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Friday, April 16, 2010

Field Trip - A long day to treat children - by road

Submitted By Jonathan Porter
First of all, I am not a doctor - so I hope that Dr Zee will add her usual incisive corrections to any medical errors in the following report.

As we are working towards setting up suitable village flying clinics around the edge the Volta Lake, we asked Manye Esther of the Manya Krobo Queen Mothers Association (MKQMA) to assist in choosing suitable locations. Consequently she asked us to join her on a 'special treatment' day in Batorkope, about 3 hours drive, or 15mins in a plane - and impossible to arrive at by road in the case of heavy rains...

We took our car to Assessewa, but were advised that it was best to use a 'heavily modified' Benz van to go the rest of the way. The Benz started life as a delivery vehicle in Europe. On arriving in Ghana it had windows cut in the sides and steel angle seats welded/bolted/held somehow to the floor. By local standards it was well done - but would never pass muster in any developed country as 'safe'. The suspension was coned, rubber added to stop the suspension actually working - which made for a smooth ride - NOT. The driver was excellent - and Rosina decided that he was the best driver in the world. To me he was the best driver for the road that ensued - for I would not have driven it!!! The ruts each side, the ruts across the road, the gulleys, the slippy bits, the slidey bits, were all rather un-savory as we descended the 600' drop from Asesewa to Battorkope. My bum hurt, my back hurt and all I could think is 'why am I not flying to this place?' - but a ground visit is necessary as a first step in setting anything up here. (But I wont be going back by road....unless I REALLY have to...)

We arrived to the most beautiful mud walled mansions with river reed thatch roofing village you could imagine - nestled amongst spindly trees about 300m from the waters edge.

People smiling, a harlequin arrangement of clothes of varying degrees of sun scorched fade, their shoes a wide spectrum of under and oversize-ness on the feet of the children who had shoes, but a welcome that would satisfy any Head of State or member of Royalty, and of course we did have Royalty aboard with Manye Esther - but this was the standard 'everyone' welcome that makes this part of the world sooooo special.

This is a pilot programme of dosing the children in the villages against intestinal worms and bilharzia. The designated treatment being very large and un-swallow-able tablets of Mebendazole (for pinworms, roundworms, tapeworms, hookworms and whip-worms) - the generic of 'Vermox' that we take every six months - just in case... and also Praziquantel - to treat against Schistomomiasis - or Bilahrzia as we know it locally. The idea was a great one - fantastic, in fact. Supported by Plan (an NGO), in conjunction with the MKQMA, this programme will probably reduce infections and improve scholarity (Bilazia can impair growth and affect cognitive development). The children lined up with their shared beakers of water, unfiltered as it is taken from the rain-water trap on the school roof (better than drinking the fluke infested lake water, which they will probably drink later). The children came class by class - but not all of the children from the village. Not all of the children go to school - for a variety of reasons - and it seems that not all were aware that they could have the medicine - as we witnessed later walking amongst the fish preparation area of a small household, and hearing a woman calling for her child who was already urinating blood (a sign of infection) to come quick for some medicine.

This was a fantastic thing to do. But I have some observations, based on outside experience that may or may not be appropriate in this context - but here it is.

1. The nurse and health worker did not smile or engage the children. Simply stood them against the 'dosing pole' and gave them their tablets - mechanically, apparently obliged to be on a punishment duty of going from the town to the village, instead of seeing the privilege it really was. (we were later told that most nurses see nursing as an opportunity to move to the city or travel outside - so village work is not seen as attractive).

2. At no point did we hear or see any explanation being given to these children as to the reasoning behind their tablets or how to avoid infections. This MAY have occurred before hand - but there was no evidence of understanding, just compliance.

3. All these children lined up for extended periods, teachers 'free' to wander around. Nobody took the opportunity to arrange additional learning opportunities - especially with the few children from the 'non-schoolers' being in the vicinity. An apparent wasted opportunity.

