Friday, March 28, 2008

Aphorisms V

It doesn´t warrant top of the blog but I liked it it ...

¨Where do flies go in the wintertime? ... They end up in these empty spaces between the double-glazing. Look, I´ll show you, there are dozens of them here. Dead.¨

Charity, Leonard Deighton

Thursday, March 27, 2008

Gascoigne Family Cremations

Our local cemetery

I regret that this country does not have a crematorium. This is traditionally a Roman Catholic country and cremation has been only permitted by the Roman Catholic Church since the 1960s under the condition that the ashes in an urn are interred in a consecrated cemetery. However, religion and tradition die hard here and cremation has never been adopted as a mode of body disposal.

In the UK cremation, I guess, was adopted for economical reasons:

a) space for and in municipal cemeteries was limited.

b) municipal cemeteries have become prime urban development space.

c) poorer people could not afford the charges municipal councils demanded for the upkeep of grave plots in the municipal cemeteries.

I remember my father getting a bill from the council every year for the upkeep of his parents' graves as he was too far away to visit and do it himself.

Here we have a solution too.

One buys a plot and erects the gravestone. Or you get buried for five years and then dug out and thrown out for the next corpse.

Even so, the city council had to open a new cemetery four years ago and it´s in a pretty ugly location.

Dad and Mum were cremated at their own behest. Probably for the above reasons and possibly for religious (they were church-goers) and ecological reasons.

Dad died in 1989. After the cremation, Mum could not decide where she wanted to scatter his ashes. So after picking up the green plastic urn (approximately 1/2 a litre in volume) and putting it in a plastic bag inthe boot of her car (next to the spare wheel and jack), she rode around with it for six years or so until she finally got fed up with them, buried them in the back garden of her 1970s Wimpey-built new house and planted a rose-bush over them. Does the current owner know? Certainly not.

Mum died in 2001 and also stipulated cremation in her will. Crematoriums, as with the NHS, also have waiting-lists - it took around six weeks (well, that is often quicker than the NHS and, blimey, there must be alot of morgues!).

I wasn´t there for the funeral but several weeks later went down to the Funeral Directors and picked up the green plastic urn and the customs documentation (which they were used to doing for they had many Hindu clients who wanted to take their deceased´s ashes back to India to scatter on the Ganges).

Pete and I divided Mum in half.

My half was soon scattered in the primary forest here, Pete scattered his ¨portion¨ somewhere in the UK - I don´t know where.

Update: Just phoned Pete - No he didn´t scatter them. They are in the spare room. Should I tell Nanda that she (and me for that matter) has slept with her mother-in-law?

So my Dad lies unknown in London´s commuter belt and my Mum lies in two continents in the tropical forest and in a terraced house near Manchester.

Fortunately, even though we don´t have a crematorium here allowing my ashes to accompamy Mum´s, if I die here, we live away from the city, and the local cemetery (photo to follow), under the jurisdiction of a local municipal council, is a small pretty affair where, if I am to be buried, I will be content.

The view from the front gate

Wednesday, March 26, 2008

Memory Pebble

Our bathroom floor

Stealing the title of Rob´s blog for this post I muse on why I am writing all this with its off-subject posts about my life in the long-past.

The recent post on Wilfred Thesiger´s Cook set me off on this train of thought ... it is not about Kezia, her leukaemia or its treatment, Jaime, Nanda, the state of the UK health system etc etc - it is about something long in my past, something that was seemingly forgotten.

By some strange stimulus this week (which I don´t even recall - but possibly Peaches call for positive contributions to the the War Child blog book project for which I have written 24 hours in Darfur) the memory was triggered.

In our Blogger profile I state, amongst other things, that this would be a record for Kezia in the future. She became ill and started treatment at the age of 2 years and 1 month, before her human capacity of memory had developed. Now, at almost 4 years old this capacity must be developing (my own first memory dates from when I was 3.x). What a strange first memory she may have - I wonder what it will be.

In our blog profile I stated that one reason for starting this was to create a record for Kezia to read when she is older. To learn what she went through. A proxy memory for her. And for Jaime too. It has also become a record of some of my own memories which, I hope will occasionally entertain you, dear reader, or give you food for thought and which in the future (unless the google servers are less than immortal) will also give Kezia and Jaime some knowledge about their father, his life and emotions, when they are of an age to begin to understand our fucked-up adult world.

