First time in the Amerindian village

Within days of arriving in Mabaruma, we were excited to hear that an outreach trip was going out the following day to one of the villages in the region; Sam would get his first genuinely remote medicine experience, and I could tag along for the ride. It seemed like a great chance to get a feel for Amerindian culture, and to see how it could be running workshop sessions with them.

To elaborate – when we met Minister Ramsammy, confusingly, his vision of what I could do in the villages seemed clearer than Sam’s role. The Department of Health had had a breakthrough in some of its education work, through the use of drama games. They’d realised what its sometimes easy to forget in the cut & thrust of theatre in London – that the shared experience of making and watching drama creates powerful and memorable and sometimes life changing experiences, and is almost definitely more effective than lecturing a group of secondary school students about safe sex. Therefore, the focus was on how to roll out edutainment to the regions. The problem here is that essentially very few (read zero) Georgetown professionals will dream of heading to the regions for more than a day at a time. Sam and I had agreed to be there for 4 months. Thats why the Minister had a glint in his eye.

His confidence in my ability to create blossoming drama in the villages was not shared by any people I discussed it with. Amerindian culture is not known for its exuberance or expressivity; they themselves tend to be quiet, unassuming people (which possibly accounts for their historical lack of representation politically, socially or otherwise). Though actually, more than anything, they generally live so remotely, their exposure to the rest of Guyanese culture – or any element of global culture – is frequently negligible.

Mabaruma, Region 1, is seen as almost the remotest of the remote in Guyana. You can’t get here by road – you can go taxi-boat-taxi-boat-taxi, as you weave your way through the profusion of rivers and tracks that wend their way through dense jungle. Or you can fly. When you get to Mabaruma, you find a single road, lined with rubber trees, so pleasantly shady, and at each side, the municipal buildings of the region. Its a tiny, sleepy town. Yet Mabaruma begins to look positively urban once you head out into the villages.

On our first outreach, we were bound for White Creek, a village maybe ten miles away, but a good hour and a half’s driving over the most terrible roads you can imagine. We passed through villages on the way – Hosororo, Wauna, finally getting to White Creek just before lunch. We arrived at the village centre – scattered buildings along the way get a little denser until you reach the Health hut, next to the cricket pitch and the local schools. The health team swung into action – Monica the local Community health officer showing Nurse Johns (the vaccinations specialist) and Sam to the spaces they could practice in, and Dentex (the equivalent of the Medex in the dental world – trained somewhere between a dentist and a dental nurse) set up his portable chair – it was his first visit to the village, as became apparent by the procession of terrible teeth that greeted us in gappy grins.

I went off in search of the captain. The Amerindian villages elect a captain for three year terms, and visitors to the village should seek him out and get permission for their activities. Norman, White Creek’s captain, was almost regal – gentle, quiet, with the most perfect posture I think I have seen, and thirteen children. The families here are very big.

I explained that I would like to run a theatre games session with some of the children – I thought this was the best plan, to get my first sense of how I could work with groups here. He suggested I use the local school hall as it was Easter holidays and sent me off in search of the Headmaster Lloyd, while Norman spread the word that there would be games for children from 10 years up the next day at the school.

That night we slung our hammocks in the Health hut – the opposite of taking our work home with you I suppose – and the next morning Lloyd let me into the school. Like a latter day Julie Andrews, I was all smiles as the kids drifted in – 50 of them in the end, and ranging in ages from 2 (Rocky a very smiley toddler) to 25. I guess it was something to do that day.

The session that followed was invaluable to me, though not the easiest or most obviously successful I have ever done. We played a wide range of games – from the very simple stop, freeze – when I found myself being followed round the room like a mother duck with fifty slightly confused ducklings behind me, to name games which were painfully slow (the children, and particularly some of the girls, were incredibly shy about using their voices in public) but great fun in the group parts when, en masse we would shout everyone’s name and action at full voice.

A big part of the shyness is to do with the educational culture, I think. Most lessons are “chalk and board” – teacher dictating, children copying – in the worst cases without really understanding. There isn’t a widespread participatory approach in any discipline as yet. So the blank, rabbit in headlights look when asked to invent an action for your name in front of a big group is quite understandable, and we got there with everyone in the end.

