Organised descent

The thing about the Mambilla plateau is that it is gorgeously, gloriously beautiful. Not in fact that dissimilar to the country around Sheffield. Wild peaks, rocks, verdant and lush moors, but never gentle.  Livestock ambling around as if they own the place (they do) and smallholdings dotted along the one major road bisecting the pass at the top of the world.

The second day of medical outreach in Gembu itself (the county seat of the Mambilla) has gone well. We were earlier and more orderly this time. I did some very fun training on current thinking about birth techniques; including care of the newborn; shoulder dystocia; breech birth and some emergencies. The dozen or so participants were aged 16-80 years of age. Some were nurses and midwives of huge experience, others were CHWs (community health workers) newly minted in their local roles. The fashion for either valorising or abhorring CHWs drifts back and fourth within the international health community. There is no regulation or standardisation of either the breadth or definition of the CH[E]W role. Many are wise and skilled but many more are very scantily trained. All 1.3 million are necessary.  From Chairman Mao’s barefoot doctors of the 1940s to Liberia’s current progressive policy of training and coordinating their community health lynchpins of wellbeing. I brought a training manikin (the middle third of a lady) and a baby which now looked like a tatty prop from a Ridley Scott film after it had been through three flights, a rain sodden pick up truck and being accidentally packed under a hundred weight of medical kit. The moral of this story being that you should never, under any circumstances, let Phoebe babysit for you.

After the training and clinic, I considered walking back to the hotel (I miss walking, I’ve been driven everywhere and I’m feeling very Tuwo shaped myself) but the kindness of the policeman, who I have just realised is following me around, deterred me. I didn’t want to add to his workload by ambling off. There are a few, extremely professional but very sweet, state security men assigned to the project – the kit we have brought alone is very valuable. I have only just understood that the heavily beweponed yet adorable Baku is detailed to me personally though.

Getting back to the hotel and seeing the newspaper I realise why – there is a massive rise in kidnappings at the moment and a subsequent political call to arms. I have friends in much more dangerous situations (Hannah ‘duck and cover’ Thompson) but it is kind that Muhammads sponsors are being so considerate. But don’t worry anyway, the politicians are promising ‘swift and decisive action with a zero-tolerance approach’. Which means about as much as your best mate assuring you at 2am while thoroughly ‘tired and emotional’ that she’s definitely, absolutely, giving up smoking in the morning. To be fair, the current incumbent has won a few military coups before his current democratic mandate so this is kind of his speciality. Whereas our premus inter pares cannot take down the last can of UK spam from the shelf in Waitrose, let alone take down armed millitia.  I am also writing this safe in the knowledge that I will be home before this blog is published and my mum will not therefore, explode in a shower of Italian baked goods when she reads this.

So, with the scent of eucalyptus on the humid but actually very reasonably temperate air up here 2000ft above sea level, we started the long journey home. Jalingo by tomorrow, then an internal flight back to Abuja, then home to Manchester Airport. At which site I once climbed a tree in a (failed) attempt to prevent the building of a second runway. I did meet Swampy though. He was a bit of a git.

On the drive back, Mukhtar told me more about Nigeria’s history – he really should write a book. He also related it to the wider history of this prominent corner of Africa. Some of the absurd things he had seen he also included, knowing about my love of the bizarre. One story was about a professional visit he had taken to Tripoli, many years ago. Gadaffi wanted to bring the radical and nomadic Bedouin people to heel so he enforced their move out of tents, which appear by night and are gone again the next morning, and into high-rise tenements. The people gathered their possessions and, by and large agreed. We all know that he was not a man who dealt with the word ‘no’ very well…. Thus, Mukhtar (or maybe his friend, I forget, carried away by the imagery) stood there in the lobby of one such sky scraper, awaiting a lift to ascend to an apartment. Only to have the door slide slowly open to display a small herd of goats and kids, waiting patiently to reach the ground floor and pop out for a quick graze in the communal gardens.

One of the interesting histories he related was about the British attempts to impose colonial rule on what was then a very diverse map of people. The early British empire protectorates of North and South Niger, were merged to form a whole during the second world war. The country was named Nigeria by a tipsy wife of a colonial general, posted to govern this fierce and magical country. Most of the tribes, the Hausa, the Yoruba and many more, fell to the colonial rule when the British forces killed or seduced both the local and state level kings (chiefs). But the Igbo (pronounced eebo) were defiant against this. Their structure of rule had been a collective, collaborative one. With a local person, skilled at hunting; farming; shamanism; or general wise sense, voted in by the community of which they were a part. So, what then, could the armed forces of the pallid tea drinkers, do to seize control of the Igbos land? They essentially had to create a kingship in order to topple it. They had to create power to depose it. There is probably an important lesson to be learned about the foolishness of the concentration of power when there are important decisions to be made. Can’t think what brought that to mind…..

Thank you all for following me textually around Nigeria, it’s been an amazing trip and I am exceptionally lucky to have had the opportunity. I’ll blog again next time I go somewhere more exciting than Manchester!

White girls can’t kneel

Muhammad, who seems to know literally everyone, keeps taking me a-visiting. We’ve met a lot of his family (he is one of 33 siblings – I kid you not). His relatives have all been lovely and, in the way that Muhammad seems to relate to me too, they have laughed at me kindly for a while. A tendency which I wholeheartedly approve of, because it makes me feel less nervous about getting something wrong. What I also like a lot, is how social the homes are which I have seen – people wander in and out, there is no meal which isn’t attended by at least half a dozen people and the family is both extended and extensive. Thus, I have taken to locking myself in my room for a few hours a day. I don’t know what one would do as full time Nigerian introvert, maybe you just hide in your own head.