Memories are events which become forgotten if not somehow recorded consciouslly, sub-consciouslly, or on paper in a diary or a blog.

However, just like the pebbles in our bathroom floor, there are gaps between them. Sometimes we lose a memory pebble. But sometimes we think we have lost them and they reappear and creep back into our consciouness from the garden shed or depths of some wardrobe to rejoin their place in the line of pebbles going up our bathroom floor.

Tuesday, March 25, 2008

Clinton and Obama

Drs Crippen and Rant often quote or cite the Devil´s Kitchen and Wat Tyler in their critiques of the UK National Health Service and the last and current Prime Ministers' handling of government health policy.

Both the Devil´s Kitchen and Wat Tyler seem to be at the Conservative end of our British (English) political spectrum. They also have many well-informed arguments so when Drs Crippen and Rant guide me there, I visit. They are the intellectual faces of Conservative thinking. And although I link them to on this post, their political viewpoint seems to be anathema to my own and I will not be linking on the right.

I have occasionally worried about the political leanings of Drs Crippen and Rant.Today I am relieved to read Dr Crippen´s endorsement of both the Democratic Party and his endorsement of Barak Obama as the Democratic presidential candidate. To the extent he has set up a new blog Brits for Barak Obama.

Dr Crippen was apparently inspired by Obama´s speech regarding or in defense of his attendance at a church presided over by a radical black preacher. Having now listened to the speech and read the transcipt, I am in accordance with Dr Crippen. If they dug up the dirt on my wearing of a Socialist Workers´ Party Stuff-the-Jubilee badge back in 1978 when I was 16 years old, my membersip in an anti-hunting activist organisation, an admission that ¨I inhaled¨ that spliff, having had ¨intimate relations¨ with someone of my own sex (etc etc), then in the US, and most probably the UK, I would be political dead-meat.

I am not as confident as Dr Crippen in the fundamental probity of any politician (whether UK, the US or elswhere) but, as he says, we do need to break the monopolies of both the Clinton and Bush dynasties.

And if the next US President is female or black, (we will have to wait a long time for a black lesbian president), it will be a big step forward

Friday, March 21, 2008

Shoot Yourself in the Foot

Dr Rant points to this important study on the DoH/Lord Darzi policy of polyclinics vs traditional GP practices.

Unfortunately, when you try to read the original article on the British Medical Association's journal's website ..,

a) the frontpage link is wrong.

b) you have to have a subscription to read the full paper.

So me Joe Public can't read it

Can Doctors cope with IT?

Shoot yourself in the foot?

Thursday, March 20, 2008

Wilfred Thesiger's Cook

In the school holidays at the end of 1985 Rosie and I travelled from Nyala, the capital of South Darfur to El-Fasher, the capital of North Darfur repeating in reverse an eventful trip we had made a year and half earlier.

We had visited some sites with rock-paintings on small jebels rising out of the flat dry savanna around Nyala. Although they looked similar to the prehistoric cave-paintings in some areas of Europe, archaeologists in colonial times had dated them (using a European timeframe) to early medieval times and almost certainly hunting records/guides. Our interest in Sahelian history had been sparked and we read as much as we could of the history and archaeology of Darfur, principally through research conducted in colonial times and written up in the academic journal Sudan Notes and Records.

Our aim was to visit Kutum, a town of 45,000 people c. 130 km north-west El-Fasher and then to continue to the oasis of Ain-Farah, perhaps 15 km from Kutum.

Looking back at my journal of that time I noted that ¨Kutum is very pretty, nestling down by a wadi with big shady trees and date palms. Today is one of the two souk [market] days so there are lots of peope sitting and walking around, buying and selling. Very much a rural market.¨

We managed to get rides to and from Ain Farah on Save the Children Fund lorries carrying food aid.

Ain-Farah consists of a jebel, on which the last king of the Tunjur (the tribe still exists) kingdom, Shau Dorshid, had, in medieval times, built a citadel overlooking a still delightful oasis of date palms and sweet springs. Many of the ruins on top of the hill, overlooking the oasis, still exist. We were hot, tired and dusty but still the scale and mode of construction of the palace and mosque (red brick!) held us in awe. The view was astounding - jebels in every direction with wide, open, flat dark and barren spaces in between - to the north Jebel Siro hiding a view of Jebel Uri where Shau Dorshid built another mountain-top palace. On the steep slopes of Ain Farah stone walls and hut circles surrounded the palace.