4. The nurse carried less than 3gs of medication (easily transported in a plane), and did not bring any health care materials - leaflets or other to maximize the event. Perhaps a simple poster for the health 'post'

5. We met James, the designated village health rep. He is a teacher and is keen to help improve the village - they have two current campaigns - one is to wash hands with soap (we only saw people wash hands with plain collected rain water) and to avoid 'defecating in the open air'. He showed us his 'health post'. At first his ambitions raise eyebrows and create wry smiles or even chuckles - but this really is the basic need. This is why we sometimes. in half jest, refer to our concept of a basic flying clinic a 'Wash your hands, blow your nose, use a toilet, wipe your bum' event.

There are still mothers out there who do not know about wiping from front to back - and so many BASIC things that can save and change lives. Consequently we applauded the fabulous artwork about not 'pooping in the bush'. It is essential to break the cycle of infection - and it is not so very difficult - provided you can reach the people on a regular basis - and, frankly, SMILE when you deal with them. Much as I appreciate the work of the nurse and the health worker - they were miserable - they did not WANT to do their tasks - and that was clear from the very first minute we got on board our four wheeled trail blazing bus!!!

We left the nurses to do their thing whilst we looked for suitable landing areas - the water being a very obvious one. We also identified a short area of raised land that does not appear to flood and asked if it could be cleared and leveled by the community. James was excited and asked 'how much would they be paid', this is a sad reflection of the political approach to development. So many DCE's and other political figures use 'guru' or 'dash' or 'financial incentive' to get even the most basic jobs done. In the city they even pay people 'sitting fees' to go to workshops. We do not encourage or engage in such an approach. An air strip must belong to the people - they must prepare it, maintain it and 'own it' - if it is going to work. In some village it will fail. In others it will succeed - we will concentrate on those that succeed and hope that the others will review their approach to self help.

If Battorkope can clear the area, and we can get GCAA approval, we hope to start a monthly flight to the village. Early flights will be educative. How airplanes work - 'School on an Airstrip' - this is essential in developping the safety culture to make the strips work. We will provide some posters and basic materials (for example a model aircraft) to the school to help re-inforce the airstrip concept. Then the medical visits can start, and as each medical visit happens it will need more support around it - this is going to cost - and we do still need sponsors - really really do.

WAASPS is the fundamental sponsor of out activities to now, without them there would be no MoM - now we need bigger solutions - we have to employ a full time Doctor (we would love to find funding for Dr Zee to be full time) and a full time nurse (still looking for one with a sense of adventure!) - they will come and it will happen - because we believe in it.

If only I could get some of the influential people to Battorkope - they would be ashamed that they continue to promote football, pop-stars and oil barons as the way forward for the people of West Africa. In the mean time we will continue to promote education, medicine, agriculture and engineering as the way to a better West Africa and a sustainable solution in what was once called 'the White Man's graveyard'.

Sunday, April 11, 2010

Alpha Foxtrot and I

Submitted by Jonathan Porter

Today is the 11th April 2010 - more than 20 years since that first infectious flight in a C150 at Sywell Aerodrome in the UK. I have flown more than 40 types, over cities, countryside, desert, lakes, sea, mountains, forests, rain forests and low level over more hostile terrain than I care to think about. But today was special.

CH701 9G-ZAF, or Alpha Foxtrot was built for the Medicine on the Move flying doctors and nurses project, and she is beautifully crafted by the hands of young West African maidens - each rivet pulled with care and a love for the new skills learnt in the rural workshop. The soldering behind the panel is, in many places, the first soldering a young erson has done. Everywhere you look on Alpha Foxtrot you see the signs of loving and caring by those who have laboured over the birth of this baby. The seat is sewn locally by a seamstress who weighs in at under 90lbs (about 40kgs), and the wire-locking has been tied off with the care that a midwife would give to the umbilical cord, separating the workshop from the child. Every cotter-pin placed and secured as if it were an earing in the small girls ears. This plane is probably the most loved by the most people plane in the world.

The Rotax 912 engine has its rocker covers polished at every opportunity and discussion about fuel consumption, engine revs, fuel pressure and the vital signs on the engine instruments treated with the respect of a nurse checking the health of the most precious person they know.

Today I had the opportunity to carry out some tests on the aircraft before we send it into some pretty tough situations in the coming weeks. I fly a range of aircraft on a regular basis, and there was no plan to have a ;special flight' - it just happened.