He has also now taken me to visit four Emirs (kings) – two Third-Class, two First-Class. Second-Class Emirs do not seem to exist, I asked and everyone looked blank; and why should Protocol follow logic, after all. Anthropologically speaking it is an opportunity of a lifetime and I only wish I hadn’t been so knackered each evening we were on the plateau, after a whole day of clinical service then formal visits, that I didn’t make more notes afterwards. Which is a tendency perhaps, of a former time, when cross cultural curiosity was unfortunately less critically analysed. Quick, hide the television, the anthropologists are coming and so forth. But then my training was in a department where anything written post 1979 was considered an upstart attempt at post-modernism.

There were these beautiful metalworked walls in the halls of the Emirs, some with Koranic verses, others with Islamic geometric patterns. Shield, spears and drums as traditional symbols of status but also a plethora of newer objects of accolade. Plaques from various government institutions; totemic gifts from visiting scholars and business men; posters advertising the good work and patronage of the Emir himself. Muhammad told me the story of the first German settlers in the plateau, who tried and failed to get the Fulani to talk to them (they preferred to shoot them, and the mountain is pretty unassailable if those atop do not want you to climb). Until finally they rescued the wife of one of Muhammad’s ancestors, oh five or six generations ago, from slave traders who were making their way through to what is now Cameroon. The Germans refused to give her back, however, until Muhammad most senior agreed to be their envoy and to get the Mambilla to do a bit more talking and a bit less arrowing. As a token of this agreement, they gave him a German flag and a military plaque and said he could have his wife back when he had arranged talks. He went home, gave the items to the nearest keen looking lad and went and rescued her himself from the camp where they had hold of her, spending days singing her name until she finally came to the fence and he helped her over it. The enterprising young man who had accepted the tokens of the flag and plaque became the envoy and eventually became the First-Class Emir. The current Emir (Lamdo Gembu) still has them and they are now the token of office.

The many houses I have knelt in, then good naturedly been ordered by all to sit in a chair rather than kneeling on the floor, are now blurring into each other. Of course, making me take a chair is actually a kindness and great honour to a stranger but as I am so tiny I don’t actually fit on the big and grand chairs in the senior Emirs (Kings) chambers we have visited and thus it becomes slightly farcical. This photo is of HRH Lamdo Gashaka. Muhammed (to my left) was trying not to laugh at my little dangling little feet.

phoebes feet


We started the day late, struggling to pull all the loose ends of the medical outreach together. An outreach is basically setting up a day long mobile clinic to offer primary care. We realised that we had been sent the wrong HIV rapid testing kits, so someone suggested we go over to the mission hospital and see if they had any spare they would give or sell to us. I have to say that I struggle a bit with the missionary fervour and, unfairly, I didn’t like Bob the director as well as I should have done. Muhammed and Mukhtar took it much better than I did, to my great discredit. Whether they are more used to it or more likely are less threatened by possible comparisons with my own medical colonialism that I, I’m not sure. However, my habit of gentle civility, despite the provocation, did actually pay off as we established a good rapport with them, I hope.

When we finally got to Kikara, a village in the Highland Tea Plantation there were more than a hundred people waiting. I started off dutifully dispensing (not a regulated profession here and therefore entirely within my remit on a business/volunteer visa) but I very soon got caught up in the clinical. I managed to excuse it to myself by a delightful encounter with the village health worker (called Community Health Extension Workers or CHEW) Mirabelle. I then taught her everything I could think of about midwifery in the time we had and supported her to do all the antenatal examinations, as she catches most of the babies round here.

You may think I’m being unnecessarily polite about my issues with working without in-country registration. But for once this is an actually boundary which one shouldn’t crossed and not a Phoebe ‘but what if I’m imposing’ insecurity. First and foremost, you have to be accountable and if you’re not registered you can’t be traced. Secondly, it’s wildly disrespectful to go to another country and work without the licensing you would expect were the local midwives to come to your own. Thirdly, I’ve seen a lot of damage done by ‘off piste’ medics over the years; safe and contextual is generally how you want your medicine.

One of the things I’ve always found hard about working abroad is the general air of gratitude from your patients; that you came all this way just for them. It is a very kind impulse and I know they mean it as praise. But I, knowing how unnecessary this work would be in the UK (for now at least, till they are prising the blue passports out of our cold dead hands after the last cache of bread and dripping is finally consumed) I just persist in feeling that they deserve much more than this, as does all of humanity. And then I feel even more guilty for feeling what I see as cultural patronising wank. “Such is the way in the life of an adventurer”, I guess, the choices don’t be easy.

Talking of receiving praise, there is a man, called a Praise Singer, who is employed by all Emirs to talk constantly about his grandeur and eminence. Most of the metaphors the Singers traditionally employ are animal related. As strong as an elephant, as kingly as a lion etc. It is the only time I have seen Muhammad irritated; a man normally so stoical you could dam a river with him. I think the bubbling anarchist below is unable to bear the obsequious fawning of such behaviour. So, I spent the evening saying ‘you’re as strong as a lion!’ every time he picked something up. He still likes me. Probably.

