Cycling The Six; As One

Stephen Fabes is a writer, doctor and storyteller. He currently shares his time between his desk, where he’s writing a travel book, and the A&E departments of St Thomas’ and Homerton hospitals in London. Between 2010 and 2016 he crossed 75 countries and 6 continents by bicycle. He now sleeps in a bed. Last week, Health Poverty Action launched their As One Campaign and Stephen tells us in his inimitable disarming way, first of his epic world tour on two wheels, and then how and why he supports As One.

Baby steps

Like most decisions of great consequence, my plan to cycle around the world was settled in a pub, pint in one hand, mini-atlas in the other. I’d finished work on the renal unit in Guy’s Hospital. That Friday feeling had perked up the streets outside, and Londoners were pouring out of offices, making little eddies of people in beer gardens. I joined them, and sat on a wooden bench outside the George pub amid a small band of my closest friends. I had a plan to pitch.

I opened my mini-atlas on a double page spread of the world, put my pen to London and gazed significantly around the table. ‘I reckon it’ll take about six years by bike’ I said. ‘You know, give or take.’ And with that, I was off: my pen skittering across roadless hunks of Sahara, over white and blue hoists of mountain, through jungles stocked with unwholesome parasites and toothsome fauna that there was definitely no need to mention at this stage. With a little flick of the wrist I winged it, unscathed, through the Darien Gap. Someone muttered something about war lords and drug cartels but I swiped at their fears with my pint-hand, dripping lager on Mexico, and I was soon merrily skidding about Alaskan tundra. In less than a minute I’d breezed back to London where, like a cross between Marco Polo and Gandalf in Spandex, I’d fondle my rambling beard and lapse into a thousand-yard stare.

At the time, I was clinging to my twenties and plodding through Core Medical Training at Guys and Thomas’ Hospitals. There were the usual professional quibbles. Yes, my social life had been contracted into a kind of anorexic myth, and what remained of my free time was stolen by revision for MRCP. But generally speaking, I loved my job. There was, though, a gnawing consciousness that I’d be working until 65 at least. I needed an adventure. A test. Something meaty and unsure that could end elatedly back in London in half a decade, or in some wild part of the Himalaya, lost, alone, barely enduring on the few moths I could skewer with a penknife. I didn’t think I’d regret an ending of emaciation and moth-kebabs. There was a romance in it.

I began saving money. My choice of flat went from Spartan to needy to perilous. At last I was wedged into an NHS-owned cupboard that was like living in the brig of a medieval warship. I found myself dreaming of adventure in spare moments (in the shower, on the bus, between resus calls). When Core Medical Training staggered to an end, I simply didn’t look for another job. I swapped time on the wards for time designing a flashy blog and researching which brand of rain jacket would be aptly expedition-grade. A vaccination for Japanese encephalitis appeared on my to do list, below ‘buy cheddar’. And I was careful to refrain from cycling. Cycling around the world would be hard, no need to endure months of training and physical conditioning as well.

So, TV dinner-unfit, I waved goodbye to my colleagues and loved ones from outside St Thomas’ Hospital. It was the 5^th of January 2010. We posed for photos. My companion was a new steel-framed, packhorse of a touring bicycle. Far too expensive, especially if it got robbed or fell under an Australian road train or got confiscated by the Russian security forces; all seemed faintly possible. A sleeping bag, roll mat, base layers, pots and pans, maps from here to Somalia, cameras and lenses, a medical kit (thank you NHS) and much more besides was stuffed into four panniers clipped onto her racks.

I leaped atop my bicycle – forty kilos of gears lurched worrisomely – and aimed myself away from the crowd. I took my first pedal strokes. I heard ‘Go on Stephen!’ and I was glad at this crucial moment my mum had elected not to call me ‘her little adventurer’. Theoretically, I was now cycling around the world. The thought was suddenly incredible. I was full of pluck and self-confidence, feelings which rushed with me to Westminster bridge, where they, like me, abruptly terminated. Unbeknownst to my friends, I pulled a quiet U turn. And then headed swiftly to the pub, where I spent the next four hours drinking through crushing self-doubt and wondering what I’d got myself into.

False starts aside

I did eventually get underway, pedaling fourteen long miles to a bed and breakfast in Bexley Heath where I collapsed onto a bed with a sore arse, and tried not to dwell on the six years of sore arses that loomed implausibly ahead. When I woke, it was to a snowscape. Serial weather charts for the next couple of days, if I’d bothered to look at them, would have revealed a pallid whorl infecting Europe from the north. Nasa satellites had snapped a ghostly Britain, southern parts encumbered by forty centimetres of snow. By the time the overnight temperature in Manchester had faded to minus 17 degrees Celsius, the army had been mobilised to assist stranded motorists. Weather forecasters were tagging it ‘The Big Freeze’ (the cold was so severe it had withered their imaginations) and nationwide, around eight thousand schools were closed. In Kent over 250 schools had delighted children by closing their gates and cancelling class. My first full day on the road was spent negotiating up to a foot of snow and gangs of children rampaging with snowballs. I was slow and preposterous-looking; the ultimate prize.