Also, as we’ve learned since being here, there is a language barrier. With most Guyanese in Georgetown and Mabaruma, the language is Creole, the common Guyanese language which has evolved through all the many groups here – African, East Indian, Portugese, English and Chinese. Its a vibrant, colourful and very expressive language. Most people, once they realise we are English, will slow down and speak more clearly (and sometimes more loudly). But in the villages, Creole is spoken with the local accent, and possibly the second language to the Amerindian local one (though more and more rarely, the original languages seem to be dying out). So the looks of incomprehension I found myself faced with were often due to my English accent.

Most successful were the group games – singing, chanting, and an adaptation of Whats the Time Mr Wolf (Whats the time Mr Jaguar) which was a big hit. Less successful were games which involved physical contact (People to People) or a vocabulary which included any sense of theatre (a sculpting game where you made your partner into any character or emotion you liked met with a nonplussed silence).

Still, what seemed clear to me was that the lack of expressivity I’d been warned about was, of course, just skin deep. Once they understood the games, and begun to know and trust me, the group were by turns highly focused, wildly exuberant and very characterful. Of course, this is just the first step, but it gives me hope that the edutainment project, when I get it started, will find a fruitful home here.

Cooking Guyanese style....

Guyana always seemed like a good bet for interesting food – masses of tropical fruit and veg as the raw materials, plus the cultural influences of generations of East Indians, Africans, Caribbeans, Chinese and Portugese, not to mention the native Amerindian food.
It hasn’t disappointed us – here are a few of our favourites:

Pepperpot: One night, Shaira, our Islamic friend and Guyanese cuisine guru, said: “a friend of mine is killing a cow tomorrow – you want some?”. And so our first opportunity to cook the most famous Amerindian dish came about.
Early the next morning we collected the still warm meat from Ray’s place. Ray is the dominos champion at the local bar. Grinning from ear to ear with a well-earned shot in his hand, he had butchered every bit of the animal, from head to hoof. And for evidence, there on the table, side by side, was the head and tail. Our bag was the last one hanging under the house.
That evening, Shaira arrived to teach us to make Pepperpot. As it wasn’t Halal, she didn’t have any, but seemed happy to see us tuck in to the thick, delicious dark brown spicy stew.

This is how you make it:
Chop the beef into 1 or 2 inch chunks and dry fry it – we had about 2 kilos of beef bits – so heat the pan and chuck the meat in with no additional oil, it will brown in about ten mins with the steam and oil it creates. Next add your seasoning – 2 onions, 6 cloves garlic, all chopped, a chopped hot sweet pepper, 4 or 5 cloves, a small cinnamon stick, a teaspoon sugar (demerera of course), eight or ten leaves of married man’s poke (local variant of basil), a generous teaspoon of thyme, 2 stock cubes and a pinch of salt. Fry off the liquid and add about 50 mls of casareep.

Ah – casareep. This looks and smells and tastes like thick salty treacle, and is one of the many products of cassava. Its had a very significant role historically in Amerindian culture. Made by grating cassava, squeezing out the liquid and then reducing it for hours until its black and tarry. Adding a rich flavour to stews, it also works as a preservative. So, living without power as the Amerindians did for millennia and largely still do, its a fantastic way to preserve meats – just boil it up once a day, you can keep adding to it as you catch more meat and game. In Georgetown there is an historic pepperpot, more than 40 years old!

As we too have no fridge, it was great for us too. It fed us for a week.

Metthem: Another Amerindian classic. On first hearing the term “ground provision” we suspected Methem might be a bowl of dust. Its actually the local term for root vegetables, which are dear to the heart of all Amerindians. This dish showcases them all in their carb-heavy splendour and may go some way to explain the chunky stature of those who enjoy it.

Its a coconut milk stew containing the big 3 from the world of ground provision – sweet cassava, sweet potatoes and eddo (a potato-like root veg which turns an alarming bluish purple when you cook it). It also contains a generous portion of dough (rhymes with snuff), which tops up the carb count. Delicious – and time for a nap.

Cook-up rice: Unusually for Guyana, everyone has their own way of cooking this – but it will always taste of scotch bonnet peppers.
Its rice and peas cooked with coconut and chilli, often with some chicken or fish, and will be familiar to anyone who has been to south London. It was really nice to get here and order something so familiar – it felt like home away from home. Ah, Peckham.

Eddo Leaf curry with Roti: There’s an initially incomprehensible love of eddo leaf here. Possibly because it grows in such profusion, people seem willing to put in the man hours to make it edible. Unprepared, it will sting your mouth like a jellyfish. Its the above-ground leaf of the underground eddo.