As I settled onto the soft foam seat and flipped the necessary switches up, calling 'clear prop' at the same time, it seems quite possible that the engine came to life as the red and white aircraft sensed the lightest of pressure from my finger on the starter button. Rotax engines have a special sound - and this one sounds extra special. Rotax knew that this very engine would end up on a flying doctor aircraft, and listening to the purr of this power-plant I wonder if they added some TLC to the crankcase too?

Temps are in range and checks all done, I taxi over to the threshold of 19, wind is calm, air-on in the mid 30sC or mid 90sF, density altitude around 3,500ft. I am not wearing a a head-set so that I can hear the most possible noises from the airframe and engine on this run. As I increase the power the nose draws the bungee tighter until I release the brakes at around 4000rpm, even on the grass runway her nose is instantly off the ground - I let her accelerate a little with the wheels on the ground, then with the smallest forward pressure on the centre stick the mains are up and we can accelerate in ground effect. With the increased airspeed the climb is dramatic for a non-STOL pilot, but it still raises a grin on my face.

Climbing to 2,000ft in a matter of minutes I start to push the envelope. I watch the temperatures, and they are all well behaved. Full power, sustained straight and level (doors off) gives 85knots indicated, 5600rpm, 110C (230F) oil, 110C (230F)CHT, without changing the power setting i pull back to establish a climb at 40kts, Ts&Ps are stable as a table the machine is as well behaved and docile as the best trained Labrador guide dog. In fact it is almost as if the plane is guiding me as to what to do next - perhaps it is a puppy?

At 3,000ft we level off and the sounds of the airframe and engine are individually discernible with a cruise setting of 5000rpm giving a comfortable 70+kts. I expect that to be close to 75 or 80 with final trimmings and doors on.
We start to dance together, turning to the left and the right, a Tango at 3000ft. Everything is so sensitive, so responsive, the air, for once, is co-operative and the visibility over 25km (15miles), I let my hand out onto the strut and feel the smooth paint, looking down at the mud hut villages below, seeing the darker green of the river lines and occasional bamboo or raffia palm benefiting from the moist tracks of water that are bonus and not a right in this part of the world. The cattle boy looks up, a stick across the back of his neck and hands draped over it as it he guides his cows to find some water, he waves, and I wave with my hand as Alpha Foxtrot waves with her wings.

As we set up the descent, notice WE are flying, me and Alpha Foxtrot, for I am no longer an individual, we have become one, our thoughts are joined and our movements synchronized in the African morning sky. The cumulus clouds even seem to be moving away to enable this flight to be so special. I look down at the beautiful runway that just a few years ago was bush-land and an unimaginable location to start this project. I feel Alpha Foxtrot smiling with me, her engine beating as a heart beats, her warm exhaust passing underneath us she breathes. WE bring the power back to 4000rpm and find that we can turn left and turn right in large sweeping 360 degree turns without losing altitude if we keep the speed just below 50kts. We both smile and I am sure that Alpha Foxtrot even giggled at the fun we were enjoying in the sky. We reduce the power to 3500 and start a gentle descent in spirals to the left and to the right and then, at 300ft deploy the flapperons for a silky smooth landing.

A short back track and onto the apron. Before I could shut down, I had to take-off one more time - this time across the empty apron. Alpha Foxtrot almost whooped with joy as she leaped back into the sky for two circuits, each with a 'power-off' approach form 500ft abeam the threshold. Nose down, speed at 60kts, a sweeping descent onto a low short final with flaps deployed at 50kts for the smoothest simulated engine failures I have ever encountered.

We taxied back and parked, both satisfied that we had proven the worth of this aircraft for its forthcomin role of taking health care to the needy, and in doing so, we had both had a marvelous time.

Walking away I smiled more than the first time I flew, for the first time in many thousands of hours airtime. I now understand why the girls kiss these planes goodnight when they put them in the hangar - for they are our babies and together we are growing and having adventures that change our lives and those of so many others.

Alpha Foxtrot looked at me as we closed the hangar, if she had eyes they would have been wide and puppy-dog like, begging for just one more flight before going to bed... I told her that there would be many more flights to come - and that she should get some rest. The girls laughed - and so did I, but I know that we have something special, Alpha Foxtrot and I!