The most cherished moment in a child’s life, I have discovered, is this: you are playing in the snow. Your mum shouts “Hey Benny, school’s cancelled, too much snow! Come inside for apple pie!” “I’m coming Mum!” you shout, but as you put the finishing touches to the densest, roundest snow ball of your young life, a huffing, unbalanced-looking creature on a bicycle teeters into view: a Lycra-entombed sack of unmuscled blubber, weaving regretfully. Your best friends gather about you, forming a kind of platoon; he sees you all, pleads with his eyes, develops a look that suggests the slightest distraction might send him painfully crashing to the icy ground. He begs a little, in a string of whimpering ‘no’s’, but it’s too late for him, and he knows it. A silence falls as you take aim. Never will childhood be this joyous again.

That, anyway, was the teething phase of my journey. Fast forward six years and 221 punctures, I’ll emerge onto Westminster Bridge to end a bike ride that spanned 75 countries, six continents and 53,568 miles (three more than anticipated, having got lost behind some charity shops in Greenwich on the way home). That’s a distance equivalent to more than twice around the planet, or 61 times the length of Great Britain, or 23,808 laps of the Coventry ring road, or 9743 Mount Everests if you’d somehow cloned the mountain and laid it end to end in space. Whichever sounds most impressive. I was more calf muscle than man.

But not so fast

It took about four years on the road for the rot to set in. Four years for a swelling sense of burnout to reach its peak. Perched on the edge of Asia, I realized that all the potential small dramas and big vistas of the continent ahead didn’t excite me all that much.

There were clearly two possible solutions to this lassitude. I could: 1. Go home; Or 2. Invest my journey with a touch more purpose. You have a great deal of time to think on a bicycle, it’s the most meditative activity I know. Something about the spinning wheels which turn the cogs of a wandersome mind. And during these spare hours, I began to wonder if I could explore some aspect of healthcare on my way home, something I was genuinely passionate about. I could begin another journey, running in parallel with the physical one by bicycle.

Over the next two years in Asia, I visited remote medical clinics and healthcare projects across the continent as I travelled. They served people who were, in one or more respects, marginalized; living in the economic, geographical, cultural and political edgelands. My aim was not to swoop in and volunteer my medical skills in the short term, in communities I didn’t know or could hope to understand. Instead I planned to observe, learn a little, contrast and write about healthcare on the margins. Medicine would be a medium by which to dig beneath the surface, discover stories and bring a new perspective to the world I was pedaling through. And my bicycle seemed the perfect vehicle. It provided a lingering, backstage view of the world. It brought an appreciation of details that have a bearing on health.

On this parallel journey, I met Kalpana*, a young and beautiful recluse from a remote Himalayan community who’d lost all her fingers and toes, unaware for more than a decade that her alleged curse is leprosy, and who self-diagnosed after hearing a public health broadcast from her wind-up radio. I met Rimaal*, one of the street children of Kathmandu who stumbled through puddles and potholes in a gang, blitzed on glue scored at over the usual price from store owners recognising the market endowed by addiction, and intent on making a quick rupee. I met Narith*, a Cambodian fisherman living in a floating village with a tennis ball-sized tumour protruding from his neck, past the point of salvation and cure, even if he could afford treatment. And I met Aye*, a young woman from the Karen ethnic minority in Myanmar, ostracized and dumped outside a monastery. Emaciated, HIV positive and dying of lymphoma; alone but for the Buddhist monk holding her hand, ordered by an elder monk to resign his calling – as monks can have no contact with women – and care for her until death.

And after about five years of cycling, I met Afghanistan.

Afghanistan

I remember the morning after my first night in the northern Afghan city of Mazar-e-Sharif. The sounds of a city waking up drifted through my hotel window. The emerging sun restored colour to the domes of the Blue Mosque, as a man splayed a piece of cardboard onto the pavement, a makeshift mat, and began to pray. A tough gang of street kids were fighting over the fruits of begging, and a scattering of women wandered about on early errands, draped in blue burqas; rippled and shaped by the desert wind.

It was the trucks though which held my gaze, as they dragged their long shadows up and down the square of road that enclosed the Mosque. Gangs of men sat in the open-topped backs, slung with silvery-worn assault rifles, legs hanging over the side, their shemaghs wrapped around their heads and faces, leaving just a slit for the eyes. One of these wraith-like men per car attended a mounted machine gun that made my heart race. Some were police; others paid militias loyal to Atta Muhammad Nur, the famously wealthy city governor slash warlord, known as ‘the teacher’ and a former commander in the Mujahidin. At least I hoped that’s who they were. When the Taliban had attacked – as they had twice that summer – they had done so in a similar disguise.

I sought out the regional hospital which hid behind a tumult of fruit vendors. Women sat in clumps on the steps by the entrance, beturbaned men stood apart by the doors. A multiplicity of skin tones and faces, emerald and blackish eyes. In the hospital I was introduced to Dr Ali*, a bushy-browed, kind-eyed orthopaedic surgeon, India and Afghanistan-trained.

