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Thin Girl with a Headscarf by Richard Mowell

Richard Mowll is a civil engineer from Croydon, who travelled to Western Uzbekistan in January 2002 with MSF to rehabilitate a 600 patient TB dispensary. He then went on to prepare a 100 bed facility for multi-drug resistant (MDR-TB) patients, where he was Project Co-ordinator of the 16 Médecins Sans Frontières (MSF) staff programme.

“The dispensary building in Nukus was a mess – the result of the near collapse of the health service in this country over many years. Through my work there, one incident stands out. A minor incident but one which left a lasting impact…”

To know what new pipework to order, I inspected the Dispensary room by room to measure sizes and to identify the fittings. As I was in one open room with just a bath in it, a thin girl with a headscarf walked slowly past me and up to the bath. She held on to the side with both hands and with apparently all the strength she had, she coughed. Weak, pitiful, tiny coughs. She was clearly beyond just ‘ill’. A friend of hers came into the room and stood beside her holding her shoulders from the side, supporting her as she coughed.

What could I do? I’m an engineer who formerly specialised in road maintenance and concrete construction – she didn’t seem to need either of those specialities just then. I couldn’t do anything, but feel out of place. I left the room. This was a private moment for them, and I wasn’t helping by being there.

There were and continue to be so many like her – six hundred in the Dispensary itself (although in varying states of illness) and literally thousands of others throughout Uzbekistan. All of these TB patients were the victims of not only the infection, but also of the health system that was not just in a state of decline, but near total collapse, where doctors earn as little as ten pounds per month (how could that feed, clothe and warm a family of four?). How could a health system so under funded help the population overcome the spread of this disease?

What could I do for the girl? Nothing, by myself. But the medical staff and the MSF project that I was working on was trying to improve the system of healthcare for TB patients by using the World Health Organisation’s Directly Observed Treatment – Short-Course (DOTS) TB treatment methodology. This was where it struck me how MSF’s work was truly a team effort. I know nothing (or at least very, very little) about treating TB patients. The medical staff knew very little about rehabilitating a TB Dispensary building. But this rehabilitation was one link in the chain, which was improving conditions for the patients and helping lower the incidence of TB. The medical staff were more links in that chain.

I never saw the girl again – perhaps she got better and left, although I kind of doubt that that could happen. This incident made me realise two things. Firstly the total need for someone to help this girl and others like her – MSF are one of the few organisations doing anything here – and secondly the way that MSF missions are based so strongly on teamwork. I guess I also realised a third thing – that I was proud that I was working for an organisation that was trying to make a difference.

Today, Richard is back in Uzbekistan working with another organisation. The TB dispensary is part of a network of State TB facilities supported by MSF. It will be handed over to Uzbek Ministry of Health control by the end of 2003. The MDR-TB programme will start treating patients in the coming months.

If you would like to contact Médecins Sans Frontières, you can e-mail them on: office-ldn@london.msf.org or visit their website:

www.uk.msf.org

Post Script:

Kidnapped: our MSF colleague Arjan Erkel was abducted more than six months ago in Daghestan, Russian Federation. We still do not know what has happened to him. Please sign MSF’s petition to President Putin asking for urgent help to get Arjan released. Click here and pass it on to your friends:


Largest countries in the world

Rank Country Area (square kilometers)

  1. Russia (17,075,400)
  2. Canada (9,976,140)
  3. United States (9,629,091)
  4. China (9,596,960)
  5. Brazil (8,511,965)
  6. Australia (7,686,850)
  7. India (3,287,590)
  8. Argentina (2,776,890)
  9. Kazakhstan (2,717,306)
  10. Sudan (2,505,810)

An Introduction to Sulawesi by Alam

Dear Reader

Please let me introduce my country, Indonesia to you. I am a native born Indonesian and have lived here all my life. My life is very simple: I live in the suburbs, in a small village, Makassar, in South Sulawesi. I am working in tourism. My parents work as subsistence farmers. I would like to relate a little information about the area in which I live. This gives me the opportunity not only to practice my English, but also to become more self reliant and learn from others.

First, I would like to change the views of anyone who thinks that Indonesia is dangerous to visit. Be assured that the real problems that exist here are internal and are related to the way our government works. The people of Indonesia are peaceful and are as shocked by the recent Bali bombing as the rest of the world, and want no part of this global terrorism.

Secondly, I want to make one thing very clear, that Indonesia is a very beautiful country and is an interesting place to visit and far different to the media’s view of terrorism and danger. On behalf of all of my people, I would like to stress: INDONESIA IS PEACE LOVING AND FROWNS ON ALL VIOLENCE.