So, I showed Mirabelle how to diagnose twins by having a good feel (palpate in the technical terminology); showed her how to listen accurately to a few squirming foetuses, discussed birth; handed out a lot of ‘not bleeding to death is good’ drugs and generally wandered around being midwifely at people. I love being a midwife, it is something I really enjoy, and I’m glad I’m finding a way back into it at home too with the Sheffield Midwifery Cooperative. Then, after more Protocol visits we went back to the strangely moist hotel and ate. This was the first time I’d eaten tuwo (which is identical to the Malawian nsima, which I spent a year or more living on) in public and literally everyone took a photo. White girls may not be able to kneel, but it turns out they can gracefully eat tuwo and stew with their hands.

Wet warrior women

8th April 2019

Most of today was spent in a pick-up truck driving from Jalingo to Gembu, a town perched high on the Mambilla plateau. The drive was stunning and I actually took some photos of the landscape. I cannot bring myself to take pictures of people I do not know as it seems so very rude, like I think they are just part of a tableaux of ‘typical African life’. I feel like I am stealing their agency. But my deep and perhaps excessive concern for consent and boundaries does not yet apply to hills and cows, so I have some photographs to prove I was here, at least. We also drove through a big nature reserve (no elephants sighted or I would have texted you all to babble with joy – they are my favourite creatures) then up a windy switchback road onto the most magical landscape of hills and what we would think of as moors.

Just before we arrived it wuthered, then it blattered and then the rain moved up into its full voice and the air was water. I had idiotically left my little holdall containing my clothing in the open back of the truck (we were in the cab) and now all my clothes are scattered round my room to dry. As if after an explosion in a lingerie seamstress’s boudoir.

Muhammad’s mum pulled a classic Nonna and sent an unspecified grandchild to intercept the convoy just as we left Jalingo and deliver a big bag of home cooked food. There were these blackbean puffy ball cakes which were delicious and peanut drink in flasks. We had a very jovial police guard, sent by the Department of State Security, for the trip as the road we were taking is apparently notorious for mercenary kidnappings. We are now safely through and in a little town called Gembu, where Muhammad’s family are from. Gembu is a beautiful place, a town built of brightly coloured slate, patterned tile and shades of aluminium, nestled high in the hills in its own little bifurcated valley.

On the drive, Mukhtar and Muhammad told me stories of Nigeria. Real stories such as the traditional nomadic pastoralists increasingly armed and violent conflict with the farmers. The nomads resent the homogenous and barren looking farms that have severed their traditional and spiritual migratory routes, along which they chase the rains to fatten their beautiful cattle. The farmers resent the smelly cows who pop up once a year and eat all their lush crops, watched sardonically by the teenagers who should be herding them. Vendettas have turned to feuds and feuds have turned to murder. Mukhtar also told me stories of the heroic Nigerian women of mythology. Stories of Amina the warrior queen of Zaria who led thousands of men into battle and claimed a large swath of Nigeria for her tribe, the Hausa. Of the ruler Daura who promised her hand to the man who could rid her of the snake in the town’s main well (symbolism being not so thinly veiled in this myth). A Moorish scholar rode in and slayed the snake and she bowed, and married him.

The team are doing a medical outreach tomorrow, partly as an awareness raiser for the health centre, partly for its own sake. The team are fantastic, us three from the UK and half a dozen nurses, strategists and other health workers from a teaching hospital in Gombe. I am in a bit of a bind as I am not yet licensed to practice here (I came to give training on birth and support to the health centre set up, which I am entitled to do without registration) so I will endeavour to help the others rather than to give any care. Never do in another country what you would not do in your own, after all. Although I do seem to be eating twice the amount of food I normally do (yum yum yum). So perhaps I should be more reflexive in the application of the famous golden rule of moral philosophy, before I become weighted to the floor with tuwo (pounded starchy staples eaten with stew – delicious and extremely filling).

On the recognition of goats

Sunday 7th April

We took an internal flight from Abuja to Jalingo today, a little fixed wing 45 seater plane from an airline confusingly called ‘Overland’, but the plane did not just taxi all the way there as the nomenclature suggests. I’m not scared of flying particularly, though the ascent and descent always make me feel a little nauseated. But these little planes really do emphasise quite how laughably ludicrous a concept flying really is. So little fuselage and a few stubby wings between you and two miles of empty air. We only went up to about 10,000 feet, so you could see the ground clearly all the way through the hour-long flight. A flight fortified with a tepid glass of water and what my mum calls ‘worthy’ biscuits, in that you hope they are doing you good because there is literally no other reason to eat them. The savannah seen from the air was mostly scrubby bushes and the meanders of what I initially thought were roads but then realised as we came in to land, were actually dried up rivers. Though conveniently now used as tracks by people and goats. Now we are in a more rural place, I’ve also started playing a game which Muhammad has called, affectionately mocking, ‘Phoebe’s goatsheep game’. In which I try to guess if the quadruped wandering idly into the road, as our seatbeltless pick-up truck screeches to an emergency stop, is a goat or a sheep. I have a 50%-win rate – so no better than blind luck thus far. It is harder than you would think.

I’m getting to know Muhammad better than I did when we were students together as we have a lot more time to talk. We have had some fascinating conversations and he really helps me think. His training was medical school then public health – a career path usually light on philosophy and ideology. So, by trying to explain ideological and anthropological concepts to his supremely intelligent mind, I see the flaws in my own patterns of understanding. The discussion about anarchism today was particularly telling. I explained the basic concepts and he said; “Yes of course that is right. But how do you get a community there, given the existing structures?” – the particularly uncomfortable anarchist question and one which has led many down the path of ‘smash it all to pieces to start again’. I have no answers to this.