The legend goes that his subjects got so fed-up with building hill-top palaces for him, they finished him off.

We returned to Kutum and sitting in the souk drinking the inevitable tea we ,struck up conversation with a very well-known and respected old man, Hajji Zanussi. He spoke some Italian having spent time in Eritrea presumably on his way to/from Mecca.

¨I was Siger´s cook.¨

Wilfred Thesiger was probably the last of the ¨Great White Explorers¨. Those men, and occasionally women, who walked, rode, sailed the breadth of the world during the 19th and early 20th centuries, principally I believe as they enjoyed it, but, as an excuse to do it at someone else´s expense, to increase European knowledge of its geography and hence power.

He was born in Addis Ababa, capital of the only independent African country at that time, Abyssinia, his father being the British minister assigned to the Abyssinian court. The family was held in such high esteem that he was to be invited to the Ras Ta Fari´s coronation as Emperor Haile Selassie. After average educational success, he joined the Sudanese Political Service and in 1934 was assigned to be the Assistant District Comissioner in Kutum, Darfur.

He was the only European in Kutum. He learned to ride a camel. And, using his newly-found, skill made trips far into the desert even reaching the Tibesti mountains in north-west Chad in 1937.

Later, he travelled the breadth of the Arabian peninsula, Kurdistan, lived seven years with the Marsh Arabs of Iraq, the Pakistan-Afghanistan border regions so much in the news today, Iran and Kenya.

He shunned ¨civilisation¨. He ¨went native¨. He despised the trappings of 20th/21st century life.

Hajji Zanussi also recounted how he had known Guy Moore, the District Commissioner based at El Fasher. We had heard stories about Guy Moore - how many ¨natives¨ were flogged on his account, how he banned motor vehicles from travelling to Kutum (a sympathy imparted to Thesiger who was also inspired by Moore to learn Arabic and travel light) and left Darfur amidst scandal when the British media discovered his ¨Heart of Darkness¨.

However, Hajji Zanussi was more positive, noting Moore´s and Thesiger´s rapport with the local population, their enjoyment of sharing asseeda and merissa (millet beer) with their employees. Thesiger also described Moore as humane and just.

He also talked of Mr Campbell, a predecessor of Thesiger, whom I have not been able to trace.

Eric Newby (probably the first of the new breed of traveller, of a ¨known world¨) describes bumping into Thesiger in the Hindu Kush:

¨The party consisted of two villainous-looking tribesmen dressed like royal mourners in long overcoats reaching to the ankles; a shivering Tajik cook, to whom some strange mutation had given bright red hair, unsuitably dressed for central Asia in crippling pointed brown shoes and natty socks supported by suspenders, but no trousers; the interpreter, a gloomy-looking middle-class Afghan in a coma of fatigue, wearing dark glasses, a double-breasted lounge suit and an American hat with stitching all over it; and Thesiger himself, a great, long-striding crag of a man, with an outcrop for a nose and bushy eyebrows, 45 years old and as hard as nails, in an old tweed jacket, a pair of thin grey cotton trousers, rope-soled Persian slippers and a woollen cap comforter."

I feel honoured to have met Hajji Zanussi and to have heard a few of his memories.


1. Thesiger was reputed to have killed the last lion in Darfur.

2. We saw old leopard traps in the Jebel Marra mountains.

3. Kutum is now an epicentre of the current Darfur conflict in the middle of Tunjur and Zaghawa territory. See this report and this map.

Tuesday, March 18, 2008

Viktor Bout

The renowned international arms dealer Victor Bout was arrested in Thailand two weeks ago. I won't go into the story at length as many others have recounted history (see Douglas Farah and Alex Harrowell).

However, he is notable in his non-partisan choice of clients - from the Taleban to the U.S. government. Now there are rumours that Russia is argung that instead of being extradited to the United States to face trial he should be extradited to Russia. Some argue that this would indeed save some American faces from turning red or worse.