Most people coming to Indonesia know only Bali, which is a great shame as Indonesia is an archipelago consisting of 17,000 islands in 27 Provinces, and one of them is SULAWESI. Sulawesi, formerly known as CELEBES has a total land area of about 227,000 square Kilometers and is divided in to four areas or provinces : south, central, northeast and the north, with a total population of over 10 million people.

Sulawesi is home to an amazing variety of people. The majority are fisherman, catching flying fish, shark, tuna, mackerel, squid, as well as other fish. We have farmers who grow wet and dry rice, maize, tapioca, sago, vegetable, coffee, cacoa and cloves. There are numerous small groups of upland people who practice slash and burn agriculture in the interior of Sulawesi. Unemployment is a big problem in my country.

Sulawesi is full of rich and varied cultures and traditions, languages and religious beliefs practiced by several ethnic groups such as: Makassar, Bugis, Mandar, Pamona, Tolaki, Manadoi and the Hulontalo. There are many religions, including Islam, Christianity, Budhism, Hinduism, Confucianism and Animism. The Animism beliefs until now can mainly be found in Torajaland or Tana toraja, an upland area of southern Sulawesi. Here the religion’s belief has a special name in the local language called “Aluk Todolo.” Aluk mean :rules or belief and Todolo means: Ancestor. According to this teaching, human beings in the world have only two problems that are opposites, for example: ” lose or benefit”, and “happiness or sadness”. This philosophy has been manifested into their ceremonies and they have two kinds of ceremony: Thanks Giving Ceremony and Funeral ceremony. The Funeral Ceremony is very sacred because according to the Animists, Death is the end of life.

If you come and visit tana toraja in Sulawesi, you can see many houses in the village, and the owners put the body of their loved ones in a coffin in a room and consider them as sick person before they died, until a funeral is held although this maybe as many as 10 or 20 years have passed from the date of actual death.

After the funeral is held, the family take the coffin to a cave in a mountain for burial. The cave can also function as a house. Their philosophy is that ” Death is an event that changes from the real world to the unreal world”.

I hope from this small article you can get a feel for how remarkable Sulawesi is. Although it is my home, I believe it is quite special. If you are planning a trip to Indonesia, do please come and visit Sulawesi, and do not hesitate to contact me for information about tours and personal itineraries. I would be very happy to share my knowledge with you and help to show you around.

For more information, please visit my simple website: http//www.alamnusantaratour.ch

Please be assured that our traditions of warmth, trustworthiness and memorable hospitality make an enduring memory for our guests.

Syamsu Alam (Alam)

Tel/Fax. (062)411-553927

E-mail alamnusantara@hotmail.com

Website: www.alamnusantaratour.ch


Volunteer Corner

Puerto Maldonado, Peru: The Piedras Biodiversity Center (affiliated with Tambopata Expeditions) is looking for for 2 volunteers to help out with an amphibian survey scheduled for November/December of this year. The project will last about 6 weeks, and the work will be “quite adventurous,” involving the night-time collection of various frogs and toads in swamps and streams. Previous experience is helpful but not necessary, and all volunteers will be trained. This is a great way to get into the jungle while helping a worthwhile project. It is also easy on the pocketbook! If this sounds like the project for you, please email Tambopata Expeditions at info@tambopataexpeditions.com and visit their website at www.tambopataexpeditions.com

Did you miss out on a Gap Year when you were 18 and are considering making up for it now? Have you always wanted to be a TV star ? The BBC have asked us to help find a number of mature (30 +) people who are wanting to volunteer abroad and star in a documentary. The programme will show how the various volunteers cope with the planning and the assignment itself. It will focus on how they are affected by the experience.

So if you have always wanted to volunteer abroad and be a TV star, get in touch with us, Muir’s Tours now. We provide a wide range of support to various communities in Asia, Africa and the Americas. If you want to be one of the 8 BBC stars you need to be free to travel abroad during the period December to March. The ideal candidates will be:

  • over 30
  • self-financing, or at least have a healthy budget
  • planning to travel alone
  • planning to leave in late 2003 / early 2004.

Get some ideas from our list of placements and then we put you in touch with the Beeb. See http://www.nkf-mt.org.uk/volunteer.html


Sun Block Study

A recent UK scientific study on the efficacy of sun creams says that although they help prevent sunburn, lotions fail to block out the harmful ultraviolet rays which can cause the skin cancer. Sun block could give sun worshippers a false sense of security.