To prepare, you need to strip out the veiny stems, and boil it twice, changing the water. Then use it like spinach to make a curry.

Roti: Dom – if you’re reading this, we have learned to make roti. Oh yes.

Make a dough from self raising flour, water and a little oil. Knead for 10 mins intil firm and springy, then roll out to a flat disc. Roll your disc into a sausage (a bit like making a swiss roll). Cut into 4 or 5 sections. Then take each one, unroll it in your palm, lightly oil it, and reroll it tightly, tucking the end tightly into the centre. Cover and leave for 15 mins – its the oil soaking in which leads to the flakiness of the cooked roti later on.

Heat your roti pan (a large flat aluminium pan which works well for making toast too). Roll out your roti to approx 7” and bake it on the dish unoiled, for about 1 min each side. Then turn and lightly oil one side, bake for 30 secs, turn oil and repeat on the other side, so each side has taken a light golden brown.

Clapping the roti – the most important part – do this as quickly and as hot as you can bear. If you need to put it in a towel. Clap the roti vertically between your hands, straight across the disc so your are (apparently) rupturing it, not flattening it. It will tear a little but basically stay in one piece – resulting in a flaky Indian pancake good for picking up curry.

Roti variant – Puri: We were much mocked in one Georgetwon restaurant for mistaking puri for roti. Puri is roti stuffed with split peas, as any fool know.

Farine and Tasso – a Rupununi special: Farine is yet another product of cassava, much loved in the south of the country. Ground up & dried, it looks a bit like couscous. Evelyn Waugh hated it as dry and tasteless, he may have been eating it uncooked. Sandy, our hostess on Dadanawa ranch made a version similar to a couscous type salad, with oil, garlic and veg, which was great with the tasso (dried preserved beef). The beef here is strangely tough but very tasty – the same goes for the chicken – could it be because they are not mass produced?

Chow Mein: the Chinese influence and emergency supper. If you have noodles and a can of mixed veg in the cupboard, you’ve got dinner.

All Fruits Great and Small

There’s fruit and veg here that you will never see in any supermarket or even on a South London market stall. Here are some examples of some wonderful and strange things we have have eaten:

Soursap: Twice the size of your head, green and scaly like a lizard and shaped like a bull’s heart, the fruit inside is white and milky with lots of black seeds inside. Chewing on the fruit leaves you with a mouthful of fibre. Best strained and made into a drink.

Plumroses: Pale yellow and round, the size of a shallot, with a green “navel”on the top. Eaten whole, they have crisp firm flesh. They smell like roses and taste of Turkish delight.

Whitey’s: Green/yellow pods – like a hard shiny broad bean. Inside: white fluffy seed pods a bit like fruit pastilles. The fluffy stuff tastes like sherbert and there is a black seed inside.

Cashews: They grow on trees! The bright red fruit is the size of a very small pear. Hanging of f the bottom is one cashew nut. The fruit bites a bit like an apple but the flesh inside is pale white and sharp flavoured.

Bananas: Of course. There are many variants of the small, very tasty Caribbean variety. Occasionally you can get “bush bananas” which progress from pinky brown to a very pretty rosy pink when ripe, and are slightly firmer than their yellow cousins.

Avocado Pear: or “pears” as they are called here. We have a big tree in our yard. The season is just starting and they say you can find them the size of a football.

Bora Beans: String beans gone mad. Up to 2 foot long, you can buy a bunch that looks like a handful of green snakes for 25p.

Passion Fruit: Here they are bright yellow and as big as your fist, but too sour to eat. Mix the flesh with water and the ubiquitous Demerara sugar (this is where it comes from) for a delicious fruit juice.

Bread Fruit or “Pap fruit”: A big green knobbly globe containing a nut and a sort of artichoke-like surround. Makes a great curry and the nut is good too – but it makes you “pap” (Guyanese for fart).

Doctor's Stuff

Here's a little insight for all the doctors who might read this, in particular, the Amersham Vale gang.

Well, its a bit like putting into practice everything I've ever learnt from medical school through to general practice training. I am the sole doctor for the 12 bed hospital - but it usually keeps in only 5 or so patients at a time. In addition, there is a daily outpatients clinic, first come, first served. So its primary and secondary care all by the same doctor.

The hospital tends to get alot of children with D&V and pneumonia, plus the occasional septic arthritis. There's A&E type work too, especially on payday when everyone gets drunk on high wine (a poisonous blend of distilled rice and sugar which seems to have a similar mood altering effect as say crack cocaine) and beats each other up. There is an unexpectedly high number of abscesses - face, shin, finger - so lots of I&D, which I hadn't done for quite a while.