I am currently reading Len Deighton's 1994 spy thriller Faith and came across this passage last night:

"They [the Americans] are buying Soviet weapons technology. I'm talking about hardware: state-of-the-art Soviet electronics, Soviet air defence systems and advanced Soviet weaponry, and Uncle Sam is paying for it in greenbacks ... Yes, Poland is the major supplier. But other Warsaw Pact countries are also trading in their weaponry. Helicopters, radar, torpedoes and self-propelled artillery.Hundreds of millions of dollars are being shelled out ...The payments go through intermediaries. They even send us price lists. The Pentagon experts and scientists go through the lists and select what they want ... Alot of this Soviet weaponry is shipped to ok countries - such as Middle East states - and then on to the US. We have established letters of credit in overseas accounts so it all looks really kosher."

Saturday, March 15, 2008

The Expanding Nurse

The baseline qualification for a Paediatric Oncology Nurse is course ENB 240: Care of Children with Cancer.

Which drugs do or don´t mix, drug safety issues, a specialist oncology nurse, more often than not, is more skilled than a doctor or a general nurse in finding that vein for an injection, to know that you don´t give an analgaesic to a febrile oncology patient, how to clean or draw blood from a Hickman Line and much much more.

On average 35.7 % of paediatric nurses working in units with child cancer patients are qualified at the ENB 240 level. I wish it was more.

Some of the nurses on the Borchardt Ward and Clinic at the Royal Manchester Children´s Hospital are trained or are being trained in the special skills of caring for children with cancer. I will assume the national average of 35.7 %. As most treatment for both in-patients and out-patients is on the day-shift, most of that 35.7 % is going to be on the day-shift. I wonder if the leading evening/night shift nurse is ENB 240 qualified.

Can´t we be told ? Can´t the hospital say we abide to such and such a standard which I can then look up ? Do I have to feel guilty at going to the PALS service ? How can I find out how many ENB 240 nurses exist on the Borchardt Ward ?

Drs Crippen and Rant have commented on and criticised many many times on the NHS use of Nurse Practitioners being allowed to make clinical decisions.

Fortunately, no nurse, ENB 240 qualified or not, on the Royal Manchester ChildrenÅ› Hospital cancer ward/clinic has ever made a clinical decision about our daughter. The paediatric cancer specialist nurse at the RMCH knows his/her limits and will call the doctor, even if it is the trainee night-time locum.

Drs Crippen and Rant - you should not be complaining at Nurse Practitioners, Nurse Specialists etc - we need more of them (35.7% is pathetic).

However, you are right to complain at the government´s policy to ¨expand¨ the nurse´s role into diagnosis and clinical work as a cheap alternative to using or training doctors

So give the specialist nurse practitioners a break, ok ?

Obviously, Nurse Practitioners, Specialist Nurses and all their variations are as much as part of the general population as GPs, consultants, patients, carers, nurses and are as susceptible to government/DoH/NHS spin as ¨John and Janet¨. Given ¨expanded¨ responsibility (clinical and diagnostic decision-making - a little bit of power ) it is, of course, in your job description against which you will be evaluated ...

The issue here is that the government is trying to hide its holes in clinical provision - in its budgetary concerns, its capital investments rather than day-to-day running costs, MTAS etc etc.

... rather than training nurses to be specialists within nursing and training doctors to be specialists within doctoring.

Perhaps the Royal College of Nursing should say something ... or perhaps they are as pathetic as the BMA.

Wednesday, March 12, 2008


Quiz time.

In the context of the UK National Health Service what does the acronym POONS mean?

And would you like to be known by this acronym?

Answers please on the back of a self-addressed postcard, well in the comments. I will buy the first correct answer apint, if we ever meet!

Tuesday, March 11, 2008

Pain Management

After two months of blood samples, drips, injections, Kezia was in a no-joking mood when we arrived at the local A & E on a Sunday morning. She wasn´t going to let anyone stick another fucking needle into her battered and bruised veins if there was any way she could influence the outcome.

It took four adults, yes FOUR, (me, Nanda and two nurses) to hold her down and still enough for the doctor to get a blood sample. You wouldn´t believe how strong a 2 year old in pain can be.


I am reading the National Institute for Health and Clinical Excellence´s August 2005 report (i.e. 9 months before Kezia was diagnosed with leukaemia) entitled Improving Outcomes in Children and Young People with Cancer: The Manual. NICE, as it is known, is the advisory authority for NHS medical practice in England and Wales.