Burns specialist Professor Roy Sanders said that the only way to really protect the skin is to stay in the shade at the hottest times of the day or cover up with hats and T-shirts.

According to Professor Sanders, one in 68 of the present UK adult population will be diagnosed with malignant melanoma – the most dangerous form of skin cancer – at some point in their life. By 2010, however, that figure will have risen to one in 50.

Skin cancer can be caused by two types of ultraviolet light, the short, energetic wavelengths of light in the sun’s rays. UVA penetrates the skin most deeply and can suppress the immune system and damage cells. UVB also damages skin cells. The ‘factor’ rating on a bottle of sun block refers to the level of protection against UVB, historically considered the greater danger. A little-known one to four star system – normally printed on the back of bottles – indicates the level of protection against UVA.


Our Friends Ryanair

Why is that the low cost airlines don’t offer frequent flier awards? It seems that unlike the US, none of the European low cost carriers have frequent-flier programs. Southwest Airlines, the model for low-cost carriers, including our friends Ryanair, gave away 2.3 million free tickets last year – more than United Airlines – with its online “double bonus” promotion, which means that with four trips you get one free when you reserve on the Web. Is this something we should be demanding?

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Our webmaster noticed that Ryanair offer a telephone service called Ryanair telecom. As we are usually unkind about Ryanair, we thought this month we’d try and find something kind to say about them, so here are the details on their latest special offer. We have not used it and can’t say if it is any good, but were bemused that this was another one of their activities. This is what they say:

We have an offer on at the moment giving away 1,000,000 FREE calls in the form of 50,000 x 20 minute calls. To get your free calls, call+353 1 246 23 33and we will call you back within 15 seconds! You must call from your fixed line phone and register with a Visa or MasterCard credit card. Once you register, you will then receive a free call from your mobile or fixed line phone. You will get a 20 minutes FREE talk time if you call from your fixed line phone to any fixed line phone (premium rate calls excluded) in Europe, Australia, China, North America, South Africa or Russia when you successfully register. This offer applies to touch tone phones and excludes calls made from payphones, switchboard phones or Internet phones. If the call exceeds 20 minutes, you will be charged at prevailing rates. Ryanair Telecom reserves the right to refuse to supply this service and may discontinue this offer or service at anytime. This offer is also subject to our normal terms and conditions .


MEETING NEWS

Meeting news from our branches around the world.


Iris’s Diary of An Overland Trip Through South America

Iris takes part in a barbecue in Brazil.

We went to a little town called Ouro Preto, in Brazil, which is in the centre of a mining area, which produced gem stones. We visited the museum which shows all the different metals and minerals mined and they have an impressive display of what they produce, including polished stones, although I am convinced the diamonds on display must be paste because they are so big and there are only teenage boys guarding them!!!

After Ouro Preto we did a bit of travelling with a one night stand at a place called Jacaraipe, which was by the coast and was the first of many camp sites which, although not on the beach, were full of sand. (How I have got to hate sand since I’ve been on this last stretch of the trip! It gets everywhere and one seems totally unable to get rid of it entirely and it turns up afterwards in my day sack, in my socks, in my shoes, in my hair, for days on end!)

Then we headed for Itaunas where we spent a couple of nights, arriving at about mid-afternoon and immediately arranging for a barbecue for the evening . We’d bought some pork and beef, and lots of potatoes so that we could roast them in the oven. We had been assured by our leaders that the Brazilians were a barbecue nation, they knew all about barbecuing, so when the owner of the camp site told our revered leader, Heather, that it would be better done on the beach as there weren’t the facilities at the camp site, she readily agreed and at the appointed hour, we packed up the food and also the ingredients for what was going to be a rather lethal vodka punch and headed for the beach.

Itaunas is an unspoilt little village at the edge of the sea, there is no real tourism there and it made me laugh to see those little village shops with their “Visa” and “Mastercard” signs in the window as they weren’t selling anything that would cost more than the odd pound or two! We trekked all the way down the main street, which is really a mud track, over the bridge, and along the track for some 500 metres, and then we had to turn off and start climbing – yes some really big sand dunes with sand that literally could come up to your neck if you trod in the wrong place! The path was marked by the odd rubbish bin and it was quite free of trees (this is important for later) but it was still at least another 300 metres from the beach and the bar we were heading for, but eventually after a half hour walk we were there.