He’s also the only person who has ever made me feel less self-hatred about my medical colonialist tendencies. His gentle way of explaining the detail of Nigeria’s history; of the complex machinations of the warring ethnic groups, the incompetent oversight of the bungling British and the effect of the civil war has made me see things in a much less linear way. It has helped me to understand that accountability for one’s privilege is not the same as guilt for a past that one had no control over. Nor guilt for a global state of affairs in which one is only a tiny lizard in a vast jungle, for that matter.

Mukhtar, and indeed everyone else, are treating me like a princess – carrying bags, opening car doors and being very concerned for my comfort. I’m fine I insist, swaying in the 38-degree heat of a dusty road today, after a terrible bout of cramping diarrhea then a three-hour truck journey over roads like lunar craters. I am going to have to burn all my feminist literature and start taking an interest in self-help books entitled Men are from Croydon Women are from Slough or whatever they’re called, because I’m loving being so tended to. I have always really enjoyed gallantry and chivalry, though I would not expect it nor invite it. I don’t know why, it just makes me feel cared about and graceful. I may need to examine this rather reprehensible little tendency I seem to have developed a bit further….

Our first endeavour when we arrived in Jalingo was to drive to the warehouse complex where the enormous amount of medical kit promised to us by Dr Sidi was being stored. This equipment – everything from bedpans to x-ray machines – was purchased at least several years ago as part of the vote winning plan to develop the North-Eastern health provision. It has remained in these warehouses; rows and rows of symmetrical one story sheds that look like a historical detention camp which is now a monument to the evil of man. But with more goats. Muhammad has enlisted Jamil to help wrangle; a retired eminent business man and the secretary of the Dechi Trust. No one knew in which of the baking hot dozens of storage lockers each bit of kit was kept and thus everything had to be opened and sorted before loading it onto a massive truck to follow us to Gembu. Muhammad is quietly angry that all of this much needed, lifesaving equipment is mouldering in a forgotten warehouse outside a provincial city seat. The purpose of buying it seems to have been forgotten in the all-important power (and contract) winning endeavour to buy it at all. PPI in the UK can answer to the same charge.

We went to Muhammad’s sisters for lunchtea (everyone seems to eat early in the morning then about 4pm). She is a pathologist in the local hospital and has an adorable small son who was literally transfixed with shyness in front of me. I also met Muhammad’s mum who looks just like him only older, smaller and femaler. I brought her some Duchy shortbread – that being the only internationally nice food to come out of Britain. We sat on rugs in the yard to eat, with poultry and rabbits ambling around and a beautiful herb garden. It was truly lovely. Muhammad and his sister then took me to the pen behind the house and said “these are sheep” and laughed a lot.

Then, for reasons completely beyond me, we went to see the local Sharia Justice in his traditional house built around a courtyard with mango trees and bitter leaf bushes growing in the sandy rectangle. Women’s rooms on one side, men’s on the other. The Justice was very small and talkative to me, but in Fulfulde, so I maybe missed some key points on religion-based parallel justice systems on that visit. I’m now back at a little hotel trying to Will the gastrointestinal hell away with rehydration salts and lying down. We have a seven-hour truck journey tomorrow so I need to be a little less co-dependent with the bathroom facilities.

God is Gilt

Saturday 6th April

Muhammed (an old friend and founder of of the Detchi Trust, under whose auspices I am here), Mukhtar (surgeon and a new friend) and I were talking over breakfast this morning about the will to power in politics. I don’t think I’ve ever been in a country as overtly political as Nigeria (sorry France, you’ve got nothing on this amazing place). Every roadside board and sign and shop has some kind of electioneering poster pinned to it or papered over it, most with the cant phrases of the political kind. Variations on ‘strong and stable’ and ‘we’ll not fuck up this time’. But some are funny, like a man called Able, whose tag line is Able is Able. Try saying that fast while laughing.

The statement that both Mukhtar and Muhammed used was “speaking truth to power”. The parrhesian concept seemed very important to them both and in many ways the medical aspect of their work is constructed by them as a tool to innovate social justice. It made me realise that mine is as well – which should have been obvious to me given my standard quote about why I got into midwifery. “Because I thought it was the last great battle of feminism, but it turns out it’s the first and we are still fighting it”.  Perhaps I knew it was my mission and then I forgot. The details of birth weaving my thoughts into a delicate sampler rather than the younger anarchistic graffiti on a bridge. I feel like I am stepping back and looking again at least.

We have driven a lot today to various meetings and errands, through weaving traffic and Keke Napeps (yellow chassis mounted on mopeds as taxis) appearing impossibly in the gaps between cars and trucks like harbingers of a head injury. Aso rock, the axis of the movement round Abuja, always just in my peripheral vision. I like cities built in the cleavages of hills like Sheffield and Mexico City, but I also like those built around rocks, like Bologna and Rio. It always seems that the god of the place is watching when there is a massive rock peering daily into the lives of those who scurry round it’s foundations.

Mostly, what the roadside billboards are advertising is god – though The God, not one of the old rock gods of a gentler plurality. These advertisements are for what is anthropologically and locally known as ‘prosperity’ Christianity. The selling of a certainty that a true belief will lead you to power and riches in this life, slightly obfuscating the normal promise of a spiritual wealth in the next. “Who has first given to him that it might be paid back to him again?” (Romans, 11) taken literally. I find this fascinating, essentially the Capitalisation of faith itself. There has been a Christian presence in Nigeria for a long time, particularly the Igbo’s adoption of Catholicism, but preaching prosperity, evangelising luxury, is relatively new.