NICE recommends that 0.7 Full Time Equivalent paediatric anaesthists are available at each specialist paediatric oncology treatment centre. Ok, fair enough, me the punter really doesn´t know. For Pain Management it recommends that ¨all children ... should have daily access to play specialists ... to assist in preparation for painful procedures¨. But NICE fails to specify how many FTE Play Specialists a treatment centre should have.

The Royal Manchester Children´s Hospital with about 150+ in-patients, and I-don´t-know-how-many out-patients has one full-time working clown and one music therapist (both, I believe, paid by charity). So the clown would stop by for 30 seconds every other day, and bring 30 seconds of genuine happiness and glee to Kezia´s face and for 30 seconds Mum and Dad could switch off and just observe a little girl laughing and giggling. The music teacher/therapist once a week.

The ¨play specialist¨ is not there when we need him/her in preparation for that painful procedure.

NICE tells us that ¨Play, the use of such techniques such as distraction, or the use of cognitive behaviour therapies to enhance coping skills, can prepare children and young people for painful procedures¨.

Both nurses and carers at the RMCH are ¨play specialists¨. I really do think the nurses should receive a paediatric oncology nurse play-specialist qualification (and, thinking about it, with only a little bit of effort, our consultant would qualify as well!).

So let´s look at paediatric oncology pain management in the community ...

Meanwhile, when confronted with that painful procedure we, the carers, will use a very well-known ¨cognitive behaviour therapy¨ - bribery.

The BBC, the NHS and British IT

Tom Reynolds posted on how he is not allowed to use an ¨internationally-recognised¨ credit card to download e-Books for his brand new Sony e-Book Reader and thus has to resort to pirating.

A commentator remarked on the BBC´s iPlayer policy whereby only UK residents are allowed to access over the Internet their programmes for free.

Back in January I posted on how to get around this. Suddenly, my hit-rate went up. In response to Tom´s commentator I commented the link to my post ... and as a result I have seen visits go sky high. (Sorry Tom, I do feel a little guilty riding¨on your own success).

My solution was to use the Tor server network which allows me to hide my IP address and adopt the IP address of a Tor ¨server¨ overseas. It is, in fact, tacitly, encouraged by the likes of the UK and the USA governments for Internet users in countries where web censorship exists.

If it is so easy though to hack the BBC iPlayer using legal means, I begin to wonder ...

a) were the contract IT security specs so vague that the contractor (Kontiki) could get away with ... uh ... nothing?

b) did the contractor (Kontiki) convince the BBC that simple IP address blocking was an adequate security measure?

c) were any BBC IT engineers consulted? Do they exist? Were their opinions taken into account? Are they idiots? Are they in the pay of Kontiki?

d) how much did the BBC pay Kontiki?

The NHS IT Spine ...

Potentilla Update

Christian Jago died yesterday morning.

I cannot add much to Dr Crippen's words except to say that the words of wise and kind advice she offered ourselves and Lucia profoundly influenced me and I will be eternally grateful for her taking the time to offer us support in our struggle with cancer when she and Colin themselves faced adversity.

Friday, March 7, 2008

Random Acts of Reality

I really should have linked to Tom Reynold's marvellous Random Acts of Reality telling of life in the London Amnulance Service many moons ago - especially as he plugged us at last year's Cheltenham Literature Festival. He has just won the 2007 Best Literary Medblog Award. So link on the right.

Congratulations Tom and apologies!

98 years ago

On 4 March a patrol from the UN mission to protect refugees from Darfur in camps in eastern Chad mistakenly strolled over into Darfur and got into a gunfight. A French soldier went missing and has been found dead. Ironically, four Arab nomads were killed as they tried to recover the body when a grenade the French soldier was carrying exploded

Captain Boyd Alexander, a British explorer, ornithologist, and ex-Army officer thought he could persuade Darfur´s Sultan to stop playing off the French in Chad against the British in Sudan and ally himself with the British.

On 29 March 1910 he attempted to enter Darfur from Dar Masalit and was murdered. His Capeverdian man-servant managed to escape and tell the tale.

The TTLB Blogosphere Ecosystem

Someone has nominated me the to The Truth Laid Bare Blogosphere Ecosystem. Within this ecosystem I rate as a Slithering Reptile which is about halfway between a Higher Being and an Insignificant Microbe but apparently my ranking has gone down because I was a Flappy Bird.

Potentilla Update

Potentilla is going through hell - and it cannot be too easy for Colin to watch. Their consultant thinks two weeks.