The beach was very narrow and the sea was in. It was also getting dusk by the time we arrived and then Heather had the news – the owner had not yet located the barbecue! Still, we lived in hope. I was part of the cook team for the evening, our actual cook being Alex, a really tall well-built Chinese gentleman who was born in Hong Kong but arrived in England in 1967 to take up a nursing career and now at the age of 55 has retired from nursing (he ended up in an important administrative post in the hospital equivalent to the old matrons) and he is an accomplished chef who thoroughly enjoys cooking and turns out some really tasty meals. He has also a wicked sense of humour and keeps us all amused with his wry remarks.

Anyway, we got on with making the vodka punch (I didn’t participate because I’m not a spirits drinker and so stuck to beer and the odd soft drink) but just about everything was going into the punch. Then came the news, the barbecue had arrived. There were 22 hungry mouths waiting for that food and so you can imagine how many steaks, pork chops and fish steaks we had to cook. The bad news was that our barbecuing host provide us with a little grill which would take 2 steaks at a time!

Out the back of the bar there was a bonfire (burning rubbish) and so it was decided to improvise (it was quite dark by now) and see if the bonfire could be utilised, but the problem was we had no grills to put across it. So our host got his workers to dig a pit and transfer some of the bonfire into it and plus our barbecue coals it seemed that was the way to go, except the only grill they could come up with was the grill which would normally go across the top of a 4-ring gas cooker! Of course it was totally inadequate as well as being totally unsuitable and in the end we had to abandon the idea of a barbecue altogether.

We just used the small barbecue to cook the fish steaks (four) and then Alex set to in the kitchen and with the aid of two big frying pans cooked the pork chops first (which were delicious and so tender – I’ve never tasted such succulent pork chops in my life before), but unfortunately when the beef was cooked it turned out to have died of old age and the cooking just made it tougher and no-one ate the beef!

So what did most people do? They got drunk on the vodka punch! Judith and I decided to leave quite early (around 2200) and so set out with three of the men who were also fed up with the barbecue and just wanted to get back into town and do a bit of drinking there, so we headed off up the sand dunes – but it is surprising how different they looked at night in the pitch dark with no lights to guide us except the odd torch!

We were first of all walking, then scrambling almost on hands and knees up and down steep sand dunes, and continually ending up at dead ends because the other side of the sand dunes there was scrubland and water, lots of it! Judith and I were often left far behind by the men, would lose sight of them and start yelling and then see their lights heading back our way because they’d had to do a U-turn! Eventually we found the right path, more by luck than judgement, and found we had walked a considerable way in the wrong direction which put at least twenty minutes on our journey back to town. On the way we encountered the odd car and van luckily displaying headlights, but then we found we were among a whole crowd of cyclists with no lights at all! It was pretty hairy trying to see and avoid them! All those people in Itaunas must have cats’ eyes!

When we arrived in town, we thanked our men friends for looking after us so well – it was sarcasm really as they had left us way behind once we were on the right path and we only saw them again when we got into town and found them sitting at a bar and one of them, a Korean gentleman we call Young, and who speaks very little English, insisted we join them and have a beer before retiring.

But although we thought we had had an adventure it was nothing that happened to all our friends who had stayed behind to finish off the Vodka punch and other spirits and beer. They all got plastered and every single one of them got lost on the way back with varying effects. One of our leaders, a chap called Martin, got himself steaming drunk, convinced Alex he knew the way home, and promptly led him a merry dance in the pitch dark without torches through scrubland and bushes, so that Alex ended up losing his shoes, his T-shirt and his truck keys, and getting his back and arms and legs scratched by every conceivable thorn and twig. Next day, Heather asked what on earth made them head that way when they knew there were no trees on the path we had originally taken! There was no answer except to admit they were too drunk to know what they were doing! Another of our number lost his trousers and his T-shirt and his camera, and another of us, a lady called Alison, got a badly grazed knee and bruised hip falling about in an unladylike manner!

So in one way it was good we’d had the barbecue on the day of our arrival because we only planned to stay two nights before moving on so everyone had a day to recover from their excesses and attempt to find their lost possessions, but all searches were fruitless as all those possessions were gone the next day (although it is more than probable they were lost on the way home and therefore extremely difficult to find) The most serious loss was of Alex’s truck keys because they open all the padlocks on the truck and we each are issued with a set at the start of the trip and are told to guard them with our lives! Unfortunately also, just prior to Itaunas we had all been issued with new keys as the old padlocks were at the end of their life and so all new padlocks had recently been fitted! I dare say Alex had to pay a fine for losing his and extra to get a new set!