We also went to see a mental health in-patient facility that my friend was involved in setting up, Called Ataraxia (‘tranquillity’). Generally speaking, mental health is the most neglected branch of medicine, in any country. So, it was inspirational to see such a dedicated team and unit. There is no way I can make this bit funny and not then be a total jerk.

There is a storm outside, I’ve just run to the balcony to rescue my bikini and the trees are bent double, the opaque air full of dust and rain. The weather is taking itself seriously again. I’d better post this before we lose power again.

Letters from Nigeria

5th April 2019

I love being in Nigeria. Though I immediately missed Malawi so much more (four years have gone by and I have not missed it less than when I left) as soon as we landed in Abuja. I am not lumping a whole, wildly diverse continent into one experience (cue Phoebe’s stock rant about people who do so – “Africa is not a country. Africa is not broken. Africa is not your project”) but there are some minor visual similarities in a lot of the Sub-Saharan region at least. Like the colour of the dust; the slightly spiky shrubbery which appears verdant despite the 40-degree heat; the psychedelically stunning, beautifully tailored apparal, and the markets which just pop up everywhere, wherever people congregate. A friend got a little annoyed today as we got stuck behind one such impromptu magical market which coalesced into existence in the middle of Main Street, with no prior agreement, just as the major Mosque in town emptied. It takes a lot to test my patience and I was instead just curious by the things on sale and the people selling them. I spent a few minutes trying to work out what the odd cake was that looked like insulation – turned out it was insulation and the market vendor was just trying to fix his cool box. I got laughed at for asking about that. And the questionable fake medicine peddlers with megaphones “this one pill will cure all abdominal ailments!” – possibly including trust and living. And the fruit, piles of pastries and cakes, kebabs and hillocks of shoes. Tiny women with massive transparent buckets on their head, filled with little bags of fresh water, shining like cut-glass in the sunlight.

Markets, established and incidental, are one of my favourite things about travelling, from the artisanal cheese pocket paradises of little French country towns to sprawling city big markets in Mexico and Guatemala, they always fascinate me. Markets are where the essentials of life become a social event. I loved the markets in Malawi as well, though the country is so much less wealthy than Nigeria there was much more dried tiny fish and local fruit and far fewer dvds and doorbells. I remember the map of scents as I followed Moreen around Limbe market, a valley of stalls and blankets with things to sell – trying to keep up with her tiny and determined form, to go and buy some painted tin plates which I wanted for camping. I still have them and I am mostly sure the paint is not wildly toxic.

I’ve also remembered how impossible it is to be an annoying lefty vegetarian while travelling in a lot of the world. I have thus far managed to get by with a ‘background level’ of meat consumption (the unspecified lumps found in jollof rice and tuna salad being the vegan option). Disappointingly, Abuja also doesn’t seem to have much of a coffee fetish. At 4pm this afternoon I finally managed to pursade a kind young man to make me an espresso and the terrible caffeine withdrawal headache was cured. I know where he is now and hopefully he will see me through the next few days; for which I will probably offer him anything he asks for. There are loads of coffee machines around, it’s a modern financial capital, but people really like Nescafe and will try and give you that as actually a kindness to strangers. I’d happily eat any part of anything to avoid offending someone, but I’m struggling with the instant coffee. Abuja is a new town, the founding of which in the early 1990’s was the result of a mission to place the capital in a more central location, ease the popluation pressure in Lagos and to place the apparatus of state in a more neutral location between the diverse areas of Nigeria. As new towns go, it is significiantly more brilliant than Corby or Milton Keynes but it is odd to be in a place where all the buildings are new; it feels slightly unreal; like a film set perhaps. The life of the city is quickening though and like anything new it will mould itself to the shape of the souls who circulate around it’s vessels.

This morning we went to The Presidential Committee on the North-East Initiative (PCNEI) to try and woo some supplies out of the scheme for our health centre. The area we are going to (North East) has been devastated by years of fundamentalist activity and was pretty neglected by the otherwise late-capitalist south to start with – being the furthest away from Lagos and very mountainous so infrastructure is scarce. So, the PCNEI was created in an enlightened move by the current president, to try and improve local services in the region. They were surprisingly glad to see us as apparently, they have a warehouse full of medical equipment in Jalingo which they need to be used. We came away, after a lot of shaking of hands in front of beautiful jewel coloured wallpaper, with rather a lot of kit.

Listening to Muhammed pitch the project to Dr Sidi, one of the big men (literally, he was very tall, but then I am tiny) at the PCNEI, I realised why I am here. I mean, I know why he asked me along, on a surface level I’m one of the lesser experts on global midwifery – not that it is intellectually difficult but it is more that midwifery is an incipient science and has not yet learnt to look far beyond the boundaries of its own national health services. Also, no one listens to us because we have breasts and so do the people we are working for.  But that is why Muhammad asked me to be here, not why I came – I realised listening to him talk that a lot of his thinking about primary health service provision is currently where I am also at in terms of considering localism, community action and collectivisation as a path to follow to try and build something which isn’t hierarchical or industrialised. This is what Julia and I are experimenting on with the Sheffield Maternity Cooperative. I’m not sure if I have any new ideas about this or if I am just learning to engage with a different realm of established thought. I’m not sure I’m right. But this feels like the first path I’ve taken for a while which doesn’t end up right back where it started in terms of the battle for birth.

This afternoon I went to buy a sim card at a roadside stall which involved scanning my finger prints and producing my driving license, and I suddenly felt guilty like I always do when the State observes me. And at least 50% of the time I haven’t done anything wrong.  Then I found a pool for a swim which was delightful. Although the other women there all laughed at me for both wearing goggles and doing lengths as pools are for relaxing and being beautiful in, which they did exquisitely.

