Doctor Ulla Ottosson from Gällivare in Northern Sweden has traveled almost 10 000 kms to serve as a Rotary doctor for 6n weeks on the remote island of Pemba - one of the isles in the Spice Islands of Zanzibar. .When she leaves another Swedish gynecologist arrives to continue the important task of being the sole doctor in the two towns of ChakeChake and Wete. 300000 people live on Pemba. Crops are cloves and seaweed. Infrastructure is poorly developed. When there is no diesel, there is no electricity. Doctors might have to operate by torch light without a/c in 30 centidegrees and 80-90 % humidity.

Follow her work for a few days. Meet happiness and deep tragedy. Imagine her frustration when her ordinations are neglected and patients die. See the primitive surroundings where specialist care is given despite lack of basic drugs and instruments.

We will follow one patient, let's name her Upendo, who would not be alive today but for dr.Ulla.

She arrives at the Maternity ward in the morning 9 months pregnant. She has not felt her baby moving for the last days. Her medical history is sad. The first pregnancy ended with a normal delivery, the baby alive. Second pregnancy ended with a caesarian section, baby stillborn. Her third pregnancy ended with a caesarian section, the baby died after two days.

Now she is terrified and wants a caesarian at once because of the pain. The midwife agrees -it would be all for the best. But dr. Ulla is opposed. Another caesarian, another scar in the uterus and Upendo's possibilities to have another baby, which is all she wants, are reduced. The patient is to be given medicine to induce contractions and admitted for close monitoring. Two hours later we come to the ward. She has not yet got her medication. After another two hours we learn that she was given the medicine only 30 minutes earlier. It is now 3 p.m. At 5 p.m. she has severe headache and fever. It is visiting hours. The ward is crammed with visitors, the sound level is dramatic. The woman wriggles in pain, no staff to be seen. She is taken for examination by the doctor who finds no changes since morning. Another dose of medicine for contractions and malaria pills for the fever and headache + a bloodslide. Reluctant staff agree. Next morning during rounds we find the patient feverish and still with a head ache. Slight contractions. Finally in the afternoon dr. Ulla decides she can no longer wait .- she must perform a caesarian. The patient objects she will be dead. No she won't die. Oh, no but she will be dead. Because a woman who cannot have children might as well be dead. It takes some time but finally she understands that there is no alternative and that she is really in the hands of a friendly doctor. Instructions to call op-staff and we go home for a snack and change.

To make a long story short. When they came for us - patient ready!!!! - she was not. It took 35 min and 12 pricks with first a canula then a needle to get a drip going. The anesthetist was angry because the patient had low BP and bad veins. Finally the patient was asleep and the operation started. The dead child was taken away to relatives. BP fell to 60/40 and dr. Ulla said it was time to give the blood as Hb was only 5. NO BLOOD!!!! Already the day before the staff had assured that although the patient's relatives were small donors with low Hb there was at least one unit ready.

At this point the doctor is tired. There is 5 cm left to stitch. She stops. Looks at the anesthetist and says calmly: What do you think. I am here doing a difficult job with very little support. I am told there is blood and there is not. Which is best to stay or for me to go home to Sweden? The answer comes after some hesitation, but clearly spoken: "I really think you should go home". The doctor finishes the operation in silence. Walks out and writes her report. We walk to the ward Upendo lies alone in her bead. No staff. Finally some one arrives with a unit of blood. Given by Upendo's relative the day before. The anesthetist comes and starts a longer lecture about educating the people but that they sometimes want their relatives to die. At this moment I walk away. Furious. Dr. Ulla comes a minute later sighs and shakes her head. We leave.

Next day on rounds we find her better but she complains of chest constrictions and breathing difficulties. Dr. Ulla asks for a stethoscope. Listens. Meanwhile the patient starts talking in kiswahili. I listen. Hard to follow the very low voice. But I get something about TB, lungs, breathing and two months. I ask the nurse. Yes, of course. Upendo had been treated for pulmonary TB earlier in the pregnancy. Dr. Ulla looks up. Startled. She was never told.

X-ray confirms lower right lung infiltration. The doctor requests a transfer to the TB ward because here she is in the middle of a lot of newborn babies. But the TB doctor is not available until Monday. Today is Saturday. No isolation. BUT if the doctor will write a new request the patient can be transferred to the female ward. So be it.

To be a doctor in a developing country is not easy. To come for a short time is even more difficult. But to come to a developing country for a short time, not knowing the language and not getting any cooperation from the local staff is a disaster.

But dr. Ulla is a cool lady. She needs to be angry. Outside the hospital. Recovers after a cup of coffee or two and so life goes on. She has another two weeks to work here on Pemba. May God be with her and all the good wishes from all Rotarians all over the world too.

Tomorrow Sunday- is a day off. We are going to beach for lazy swimming and resting in the shadows. Mondays is the start of a new week. New frustrations But a lot of grateful patients. Grateful because this doctor does not get angry and yell at them when they scream in fright and pain. This doctor is a dr.Ulla from the Rotary Doctor's Bank from Sweden. Here to help them despite all difficulties.

The pure joy at a happy ending. After a week I am still surprised that so many babies are born white. After a long day we go home to cook dinner. Talk a lot. Laugh a lot despite all that has happened. Like many people working in development countries dr. Ulla has the attitude: "I will help those I meet, I wish someone else helps the rest".

Dr. Ulla is someone Rotary can be proud of. AND she has a lot of colleagues like her.

Dr.Ulla and the Docmobile The car flashes the Rotary emblem on all sides. It is a well known sight around the island.

Dr. Ulla and her moral support Pelle. Pelle is in his ordinary life in Sweden manager at a mountain station. Before that he was a a high school teacher in mathematics and biology. Here on Pemba he is the professional tourist. He walks the street, greets the people and visits the mosque. Every Friday he receives 20 shillings, 2,5 US cents, from an old man -" for a higher life". Being generous is one of the pillars of Islam. And this man giving Pelle the money has now made a good deed - three times. Pelle contemplated this and from his conversations with men he also understood the generosity part of Islam. At his suggestion some men will talk to the Imam at their different mosques and suggest that all healthy men should donate blood three times a year to the hospital Blood bank at Chake hospital that always is low on blood. One man from each of the three towns, ChakeChake, Wete and Mkoani have been approached.. Each was told the simple facts. You have 10 pints of blood, give one and that is a very good deed. The blood regenerates and it won't hurt and who knows maybe a close relative of yours will survive because of this blood. Now all that remains is to see if this works.