West Devon nurse Emma Edwards, who in October told the Times of her intention to work on a healthcare outreach project in East Africa, tells Jane Honey of her experiences on her return including treating 7,500 people in six days!

AS West Devon residents are recovering from the onslaught of food, drink and commercial excess that typifies a European Christmas, Tavistock nurse Emma Edwards has been reflecting on a very different experience.

Emma, who works at Tavyside Health Centre, has recently returned from a period of voluntary work in rural Kenya — an experience she described as 'the best and the worst of times, all mixed up'.

Emma was one of a team of 22 healthcare professionals who travelled to Makongeni, a small village with virtually no medical services available to its 2,000 people. In rural Kenya around 70% of people are living below the poverty line and access to proper healthcare can be limited or non-existent.

The accommodation was basic — the team slept in dormitories in mud huts but they did have cold running water - tepid if the weather had been very hot - and shared their home with Colubus monkeys.

'They make ten different noises — one of which sounds like a burglar alarm going off,' said Emma.

After a day's orientation, the hard work began.

The number of people Emma and her colleagues treated during the two-week, one-off health clinic is mind-boggling — and worth thinking about the next time you are inwardly cursing about the wait at your local GP surgery.

Emma said: 'Over the two weeks we did eight clinics in six days — and treated just under 7,500 people — it was amazing.

'We were treating various conditions, from worms to malaria and TB and seeing just under 1,000 people a day. We'd have one of us consulting, another would be doing prescriptions and others would be dispensing any medications while we had them — but we did run out.

'While that was going on the worming programme was taking place and the treatment of jiggers, which are like fleas. They infest the children's feet — we treated them by washing their feet, soaking them in antiseptic and creaming them, and then tried to get them to wear flip-flops.'

Emma said so many of the conditions, like jigger infestations, were simple to treat — educating people was the key to prevention in the majority of cases.

The area of Kenya in which the team was based was only four kilometres from the coast but in a very remote area of the country.

Emma said: 'There were a lot of people there who had actually never seen a white face, so they were absolutely terrified. The younger members of the team spent a lot of time interacting with the kids, who were fascinated by their hair — they kept wanting to play with it because it was so soft.'

She said the reaction of those attending the clinics, many of whom walked for miles to get there to the British medics, was positive.

'Lots of them were just very quiet. There was one woman who was very emotional throughout her consultation and eventually, she said that she couldn't believe people had come all this way just to treat people like her and that they were so grateful. 'And going back to the jiggers, they seemed to think it was quite a thing for a white person to be washing their feet for them.'

Emma said she quickly learned to treat patients in a completely different way.

'Kenyan time is an amazing thing,' she said. 'They have no concept of time in the way we have.

'You are trying to take a medical history and you ask how long they have had a condition, but it could have been three days or three years, and a lot of the time they don't know how old they are.

'They would say "I'm 39" and you'd think "No you're not, more like 69". Some were lying about their age but some had literally no idea.'

Emma said they had translators with them in the clinics, but a lot of the communication was non-verbal, using signs. Because of the need for a translator, confidentiality could be a problem, and there was also nowhere that people could undress to be physically examined.

Emma said: 'Just the whole thing of being in a Muslim country made it more difficult — the women have to cover their shoulders and knees, so you are having to go through all these swathes of material to see anything.

'We had to think about things completely differently. In this country if you are concerned about somebody we ask them to come back, but there, we knew we wouldn't be back for another year, so you have to think in a worse-case scenario and prescribe much more widely. Plus you have no blood tests, no X-rays, you are using your instincts and basic knowledge. 'Once you get in the mindset of doing it, it's ok, but it is odd.'

The range of illnesses and conditions that Emma and the team treated was wide — from ordinary ear infections and tonsillitis to TB, malaria and schistosomiasis — a nasty little parasite that gets in between the toes when wading in shallow water and heads for the liver.

'There's a huge stigma attached to TB because most who have it are HIV positive, and if you have that, you have no worth in the community, particularly if you are a woman,' said Emma.

'Patients would never admit to having a wet, fruity, cough because that could indicate TB.'

The position of women in society in rural Kenya was also completely different, which had knock-on effects in terms of health care and disease prevention, said Emma.

Men took precedence in the huge queues at the clinics — and as far as family planning was concerned, women were keen to use 'hidden' methods, as men were reluctant to use condoms. This in turn was affecting the rates of HIV/AIDS in the country.

Emma said there were health education posters to be seen in the city — but certainly none out in the rural areas.

The Kenyan government does pay for treatment for malaria and TB — but sufferers need to be able to get to places where they can get it.

Emma said there was one particular clinic in which the team saw how hard this could be.

'We had run out of all our medications, so we had no anti-malarials, no paracetamol left to treat fevers, and this three-month old baby came in, fitting with malaria. We told them they would have to go to another clinic where we knew they had some, but they needed transport, that costs, and they had no money. I don't think she would have survived the day, and it was terrible, because it's so preventable.

'We came away thinking we just hadn't done enough.'

The medical team worked between 10am and 4pm at the clinics, sharing a hot meal in the evenings.

The weather while Emma was there averaged around 32C and was very, very humid. The bugs and creepy crawlies she had dreaded were not as bad as she feared, although she was badly bitten by mosquitos and sandflies — so badly that she ended with up cellulitis and on antibiotics herself.

But she said the experience was incredible — and one she was determined to repeat.

'I was completely inspired by how content people are when they have nothing, how happy they are. You go down the street and people wave and shout "Jambo, Jambo" which means hello.

'When I said people don't do that in the UK, they couldn't believe it.

'The fact that the local hospital has no running water, people are living in mud huts, sleeping on the dirt and they are happy and content — the contrast, coming back here and watching people in Morrisons, their trollies piled high, with glum faces, really makes you think.

'Coming home was lovely, but coming home at Christmas, such a time of excess, was hard.'

The medical clinic at which Emma worked was a two-week, one-off event — but the feedback from local healthcare professionals has been very good, and there are plans to hold another next year.

'I think what we were doing was a drop in the ocean, it's almost tokenism, but for the people that we treated, I like to think we made a difference to them,' said Emma.

l Emma is raising money to put towards the construction of a water borehole at the nearest hospital to Makongeni.

Anyone who would like to make a donation should call in to Tavyside Health Centre in Tavistock or go to the website http://www.justgiving.com/Nina-Crombie">www.justgiving.com/Nina-Crombie