Not much tropical medicine though. I haven't seen a single case of Malaria, perhaps due to the strength of the bed net programme. Lots of TB - and there's a well organised team of DOTS workers who manage that.

Primary Care: there's a lot of hypertension and diabetes, and a lot of headache and "weak weak doctor" which may sound familiar to South London GP's. Depression is not a recognised diagnosis, which is reflected in the drug cupboard: just an unopened old pack of Amitriptytlline.

In fact, the drugs supply is very good for such a remote hospital in a relatively impoverished area. The only glaring absences are statins (only available in the capital Georgetown), Mefenamic Acid and ear drops for otitis externa.

The personnel problems are dire. No Guyanese doctor will work here. About 50% of the Guyanese population live in Georgetown, and it appears that very few ever go to the regions. This government has initiated a big training scheme, with over 60 medical students from the regions - meaning largely Amerindians - currently training in Cuba, and it is hoped that some of these will want to return to the regions. But until that results in more doctors on the ground, the government have gone for a dual solution: import Doctors from Cuba and train up "Medex's". These are like super-nurses, with similar prescribing rights to doctors and plenty of experience, but less formal training. They are the backbone of the country's health system.

Unfortunately, the Cubans don't tend to last long. In Mabaruma they seem to get sick, go to Georgetown and never appear again. Having seen the conditions in which they work, I don't blame them. Its hard enough working in a new culture, not to mention a new language (their English is invariably abysmal, and Creole takes some getting used to even as a native English speaker) but on top of that they are on call 24/7. Not to mention the distress of the frequent deaths of young children, which is unfortunately not a rare occurrence, often due to the long distances they travel to hospital whilst seriously sick.

In addition to Medex's and Cuban doctors, each village has a local Community Health worker. Highly knowledgable about their communities, these workers have quite limited prescription powers, and work directly in the villages, referring people to hospital when necessary - though unfortunately not always in time to help.

So its the Medex's and the CHO's that I will be working with for the rest of my stay - some of this has begun already, and I hope will be a means by which my presence here achieves more than just patching up drunk boys on payday.... Fingers crossed!

Bon Success!

A week after our arrival in Georgetown, our supposedly imminent departure for Region 1 was hindered by the freakish, London-bus like gathering together of public holidays. Guyana is a very multicultural nation, with the public holidays reflecting this - from Thurs to Monday there was a succession of Islamic, Hindu and Christian holidays, all of which were celebrated.

Declining the opportunity to fly kites, eat hot cross buns and throw coloured dye at each other, we accepted instead an invitation from our very new friends Kathy and Nigel to drive to the south of the country to visit the legendary Rupununi savannahs. The trip started in the small hours of Thursday morning; it took us 13 hours driving at full pelt to cover the 400 miles to south Rupununi. There's only one road running from the north to the south of the country, and currently, south of Linden (a bauxite mining town a third of the way down) its packed red earth with crater like potholes from the massive logging trucks which run up and down it, and which turns to an impassable mudslide in the rainy season.

Historically some of the road's route is based on the cattle route from Dadanawa ranch in the south (where we were headed) to Georgetown. As a route, this was heavy going, with up to 40% dying in the rainforest on the way. In terms of the road's future, Brazil is just completing a major bridge at the border in Lethem, and has plans to get funding to tarmac the road through to Georgetown, as a means of export. This will mean huge changes for Guyana, with maybe a big shift in continental outlook - currently its strongly aligned with the Caribbean.

Dadanawa Ranch has been managed for the past four decades by Duane de Freitas and his wife Sandy, who regaled us with some amazing stories about their lives there. Its absolutely huge - 1,700 square miles - and farms thousands of head of cattle, which basically roam free on the ranch, rounded up twice yearly by the vaqueros (cowboys) for a head count. The ranch is not at all South Fork - its truly wild, wide open savannah with cattle roaming freely for miles on end. The houses (like many in Guyana) are on stilts - good for the floods in rainy season, and very elegant looking and airy. Its a real outback lifestyle - the nearest town, Lethem, is 2 1/2 hours away by track, if the road is good.