We went to see a police commissioner this evening (the spouse of a family member of Muhammad’s) to try to get a police guard from the trip from Jalingo to Gembu on Monday. We went through this terribly austere, concreted cavern of a place into a corner office which had big pink sofas, rose candles and a fluffy carpet. A woman of about my age in a hijab was praying in front of the institutional desk, so we politely waited. Then she finished, pulled the hijab off over her head and turned out to be wearing a camouflage print uniform, with those very important looking epaulettes with stars and a holster which she then slipped her gun back into. There is probably a very poignant feminist emblematic message here, something about women never leaving the female role behind even when one is a tough police goddess, but I just loved it for the fantastic contrast. She was also extremely kind and inspirational.

(from here on it’s four years old Malawi wibbles – -feel free to read but it’s aged). Weeb’s Christmas Message to the Nation

Good afternoon my loyal followers, all 35 of you. One is very pleased and honored to be sitting on a wicker chair on the balcony wearing nothing but a new scarf and a smile and wishing you all a very happy Christmas. Here we are, having a lovely and relaxing time in a small wooden house on the very edge of the escarpment that falls down to the Great Rift Valley. We are right in the middle of the woods, surrounded by fantastical insects, impala and nyala* and really terrifying many legged horrors. The house is on the small reservation of a Christian charity who do health and education projects, including supplying washable sanitary towels to teenage girls, which wins my heart every time. There is a beautiful pool further up the hill, with this view over the Great Rift.

rift valley

Looking South into the Great Rift Valley.

Last night we had a storm of queen ants, I’ve seen them before but never in this number. When we woke this morning the entire house was surrounded by discarded wings, and dying queens. They swarm to found their own colonies and shed their wings to crawl into a suitable space, but most of them die on the way. They are helpless and almost immobile after their first and only flight. Being a republican I was thinking this would be a good way to settle the popular controversy about the next head of state in the UK. Strap wings to Charlie and his firstborn and see who manages to fly from the top of the Shard into Buckingham palace before they fall off.

We’re not far from Blantyre here, about three road blocks away (10 miles). The road blocks seem to be part of the scheme for full employment in Malawi – the police set up barricades, seemingly at random, to discuss the health of your family and the loveliness of the weather. They even sometimes check your license if they are really bored. Which led to a half hour discussion with a reasonably senior Malawian policeman about why I hadn’t changed my name and what exactly ‘Ms.’ meant. I have to say, when I stood by my feminist principles and insisted on the matriarchal descent of Pallotti, I didn’t anticipate having to explain myself to an elderly African man in an extremely natty uniform He had very dashing epaulettes and one of those cord thingies that go round your shoulder and clip to the breast pocket.

A few days ago we descended into the valley to go to one of the National Parks (Majete). We saw lots of hippos, warthogs, and innumerable deery-boks but somehow managed to miss all 180 elephants. They must all be up a tree, waiting for autumn. I’ve always wanted to see an elephant; they have long captured my imagination, fiercely loyal, immensely strong creatures that get drunk for fun – everything I have always wanted to be. There isn’t much big wildlife left in Malawi, it is the most densely populated of all the East African countries and much of the land is agricultural. We thought we’d go to Zambia in February to go on safari properly and see some amazing animals.


A baby hippo and it’s family of hippopotomi having a wallow in the Shire River.

moth Fishermans Rest

A really splendid moth, who was on the wall outside our kitchen, having an afternoon nap.

For my final act of oddity of 2014, I managed to continue my fine tradition of inappropriate nudity at surprising times. I have taken all my clothes off, entirely conincidentally, in front of an Order of Orange March in Hyde Park. I used to pose for art classes to earn some spare cash as an impoverished Anthropology student and I once greeted the parents of a boyfriend, home earlier than expected and whom I had never previously met, wearing nothing but two strategically placed mugs of coffee. I try not to take my clothes off all the time now, but somehow it never works out. Yesterday we were all up at the pool and had got out and dried as the charcoal mountains met the heavy ochre sun. The Christian fellowship were all up there too, organising their house and generally doing worthy things. Just then Lyra, who had been skimming the pool with a net, fell fully clothed into the deep end. With the dexterity born of eternal mother-worry, I ran towards the pool and pulled my dress (all I was wearing) over my head as I went, reaching her within a few seconds and hugging her by the side of the pool, she was fine. I turned round to the row of fully dressed young Christian men with faces redder than the setting sun, and appologised. I didn’t help that, when the one who recovered the quickest quipped that he had never seen anyone get undressed so fast, I replied that midwifery was ‘only my day job’ (wink). The palpable embarrassment was so thick it was hard to breath. Thus my New years resolution: when talking to a line of virgins whilst dripping wet and naked, to try not to make jokes about prostitution.

Happy Christmas and a Magical New Year Everyone.

*Very similar graceful thingy-boks but the impala have a big black M on their arses.

It’s Raining Elephants and Cows

The Rains are here. The meteorological tyranny of the last few months, everyday being hotter and drier than the last, suddenly ended with the most cathartic tropical storm at about 10pm last night. This was no Mancunian fine yet permeating drizzle. Nor the ‘oop Mam Tor in October blatter. This was the super size in water delivery solutions – the whole of the sky released an ocean of water in one go and let it free-fall onto the baked earth. This is a photo of the storm and of us the following morning, it was still raining. Most of our road is missing, and quite a lot of other people’s walls are not where they had left them the night before.

