lights and the occaisional tv.

Just over the dock fron the Africa Mercy are dozens of lorries, ready  to collect rice from a waiting Thai tanker, and Chinese containers full of goods for the local markets. Lome port offers the landlocked countries of the Sahara a vital lifeline and is a good source of business for Togo. Perhaps the trade is a bit one way, but Togo feels a little more prosperous than Benin and Liberia with a great deal of potential for agriculture and minerals. From the ship we see a gorgeous rolling Atlantic beach- surf waves crashing onto the sand- green sand dunes and lushious trees- ideal for tourism. Though none come. It’s too dangerous and there is no infrastructure, but lots of potential .

Togo doesn’t do branding – its off the radar, streets are relatively free of communications and its refreshing just watching the people doing their thing. Nevertheless branding can be a force for good – raising country profiles,branding their commodities, authenticising products and increasing margins and income- helpful stuff.  There’s a project here somewhere.

Tonight we enjoy a service with the local African choir- Gospel pop meets French Africa. Good singers. I wonder why they prefer it to the  natural sophistication and richness of native African music :Felakuti,Chora,Ladybird Black mambasa(?)  and AliFakatori . Tomorrow we’ll visit the wards and hospitality centres.

Street seller in Lome

Visit to Togo : Lomo and the Africa Mercy

July 8, 2010

Hello. we’re just limbering up to visit the Africa Mercy in Togo on 17th -24th July, where the medics have been doing fantastically effective and volumous work. Tim Cole and I ( Ashley) from Saatchi Design are there to take photographs of Mercyships work in Lomo so we can show supporters , donors, prospects and volunteers.

The Africa Mercy in Benin…09

Each country has it’s own challenges, and this year Togo have just experienced riots and unrest, so we may be limited in our ability to visit outreach projects, surgeries and hospitality centres. Neither are the local people keen on having thier pictures taken – believing we are stealing thier souls.  A combination of clandestine and upfront requests should do the trick, but it can be hairy work.

One of the things we want to achieve this year is to capture the Brits contribution to the ship. We’re hoping to spend some time with volunteers to hear their story, discover thier motivations and record thier work as a visual narrative.

We’re proud of our Doctors, Nurses and support staff who give often years of thier lives to care for the African poor, and its such an unsung, unassuming activitythat is touching and humbling for us to witness. The big society is very much alive and well on board the Africa Mercy.

I hope to blog about our experiences daily, so do tag along from Sunday 18th..regards. Ashley

Ganvie lake life

October 30, 2009

The people of the lake came down in 1770 to escape a conflict and established a stilted way of life, based on fishing. The AIZO predominate at the northern village of Ganvie but they are spread right around the lake to subsist on the fish. On the way over we encountered river buses crammed with gaily coloured people making their way to the shanty markets in Cotonou, to work, buy and sell produce. The boats are made of sturdy wood, but even they strain low in the water with the 50 or more people on board.

In between are the small canoes, like dug outs, with poles and paddles. Towards the middle of the lake it seems that nothing has changed for thousands of years, the lake people are topless fishermen, covered women and active children acting out a timeless scene – silhouetted against the vast flat water. It’s shallow, people stand at times and drive poles into the mud to propel the boats – even large barges with wood and materials. In lake Aleppy, Kerala in India, the same silhouettes appear – fishermen in similar boats, poles, digging mud in the morning light, netting and singing. I’m sure the same scenes happen in Latin America and they used to in early Europe around Crannogs and up the big river valleys in England. What we’re now seeing is an ancient aboriginal hunter gatherer behaviour that extends back even before agriculture, something that defines the humanity and sustained us over the centuries- fishing in simple wooden boats, living on the lakes in small communities. I suspect we see in Ganvie the early shared human experience, and for that it’s fascinating.

But there is a the threat from the population boom, that turns an innocent activity into a dangerous pursuit, and its beginning to happen in Cotonou, where we see hyper-growth, too many fishermen and squalor. But at the northern edge of the lake its still fishable, the people build palm stockades to farm the small fish and harvest them before the floods come, ready for the next lot. All over the lake are large square plantations, delineating family fish farming plots, like islands in the mud. Closer to Ganvie village a green bloom of water jasmine is creeping over the surface. It looks pretty with a hyacinth-like flower, and great green trumpet leaves sticking up about 2 feet. Our host Udo said that since he last visited some weeks ago, the waterways have become over grown. Judy, Mercy Ships UK CEO, hasn’t been back for four years; back then the weed didn’t yet exist. But now it covers large tracts over stockade, acres of green now surround the village and its getting hard to cut through the vegetation. This flower like nitrates, something is disturbing the balance and its become an invasive species. Soon the people will find it takes the oxygen, and fish yields will drop, the lake will become subsumed. On the up side, it is good for composting, but in general it’s a concern. Hopefully they realise, or there will be trouble in the next 5 years. The same goes for Bangkok klongs, and Aleppy, its either human waste or fertilizers, and both need to be managed, as does the plant.

Ganvie stilted village

October 30, 2009

As we reach the village the most amazing sight of largely wooden houses, built on stilts, looms into view. Most of the houses are covered in traditional palm and rush roofing, supported by misshaped wooden poles, possibly 10 across. The flooring is wood and the sides are light balsa or corrugated wood effect – some are ancient, or at least look like they popped out of the neolithic – this feels like Africa I saw in the 60’s geography text books. Apparently the houses can last for up to 20 years, with a bit of maintenance and they can build one in two weeks. On the whole, it’s a beautiful group of ancient houses worth a visit while it lasts.

You encounter dozens of houses, in a real community, with people in canoes travelling up and down the village high street waterway on their way to market – a floating group of women and their loaded boats, or to school, a solid building at the back on the river bank. Kids laughing and mucking about in their neat khaki clothes, waving to us and enjoying the ride.

This is an entire water bourne village – a Venice of the northern lake. We stop to visit a couple of hotels and tourist shops – surprisingly good work, among the usual trinkets. A jovial and slightly mad owner in one, who pulled eccentric faces and tried to sell us weird handy work, but all in good humour, we bought things for our families – and I enjoyed haggling with a grumpy teenage girl who smiled when the sale was done. Coming from Oxford I wanted to  show them I could punt too, but I didn’t fancy tipping into the grimy water on a fragile canoe.

While all looks ideal, its still worth remembering these people are very poor and have no access to health care other than that provided by Mercy Ships and other NGO’s. They have high infant mortality and the hospital ship sees many people with tumours, fistula, dental and eye problems and of course they are in deep malaria country in the reeds and over the water. It must be hard for them, but as usual they are bearing it with fortitude and good humour.


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