Sandy and Duane are real children of the 60's, living sustainably raising what is effectively free range, organic beef (absolutely delicious, Sandy served us filet with very fancy farine on our first night), running an eco-friendly tour-guide business on the side (Duane knows the rivers of the country like the back of his hand) and both disdaining to wear shoes in some of the most unhospitable terrain imaginable. Quite strangely, there is a huge divide in the country - almost no-one in Georgetown has visited the Rupununi, or Mabaruma in Region 1 where we are posted. This is partly economics and logistics - travel is hard and expensive, which makes it difficult for many - but also its cultural - Georgetown is seen as the epicentre of all that is happening, which is a shame, as what we saw of the savannah was just beautiful.

We spent 2 days on Dadanawa; over breakfast on day 1 we had a tornado, followed rather magically by the arrival of an "anthropologist" who had "run out of fuel". Theories abounded as to the power of satellite technology tracking our diplomatic plates heading where no cars go.... We concluded that "Jo" from Hawaii University (!) was actually a spy. Maybe we were a little paranoid, maybe the solitude was getting to us, but it did seem a little weird. Other highlights - Duane showed us some petroglyphs (rock etchings) in the middle of the savannah; we climbed Shea Rock, the Ayers rock of the Rupununi; we met Duane's pet otter (he's raising it for the Florida Zoo) and we saw the pelt of their pet jaguar which just outgrew them... Duane showed us what was more disgusting than an anaconda ingesting a boa constrictor - and thats an anaconda spitting it out again. Just some footage he shot while out in the bush. The stuff of nightmares, truly.

We drove home taking in the rodeo at Rupununi - where we unfortunately saw one rider take a really painful fall, face first into the dust. Next morning we visited the canopy walkway in the rainforest at Iwokrama - a rope and aluminium walkway hundreds of feet above and in the canopy of the rainforest, very beautiful and peaceful and also a bit alarming as it sways and creaks under you.

In case you're wondering, Bon Success was the original name for Lethem, the border town with Brazil. We gleaned this from Evelyn Waugh's very funny book, 92 Days, where coincidentally, he follwed almost precisely the route we just did. It took him a lot longer, but quite amazingly, so much of what he wrote about the environment and the culture here still remains true today.

Our love to you all, we're having fun, but we miss you XXX

Who are the Amerindians?

"....the more I saw of Indians, the greater I was struck by their similarity to the English.
They like living with their own families at great distances from their neighbours; they regard strangers with suspicion and despair; they are unprogressive and unambitious, fond of pets, hunting and fishing; they are undemonstrative in love, unwarlike, morbidly modest; their chief aim seems to be on all occasions to render themselves inconspicuous."
Evelyn Waugh, 92 Days - Travels in Guiana and Brazil, pub: 1934

Getting thru'

Welcome to our blog! Here's a little introduction to what we're aiming to do here....

Sam: A year ago I completed a 3 month course in Tropical Medicine at the London School with the aim of using it- with my GP knowledge- to work in the developing world. Aim: part altruism, part academic interest, but largely just a great way to immerse oneself in a foreign culture without having to open a beach bar.

Becs: Through a process of four degrees of separation (thanks Fania, Maradowa and Sarah) we found Guyana welcomed us with open arms. The combination of Latin American climate, Carribbean culture, English as the first language and the serendipity of the regional arts festival 'Carifesta' being hosted here this August made for an irresistible prospect.

Sam: Fast forward months of preparation and 10 days of intensive meeting and greeting here's where we're at: next week we will be flying out to Mabaruma, a settlement in the North West region. Though only 200km as the crow flies from Georgetown we are told it is very remote, with very limited transport (some journeys require all 3 of car, boat and foot). It is populated sparsely by Amerindian peoples.

Becs: What we'll be doing: Sam has been tasked by the charming Minister of Health (Dr Ramsammy) to spend his time working with local healthcare practitioners- called Medex's. He will spend his days as a roaming GP conducting outreach clinics in tandem with the local Medex and skill sharing. We're hoping his daily commute will be by dugout canoe, which will make a change from London cycling.

Sam: As for Becs, she will be working with local Amerindian groups to develop their own 'edutainment' pieces, the aim being to transmit public health issues to their local communities through theatre, dance and song. It's going to be a bit of an experiment in a something called Applied Theatre, and there are plenty of thorny socio-medical issues to base it around.

Becs: Before the hard work begins, though, we have been invited to visit a vast cattle ranch near Lethem on the Brazilian border. The scenery and wildlife are said to be spectacular, so we'll try and get some pictures up for all to see.

Bless up xx