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Lightening in the dead of night, over Blantyre

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Lyra and Luka playing in the rain in our front yard. That is one of the infamous ‘Matola Taxis’ parked behind them.

malawi rain

Grace, Lyra, Luka and me, all very wet.

In Malawi most bricks are made by shaping natural clay into tablets, stacking them all together in an elongated pyramidal shape and then setting a fire in the inside. When I first saw these curious structures at a distance, being a recovering archaeologist I thought that they were some kind of religious earthworks. Crumbling fragments of the hopes and dreams of a long-dead civilisation. Then I saw one on fire, and I worked it out. I don’t have a photo as I’m mortified by taking photographs of strangers, so here is one of my sketches.

sketch of a brick kiln

A Malawian brick kiln, two ladies and a tasty-bok.

The kilns are interesting and eye-catching but I don’t think that they produce very strong bricks. I guess the heat doesn’t fire the tablet evenly, leading to one side becoming more porous than the other*. As a result, most of the carpentry shop next to our house is now in the Naperi river.

Nonetheless, everyone agrees the storm is worth the destruction and celebrates the coming of the Rains. The Rains are the end of the ‘hungry time’, between the reaping of the last crops and before the new growth can begin. It feels like the earth has suddenly opened its eyes and sat straight up, awake and refreshed. As Betjeman said, “The earth exhales”.**

Lyra slept through the immense din of rain drops as big as gobstoppers falling on the tin roof. The lightening lit up the whole sky and thunder pummeled our ears, but she slept on. Jody and Nonna were a little nervous (shit scared) but I loved it. I am frightened of centipedes (q.v.), stairs without backs, and diagrams of the human central nervous system, but I’m not frightened of storms. My atavistic defences are overrun by the excitement of natures’ tantrums; there is something so ferocious and vital about a tropical storm, especially if it’s over the sea. It turns me on, ‘look at the pressure front on that mother’ I think. I’m obviously in the running for a Darwin award sometime soon.

In More Tales of Malawi Water, we went to the mountains this weekend and swam in the most amazing waterfall.  Blantyre is on the Shire (she-ree) plateaux, ringed by hills like Sheffield. Part of this plateaux is the mountain range of Mulanje, a huge volcanic rock that seems pulled from the earth into this towering, sheer sided giant, wreathed in grey clouds. It is said (my source for this is a pizza menu, so I’m not very confident of this fact) that Tolkein based the Shire on the plateaux and Mordor on the mountain. This photo doesn’t really do it justice, but my damn camera broke as we approached, so I’ll just have to go back and take some more pictures for you all.

mount mulanje

Mount Mulanje, approaching from Satemwe

In more personal news, we are all well, I’m still not a full Weeb, but I’m much better. Lyra is having a lovely time, especially since Nonna is here. This is her and her friend Luka playing ‘mummies and daddies’ with their babies in chatenges (wrap slings).

lyra and luka with babies 1

Mummy Lyra with baby Benjamin and Daddy Luka with baby Nyah.

*I am talking out of my bottom here, if you have any actual facts about brick making, please share.

**In the interests of accuracy I should point out that he was talking about bombing Slough, not about a tropical storm, but the line always caught my imagination.

The African Offside Trap

I keep meaning to blog about working on the labour ward here in Blantyre, but in the true style of one unwilling to face the still-parsing traumatic observations of the last month, I’m going to talk about football instead.

I am feeling much better and have been going to the gym again. I like the College of Medicine Sports Centre, it is wonderfully reliable in that all of the machines are equally broken – they all work a little bit. Maybe if you put an arm on one machine and a buttock on another, you might get some exercise. So mostly I run the track, do the occasional aerobics class and sometimes go and look at the cute men in the weights room lift some weights.

Over the last few months one of the trainers has been organising a football match on Tuesday and Thursday mornings. Those who know me will have heard my tirades against football, but you may not appreciate that this is nothing to do with the actual game. I despise drunken groups of men sexually harassing me. Because of course, shouting ‘Oi love give us one!! hur hur hur!’ will endear me to their laddish yet refreshingly honest embrace of mainstream masculinity and will charm me into ripping my clothes off. I find the disruption to public transport ludicrously annoying. I abhor the violence and loath the implicit regional jingoism. I also hate the bastardly awful tuneless songs. Bear in mind that I have lived within half a mile of Old Trafford, Highbury and ‘The Den’ in my life, which probably goes some way to explaining my ire. When we lived near Millwall I used to keep a head trauma kit by the front door (pen-light, dressings, gloves, antiseptic spray and a can of Special Brew). Occasionally I feel left out, but then I remember that I would rather eat an ear than have some pot-bellied nylon t’shirted testicle think it is acceptable to pinch my bum and smirk.

However, I have always loved playing football, it is a beautiful, graceful and exciting game (unless anyone in the crowd is going ‘hur hur hur!’). I used to play as a child, though I wasn’t allowed to trial for the school team because of my potential to one day grow breasts and multitask. I played for university too, being the small, fast and usually hung-over centre forward for Newnham Twos. But then you get a busy job, have kids, and next thing you know you get out of breath lifting the wine glass. Since we’ve been here, however, I’ve been enjoying getting fit again, so I was really excited when they invited me to play last month.