Thursday, March 6, 2008


The results of the British Medical Association's General Practioner Poll on the provision of Out of Hours services are out - the GPs are not happy.

24 hours in Darfur

06:30 - Fajr

It is still and quiet. The myriad of stars in the sky look down upon our sleeping forms.

Across the city of Nyala, the capital of South Darfur, a muezzin starts the adnan, the call to the Fajr prayers. Maybe you hear it, maybe you don´t and you continue sleeping. A second muezzin starts 5 seconds later calling somewhat closer. Still maybe not enough to wake you up.

Forget your images of golden domes and minarets with an old bearded berobed muezzin climbing hundreds of steps to call the faithful to prayer. From the outside, our local mosque looks like a somewhat shoddy delapidated concrete warehouse with a couple of loud-speakers tacked on the side.

30 seconds later the loud-speakers crackle into life and spend the next 3 minutes or so harangueing us to get out of bed with perhaps the most out-of-tune adnan ever heard. And as 5 times a day 365 days a year this muezzin´s adnan is out-of-tune to the same key in the same places, I suspect it is a cassette recording. Furthermore, all the mosques through the town have started slightly out of sync with each other, so the cacophony of adnans lasts about 10 minutes .

I crawl and groan out of bed. It is not yet dawn. The population of the city has been called awake and gets ready for work.

Except us. For today is Friday - our weekend. We work as teachers in government schools and this is the government´s day-of-rest. But religion does not respect government edicts, and buisness does not respect anyone. So nobody will respect my desire for a lie-in.

I light the charcoal stove to prepare tea and as it gets going, I head four-doors-down to a neighbour with a cow. As I arrive, she is still busy milking and I buy a mug of warm, frothy, creamy fresh milk. A totally different product from the supermarket milk of the West.


The sun comes up.

Tea. Ablutions and then, our landlady with whom we share the courtyard offers us coffee with ginger and cinnamon.

The neighbour´s cow passes the gate on its way to pasture.

Breakfast? Not today. There is a treat in store.


The sun is not too hot yet and so we walk the 45 minutes to the main market. A huge sprawling outdoor market on the banks of the wadi. Some have ramshackle wooden stalls with tin roofs, others pitch on a piece of ground,

Friday morning market is, above all, a social occasion. First of all, a bee-line to breakfast in the market´s fast-food section. Women call out to us to try their wares from all sides but we politely refuse as we are set on our destination - Fatima´s.

¨Salaam wa aleikum¨

¨Aleikum wa salaam¨

¨Kif halek?¨

¨El hamdulillah¨


¨Allaysallimak. Kif halek?¨

¨El hamdulillah ...¨ etc etc for five minutes until the crucial self-answering question (as there are several enormous pots in front of her and as there always is) ¨Is there asseeda for breakfast today ?¨.

Soon we are squatting on the ground over a huge bowl of asseeda - a polenta-like mound of steaming sorghum flour surrounded by a rich creamy spicy sauce of sesame oil, peanut-butter, dried tomato, dried fish and more - too hot to dip our fingers into.

Two young Mbororo men stroll past, just back from walking their cattle to and from the Central African Republic. Tall and resplendent in their colourful clothes, kohled eyes, earrings, plaited hair and tattooed faces - the local traders lower their voices to a whisper, to a hush.

We take our leave from Fatima and slowly wind our way up from the wadi through the maze of stalls. Called upon from every side to sit and take tea (then I can hit you with my sales ploy), we find our way to Abdul-Karim´s jewellry stall.

Abdul-Karim is a good-natured and somewhat flirtatious Chadian goldsmith (after all, it is the ladies to whom he sells his wares). He tries out his French on us ... right now our Arabic is better.

We sit and chew the rag - when suddenly something catches my eye on a neighbouring store.

The Sultan´s Palace in the neighbouring city of El-Fasher, once the capital of the entire Sultanate of Darfur, has been converted into a museum and I noted an exhibit that was a late 19th/early 20th century Russian samovar. Here, in front of my eyes, is its twin.

¨70 Sudanese Pounds¨

¨Not interested¨. (Of course I bloody am).


¨Oh come on, it´s all beaten up and there´s some soldering here¨.