Meeting News from London by Padmassana

On October Saturday 4th, our first speaker was Globie member Roger Widdecombe who showed us what a Raleigh International expedition is really like. Roger’s project was in the west African country of Ghana. These trips are no holiday: participants undergo assessment and rigorous training in orienteering and crossing rivers, first aid etc. Once in Ghana, there were many projects for Roger and his group to take part in, including building a school in a remote village, health programmes dealing with blindness caused by cataracts and for those who wanted to work nights, working on a project monitoring turtles as they came in each night to lay their eggs on the beach. Roger assured us that although the participants do work hard, they also have a lot of fun, including playing football in forty degree heat with the local people and enjoying canoe expeditions on Lake Volta.

Whilst our first speaker had talked of travelling and doing good, our second speaker Juliet Coombes’ theme was travelling and having fun! Juliet’s talk was about the festivals around the world. She showed us colourful photos of the bulls at Pamplona, mad water festivals in Thailand, The Full Moon festival in Laos, and the colourful Venice festival held in the weeks leading up to Lent. The Venetian festival involves lots of dressing up, particularly in masks and in previous centuries was an excuse for much debauchery, sorry Globies, you are 200 years too late! There are thousands of festival around the world each year, too many for Juliet to show us, but she did tell us about boat festivals in Cambodia and Elf festivals in Iceland, before winding up her talk by looking at London’s own Notting Hill carnival.

Next month, on Saturday 1st November, Amar Grover will talk about India – The “Hindustan Tibet” road and on to Ladakh in which Amar looks at India’s National Highway 22 “The Hindustan-Tibet” Road, an old trading route that exited the Raj but never quite took off. His talk includes the Tibetan regions of India, Spiti and Ladakh.

After Amar and the break, Tom Freemantle will be talking about Mexico to Manhattan with a Pack Mule, a 2,600 mile walk retracing the footsteps of his ancestor, Colonel Arthur Fremantle, who travelled from North Mexico to New York at the height of the American Civil War in 1863. The swashbuckling colonel used stage coaches, paddle steamers and steam trains to get around but nearly 140 years later his great-great nephew used a cantankerous but heroic mule called “Brown”

London meetings are held at The Church of Scotland, Crown Court, behind the Fortune Theatre in Covent Garden at 2.30pm the first Saturday of each month. There is no London meeting in August, but we will be back in September. For more information, you can contact the Globetrotters Info line on +44 (0) 20 8674 6229, or visit the website: www.globetrotters.co.uk


Chagas Disease

What is Chagas disease? Also called American trypanosomiasis, Chagas disease is an infection caused by the parasite Trypanosoma cruzi. Chagas disease primarily affects low income people living in rural areas. It is estimated that 16-18 million people are infected with Chagas disease; of those infected, 50,000 will die each year. Chagas disease is locally transmitted in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela.

How do I get it? Small critters called “kissing bugs” that live in cracks and holes of substandard housing primarily found in South and Central America. Insects become infected after biting an animal or person who already has Chagas disease. Infection is spread to humans when an infected bug deposits feces on a person’s skin, usually while the person is sleeping at night. The person often accidently rubs the feces into the bite wound, an open cut, the eyes, or mouth.

How do I know if I have it? There are three stages of infection with Chagas disease; each stage has different symptoms. Some people may be infected and never develop symptoms. Acute symptoms only occur in about 1% of cases and most people infected do not seek medical attention. The most recognized symptom of acute Chagas infection is the Romaña’s sign, or swelling of the eye on one side of the face, usually at the bite wound or where feces were rubbed into the eye. Other symptoms are usually not specific for Chagas infection. These symptoms may include fatigue, fever, enlarged liver or spleen, and swollen lymph glands. Sometimes, a rash, loss of appetite, diarrhea, and vomiting occur. In infants and in very young children with acute Chagas disease, swelling of the brain can develop in acute Chagas disease, and this can cause death. In general, symptoms last for 4-8 weeks and then they go away, even without treatment.

What should I do if I have Chagas disease? See your doctor for a blood tests to determine whether there are parasite or antibodies in your blood. Medication for Chagas disease is usually effective when given during the acute stage of infection. Once the disease has progressed to later stages, medication may be less effective. In the chronic stage, treatment involves managing symptoms associated with the disease.

How can I prevent Chagas disease? Avoid sleeping in thatch, mud, or adobe houses, and use insecticides to kill insects and reduce the risk of transmission. There is neither a vaccine nor recommended drug available to prevent Chagas disease.