There was an expat doctor on crew throughout the above period. In addition a Swahili speaking paramedic was present for the final four weeks.
The medical equipment was unchanged from the previous contract, and though adequate to cope with resuscitation in acute trauma, there remains no provision for microbiological diagnosis.
Pharmaceutical stocks were, in general adequate, though delays in resupply meant some simple ailments could not be treated causing not inconsiderable suffering.
Once again, the mission hospitals at Nyangeo and Ndanda proved to be helpful and efficient in the treatment of the more seriously ill nationals. The theft of items from the survival packs has rendered most of them useless, only five packs remain. There were insufficient first aid kits for each vehicle to be provided with one, happily, these have now arrived, the survival packs remain incomplete.

Expat Health.

The most worrying medical problem during this period was the appearance of malaria amongst the expats. Two clinically diagnosed cases occurred and repatriation was considered in both.
Case 1 was an example of breakthrough malaria (where resistant parasites multiply despite correct use of prophylactics) The response to quinine sulfate 600mg 8 hourly for five days together with a single dose of three tablets of fansidar was excellent and the patient decided to stay and complete his tour.
Case 2 Occurred against a background of poor compliance with the recommended regime of anti malarials: Proguanil 200mg daily were taken regularly but Chloroquine Phosphate 500mg weekly were omitted. Response to treatment with Chloroquine was poor, some improvement being seen with quinine and fansidar, The patient was evacuated on a scheduled flight.
Feedback on his medical progress was woefully inadequate, not surprisingly this was interpreted by some crewmembers as an example of the uncaring attitude of head office. Two further cases of Malaria may possibly have affected staff on their return to the UK. however at the time of writing no conformation has been received. It is essential that the crew medical officer be informed that such changes to the prophylaxis regime can be made if necessary.
There are four species of malarial parasite and the treatment for each varies slightly. At present there is no way of making a species diagnosis on crew, indeed there is no way of confirming clinical diagnosis. It is unfair to expect an ill patient to travel 110 miles to a mission hospital for laboratory tests, thus the provision of a good quality microscope must be considered a priority.
The other major cause of expat ill health was gastro-intestinal problems. There were the usual cases of mild self-limiting diarrhea that the majority of staff coming to and returning to camp suffer with. However the number of cases of a more chronic, more severe gastro-intestinal upset was dramatically increased. With no lab facilities, treatment was little better than guesswork, a microscope would enable a much greater rationalism in the therapy of these potentially life-threatening disorders.

National Health

Amongst the nationals the major cause of ill health was malaria. Presumed resistance to chloroquine was noted in these cases and quinine and fansidar used in two cases systemic upset and prostication were severe enough to warrant hospitalization (for 3 and 5 days). However the majority responded well to chloroquine and few work days were lost.

Pre-existing disease amongst the nationals accounted for a considerable number of consultations. There was a serious case of neglected hypertension in a much appreciated waiter which fortunately responded to the ministrations of the good nuns of Ndanda.
After moving to the new camp at Mnazi Moja, there was a dramatic increase in the incidence of non-specific urethritis as the laborers gained the acquaintance of the village girls. Minor wounds, skin infections, eye infections, diarrhea, and miscellaneous aches and pains accounted for most other consultations.

Camp conditions and hygiene.

Regular inspections of the latrines, kitchens, food stores, and rubbish dumps were carried out. The general good conditions were maintained whilst the crew was based at the Nanguruwe site, though the quality of the food began its inexorable decline. However the move to the new camp a Mnazi Moja was badly mismanaged. Expats were expected to move in before regular water supply was organized, before sufficient food could be provided, before adequate latrines and showers were erected. The hygiene conditions were appalling : meat was prepared in the sun beneath clouds of flies, the fridges were black with mould and filth, the area around the cooks tents was littered with offal and waste food, vegetables were stored on the ground, the washing up water collected in a festering puddle. This went on for far too long. Complaints to the Party Chief were dismissed; my attempts to improve conditions were undermined by being asked not to speak directly to the OSI camp boss. Apparently head office was made aware of conditions only after reports to Exploration Logistics were passed on. The morale of the crew, already low, dropped further, and more than one member of staff decided they were not prepared to stay on.
Tents with broken screens and ripped insect screens crusted with mould, were infested with rats, and flooded by the sudden downpours; mosquito nets were holed, and of a design inappropriate to the beds used. The laundry facilities were inadequate, such that damp sweaty clothes had to be worn again, or came back from the wash, more soiled than they had gone in, predisposing to fungal skin infections.
Supplies of diesel were erratic and insect breeding in the latrines was a problem: lifting the lid would often release a solid tube of filth laden flies.
Bleached tea cups being inadequately rinsed, beer cans in the freezer next to meat, jackals scavenging from the rubbish pit, long queues for showers, inedible food, maggots flies and weevils in the bread, rats in the food store, muddy drinking water tasting of charcoal and swimming with water beetles. These were the conditions that bred much bitterness and discontent. Management response was slow and depended entirely upon the return from leave of OSI camp boss Jimmy Nzyuko for the success in bringing the standards up to an acceptable level. Camp organization fell apart for 2-3 weeks and the seriousness of the situation misunderstood, denied or ignored.

Recommendations

The physical and mental health of the staff on crew must come before any other consideration. The response to any deterioration in standards must seen to be swift and efficient. Higher priority must be given to the provision of recreation facilities: a new TV to replace the eternally awaiting new parts set would have been a small price to pay for months of sleepless nights of frustrated boredom.
To be prepared for unpredictable patterns of despise incidence. Large stocks of expensive medications must be provided where the resupply time is extended. Should this be reduced the safety margin in the stores could also be reduced. The provision of a microscope and opthalmo/otoscope would considerably improve the level of medical care that could be given. Accidents can happen weather a crew is in production of not, only three safety meetings were held in this ten week period. This forum for discussion, of health safety and hygiene matters, could have relieved much tension and averted much of the ill will generated by the apparent lack of communication between the crew and party chief.
Senior management should be aware and not under estimate the potential health problems encountered by a crew in Africa. Staff due to fly out should be adequately informed of preventative measures that can be taken while in the UK. It is not acceptable to send staff out with out giving them time to be vaccinated against yellow fever, cholera, typhoid, Hepatitis A (and Tetanus and polio if relevant) The current cholera epidemic in the Lukuledi valley emphasizes this point.
The manning of radios was not at a level that could be considered safe. There was only one serious incident on line, and fortunately it was possible to reach the injured man within ten minutes. Had the incident been more serious, and were it not for the fortuitous chance that the client rep was listening in on the VHF radio, the consequences could have been more serious. Luck should never be relied on where safety is concerned.
Puff adders and green mambas were seen on roads and in the nationals camps polyvalent anti-venom should be available