... and so on and so on until the final deal is 40 Sudanese Pounds (about 7 sterling pounds) and I am the proud owner of a 1900 Russian samovar bought in the centre of Africa, which, with a bit of coaxing ... works!

13:30 - Dhuhr


On weekdays, perversely, the last lesson of the day at school is 13:10 - 14:00. At 13:30 the entire class gets up to pray.

It is now too hot to stay outside so we pull our beds into the dark cool of out thukl (a round reed hut - we also had a tin-roofed brick room).

Occasional interruptions to our dozing from boys receiving their education from a faqir (rather than a state school) outside the gate chanting from a louh, wooden board on which the latest sura of the Quran they are learning by heart is written. We soon learned they wouldn´t stop chanting until they had received alms so the best strategy would be to get up immediately, put some food in their bowl, they would depart to the next courtyard on their itinerary and we could resume our siesta.

It was 1985. Famine throughout North Darfur. The population was on the move southwards and towards urban centres. Throughout 1984 the government ignored it. Many died. The government claimed they were Chadian, of which some were but most were not. The territory of the Zaghawa has no respect for the desert boundary between Sudan and Chad.

As the months wore on, the cry of ¨Karim karim¨ from wizened prematurely-aged women would increasingly be heard outside our gate. Finally, the government was overwhelmed, admitted a problem, set up refugee camps, allowed international aid agencies in and kept the refugees out of town.


The sun lowers itself in the skies, it starts to cool and social calls begin to be made.

Egi (Mohammed), my best friend, an Mbororo gone slightly Sudanese as he works at a local international aid project, comes round ... the inevitable tea as he tries to teach me the Fulani language. The Mbororo have both Fulani (private) and Arabic (public) names.

Or I would visit his parents. Respect for one´s elders and seniors in Mbororo culture entails going down on one knee and diverting ones eyes to the floor. When Egi first introduced me to his parents, I followed his example and after their initial embarrasment, the family seemed touched.

In Nyala the Mbororo who stayed behind - the old, the pregnant and those still weaning - when the young men in all their finery took the cattle to CAR, would be employed as live-in guards on half-built houses or in workshops. Egi´s parents lived in one room in the corner of a mechanic´s yard.

17:00 - Asr

A minor interruption to the visiting cycle but a sign to start preparing for evening. The visits would wind up. A bucket shower and meet up with our colleagues Sue and Pete, sometimes Egi, and stroll down to the major crossroads with two outdoor restaurants on each corner.

Ful bin jibna with a tomato salad and unleavened bread every day for two years and I never tired of it! A mixed group of hawajjas (foreigners) sitting outside was tolerated but only occasionally would one see a Sudanese woman with her husband, obviously travelling and without anywhere else to eat, disappear into an inside room.

19:30 - Maghrib

Again the Maghrib adnan was little respected but served as a sign the day was coming to an end and we would slowly wind our way home, sometimes stopping at the baklava shop on the way.

If we wanted to finish the evening on a party note, Pete and Sue would come round for a joint (Darfur being Sudan´s largest producer of marijuana), a shot of date, or even better, orange arragee or home-made hibiscus wine (hibiscus and sugar, ferment in a bucket for two days, no need for yeast).

20:40 - Isha

Somehow the adnan seems quieter.

Time for bed. The town falls silent, I gaze up at the stars and fall into Allah´s slumber.

The nightsoil men begin their rounds.


In 1987, soon after I left Nyala, a train of refugees from the war in the south was set on fire by Rizeigat at Ed Daein, the first station down the railway line from Nyala to Khartoum. One thousand were killed.

It has been reported that 95,000 died in the Darfur famine of 1984-86.

It is reported that 200,000 - 450,000 have died in the current conflict.

This map ( shows the villages suffering now. Masalit in the west, Fur in the centre and Zaghawa in the north. The government uses the south-eastern Rizeigat tribe as their proxy ¨civilian¨ militias, the Janjaweed.

Mass graves, lost bodies.

As I write this, many many more fond memories come flooding back . People get up, pray, go to work, laugh and cry. A child dies - its parents cry. And I cry wondering what has become of my friends. The people of Darfur taught me a profound humility in the face of their adversity. The unrecorded history of the War Children of Darfur started many centuries ago and continues today.

Every Darfuri child has always been and remains a War Child.