At first it was all very uncomfortable. Unlike playing on a mixed team in the UK, with guys who are programmed from their first day of school never to pass to a girl’, the men here were gentleman like and courteous. Unfortunately. Every time I went to tackle someone, and usually I had no hope as they are mostly much better than me and all about a foot taller, they would politely tap the ball to me and stand out of my way with an encouraging smile. This is chivalry, but also it is the natural Malawian deference and kindliness; it is more important to be polite than it is to win. Things quickly got better though, after I scored a goal and did my ‘Snoopy dance’*. Strangely, they then seemed to loose some deference (respect).

So yesterday, still a bit pale and about 10kg lighter than I was before the sepsis, I played once more and it was brilliant! Genorino, who is really good, has taken me under his wing (literally, I don’t reach up to his armpit) and let me play on his team. For the first time in a decade I felt again like I could fly. I also realised that I am feeling at home and becoming less of a stranger in this hot and peaceful land; more in tune with the local emotions and behaviours. I scored a goal and instead of the idiotic victory dance, I spent ten minutes stubbornly insisting, against all the kind reassurances of the other team, that I had, in fact, been offside.


Lyra and I lying in hammocks by Lake Malawi, just to cheer all you freezing people up.

*Head back, twirling round, flapping paws and grinning. Usually very sweaty by this point. V sophisticated and sexy.


Last week I nearly died. So I hope the delay in blogging will be forgiven by my three avid readers and fans and I’ll tell you all about starting work at the hospital in a few days. What made me sick wasn’t Ebola, nor an exotic something which an episode of House would be based around, although like Hugh Laurie I did get given a lot of Tramadol. It wasn’t even something gross and tropical, such as a leg-worm you can wind on a stick like candy floss. It was common or garden septic shock. We still don’t know what the bacteria was, the labs here are slow.  But the unnamed pathogen won the fight against my immune system, taking advantage of its naivety as a stranger to these spirited African strains, fumbling for its Lonely Planet Guide Book to Nasty Bugs, to ask for “some more please T cells thank you” whilst the bacteria danced happy reproductive swirls throughout my increasingly depleted circulation.

I suspect that whatever it was got into me when I was cleaning down the labour ward here, drenched in filthy water, trying to scrub bodily fluids in a range of attractive pastel colours off the rusty bedsteads with Vim powder. What our maternity wing in Blantyre really needs is not just more midwives and doctors, we have those and for the most part they are excellent clinicians. What we need are more HCA’s, cleaners and someone to get the damn autoclave to work.

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A labour room.

I was ok in the evening, a little blurred vision but I thought I was just over-tired, maybe a touch of migraine. I developed a fever overnight and woke up dizzy, but apart from the ever-present hypochondriac ‘maybe I’ve got malaria’ worry, I was sure it was just a cold. Three hours later I was unconscious in the Mission hospital with a blood pressure of 75/40mmHg. I tell you this mostly because I’m now well enough to dramatise and hope for your sympathy – the only good bit about being sick is that people tell you that they love you and bring you tasty things. I feel very far away from Nonna’s aubergines today. But also because it again reminded me of how lucky I am to be me. We have health insurance, a car and a lot of medical knowledge between us, although not, I must say, evenly distributed. I still can’t remember which side of the heart is the red bit and which is the blue bit.  It only took Jody half an hour to get back from work, when I found I couldn’t stand up and called him, and another 15mins for him to get my delirious tiny self to the hospital. If I’d been 999 out of a 1000 women in Malawi, I wouldn’t have reached the main road.

I would really like to say that such an extreme experience, certainly the closest I have ever been to non-existence, gave me some fresh perspective on life. I felt really terrified being incapable and with Lyra, but that was fear of leaving her alone and scared, and Jody turned up soon enough. But otherwise it all felt really prosaic; painful but really ordinary.

Other times I have ‘narrowly avoided catastrophe’ have all been much more tenuous and with surpassing dramatic narrative. Hungover and sleeping through my alarm, thus being late for the meeting that would have seen me at Kings Cross Underground just before nine o’clock on 7th July. Being chased across a river by comically mustachioed Mexican malditos with rifles so old-fashioned, a musket would be an upgrade. One May Week long ago, missing my footing and dangling off the guttering of Trinity College with a pair of heels over my shoulder, trying to impress the (turns out un-impressible) long-haired ponce I had a crush on. However, this time, after the very unglamorous reality of a shot over the bows of mortality, I don’t feel invigorated. The constant ache for my mum, Bridges, Chanje, Jaymi, Dave and the rest of the people I love is intensified, but I knew how important you all were to me anyway. Maybe I’ll have an epiphany or similar insight into the meaning of existence when the headache and nausea go away.

One unexpected dramatic twist though, was my attending doctor. When Jody and I were both still medical/midwifery students, we paid the university fees of a young medical student in Blantyre. This was through a very small project set up by Malcolm Molyneux, a principled physician who has spent his life working to improve health care in Malawi and who was an inspiration Jody. It wasn’t that much each month, but still we struggled to make the payment sometimes, living in London on a leaky boat and not having much of an income.  This was a decade ago, and I thought for sure we’d never meet him – most qualified doctors here leave for South Africa where there is a better quality of life for their families and where they can practice medicine with more resources and support. But James stayed, and happened to be the Consultant on call at a small Adventist Hospital here when I was brought in. He realised who Jody was, despite my feminist refusal to ever take his surname, and hugged him when they met. Back then I’d imagine him sometimes when dreaming of Africa, as a student doctor working on sunlit but bare wards, in a city of noise and heat. I would Imagine him treating patients in a similar states of collapse, being quick and definitive with the instructions to “put Ringers up and start the antibiotics stat,” and thereby saving their lives.