Wednesday, March 5, 2008

Lessons Learned

From the website of Doris Gowen (1986 - 1999):

"IF I SEE, HEAR, OR READ one more thing about breast cancer, I'm just gonna throw up," she said as we stood at the microwave in the visitors' lounge watching chicken reheat. It was late in the evening and quiet on the hospital's pediatric inpatient floor.

We were sharing a respite from our children's cancer treatments. Her son had osteosarcoma, a bone cancer. Evidence of his four-year battle included a missing leg and a shiny bald head, the result of surgery and chemotherapy to counter the cancer's every move.

My daughter had leukemia, a condition that had relapsed following a bone-marrow transplant. Bald too, she had difficulty walking, and had recently been informed that her treatment had failed and that she would not live to see the millennium.

If given a choice, parents would gladly choose for themselves to have cancer over their children. But cancer never gives them such a choice.

I've been thinking about the woman's words. The television and print-media blitz on breast and prostate cancer is a mixed blessing. The focus on detecting such cancers provides a needed community service to the extent it motivates individuals to contribute time and money to cancer organizations. Also, breast and prostate cancer are relatively common among adults. Over the last decade, for instance, the incidence of breast cancer ranged between 76 and 123 per 100,000 women. The mortality rate was 27 per 100,000.

But cancer is entangled in politics and corporate greed. Government agency budgeteers take advantage of politicians' pandering by spiking their proposals with much-needed requests for cancer research funds. Meanwhile, to boost profits, drug companies invest heavily in advertising and lobbying to influence the political funding process.

Like the mother of the boy with osteosarcoma, I do not appreciate this frenzy over adult cancers. I acknowledge bias, having recently lost a child to leukemia. Yet I wonder: To what extent does the emphasis on breast and prostate cancer hamper the detection and treatment of other cancers? Do the extra dollars going toward breast- and prostate-cancer research pull away dollars that might otherwise fund studies of other cancers?

The National Cancer Institute's proposed budget for the coming fiscal year indicates a clear emphasis on breast and prostate cancer. At the institute's Web site, I ran a word count on "breast" and "prostate" and got a large total. However, "child," "pediatric," "leukemia," or any other term connected to childhood cancer only sporadically showed up in the mammoth site.

The incidence of childhood cancer is 14.1 per 100,000. Although the mortality rate for children with cancer has decreased by 42 percent in the last two decades, cancer's incidence has increased 10 percent. For black children, the increase is 14 percent.

Particular childhood cancer rates have seen higher increases: soft tissue sarcoma and brain cancer, 25 percent; acute lymphoblastic leukemia, 20 percent. Though it appears that the incidence and mortality rates for childhood cancer are small next to cancers among adults, if analyzed in terms of lost years of life, childhood cancer is much more devastating to society.

The average age of mortality for adults with cancer is 50, which represents a loss of more than 20 years of life per adult. In contrast, a child who dies from cancer loses 60 to 65 years of life.

This incalculable loss, however, is not immutable if we understand that research on childhood cancer is often successfully applied to adult cancer. Cancer scientist John Lazslo calls childhood leukemia a "stalking horse for other cancers." When childhood leukemia is cured, he says, cures for the rest will soon follow.

The first cancer clinical trials involved children with leukemia. Children with cancer are usually otherwise healthy and can tolerate greater drug intensity than adults. Each child that has participated in a clinical trial to test a new treatment but succumbed to cancer has bestowed a precious gift--improved treatments--on those, including adults, later diagnosed with cancer.

Much of the early development of bone-marrow transplantation targeted children with immune-deficiency diseases and other causes of bone-marrow failure. Since then, both adults and children with leukemia and other cancers have received bone-marrow transplants.

Some important discoveries about the molecular biology of cancer have originated in pediatric studies. The study of the rare pediatric eye cancer retinoblastoma led to the landmark discovery of the first human cancer gene. The absence of this particular tumor-suppressor gene leads to several adult cancers--including prostate cancer.

The first applications of gene therapy in children with brain cancer and neuroblastoma, a cancer of the central nervous system, are under way at a children's hospital, and eventually will have adult applications.

Our daughter participated in the first comprehensive trial of an immunotoxin. The side effects from the experimental therapy were devastating, and the eventual result was not positive. But we know of several children who are alive today because of it. Treatments using immunotoxins will soon help adults with cancer and AIDS.

Children with cancer have given a tremendous gift to adults with cancer. Are we adults so generous?"