We walked and talked, pushing through a door stickered with a No Guns sign which led to the orthopaedic ward. ”Medical schools here can be a joke” he said. ”Doctors come out with virtually no experience, trained inadequately in one specialty by teachers of another. The difference between a teacher and a student is one night’s reading, I’m serious! Information is passed on like water is passed between hands, and after enough hands, there’s no water left.”

I joined the swinging tail of a ward round. On any given day around 70% of the patients here were victims of road traffic accidents, but the peril of the region’s hectic highways was old news. It was the 20% here, by actions of an insurgent Taliban, which was the fraction growing the fastest. And violence was infectious. Family feuds could be settled using guns, and Dr Ali* recounted stories of wedding party massacres, insisting this was never the case just five years ago.

We stopped then at the bed of an 11-year-old boy. As we gathered round his face clouded over with fear; his mother, a small lady in a white veil, reached for his hand.

Tanim* had been at the bazaar in the northern town of Maymana with his mother to buy new sandals when a woman detonated a bomb in a pressure cooker. The blast wave threw him into a nearby canal, where he lay with a head injury and broken femur. After being rushed to a private clinic with no expert orthopaedic surgeon, fixators were applied to adjoin the ends of fractured bone, but they were poorly sited. Dr Ali* held up an x-ray film for me to examine: ”totally unnecessary” he grumbled. He could have been referencing the misaligned pins, the incompetence, the lack of training, the bomb, the decades of war. When the bones failed to unite, Tanim* was taken by his mother to a mullah who proclaimed the boy to be cursed and responsible for his own pain and disability. Months later the boy had arrived here, where he waited for further surgery and psychiatric evaluation. At night he woke, screaming and tearing at his bedclothes.

I offered his mother a seat, but she refused, opting instead to crouch on the floor, gazing up at me past the chair and speaking through a white veil drawn half over her face. Before the bomb blast, she said, her husband had become addicted to opium and had left her to look after their six children alone. Now, after her son’s injury, her other children went to school for only half the time, for the other half they were forced to work, stitching together clothes to collectively raise two dollars a day for food. The violence would ripple through the generations.

But for now, her main concern was her son. ”He’s not normal” she told me, quietly, sending her words to the hospital floor. ”He screams. He talks to himself at night. I pray his leg will heal, but I worry most about his mind.”

As One

This is the brain drain. This is a poverty of resources. These are the shadows of those faceless WHO statistics. This, I hope you agree, is tragic and unacceptable.

When I first heard of the As One campaign, it was the orthopaedic ward in Mazar-e-Sharif that came to mind, but I’d seen the challenges of resource-poor settings many times before. We live in a world where capital can move unhindered, attaching itself to cheap labour and weak regulations, but where the movement of people is restricted and entire groups are demonized.

This has implications for our colleagues. Afghan doctors struggle to get visas to study abroad, and in resource-poor settings like this, with an intense work load and little time, money and opportunity, high quality training can be hard to come by. With so much experience of trauma, the flow of expertise could very easily be bilateral too. Mentoring, training materials, group chats: all can be empowering.

What is As One? / As One is a campaign run by Health Poverty Action – a charity designed & led by health professionals. It aims to support health workers in resource-poor countries, with a view to making health services better and equal for all – focusing on local development programmes, influencing policy and disaster/emergency responses. They ask you, health professionals from around the world, to support other health professionals from around the world. Follow their #AsOne campaign, and consider donating what you can. The cost of your weekly coffee? The price of a stethoscope? Visit their website to learn more.

Why support As One? / I support the As One Campaign because the medical profession needs unity to thrive, not just at home, but internationally. If you want to do so too, its quick, easy and, let’s be honest, it probably won’t dint your paycheck.

How to support As One? / Support them, advertise their campaign, and donate to their cause via their justgiving site. I know some doctors are donating money they earn through filling in cremation forms and the idea really appeals to me. It’s cash we hadn’t anticipated, that stems from a sad situation and can be used for a positive purpose. Without getting all mystical, I just feel there’s some good karma in that.

Advice for our readers considering their own epic journey / Simple. Just work out whether the cost of taking such time out is worth it. Without wanting to sound negative or whiny (obviously this was of my own volition and I don’t regret the choice at all) there were some prices to pay for taking six years out. I didn’t see friends for a long time, and relationships probably suffered. I was deskilled and broke. I arrived home in debt to everybody, a balding 36 year old living with his mum who took him clothes shopping like a ten year old. I had to re-train. Yes, it was worth it, but be realistic about the cost of taking a such a journey. It’s a very personal decision. If you deem it worth it: go for it! (also… retain some connection with the place you used to work in. Personally I’m also grateful MRCP was out of the way before I left.)

Useful kit for a long bike ride / Take an iPod, a journal, a constant supply of good books, and if you’re going to cycle across Mongolia in the winter time, bring a Thermos.

Want more inspiration from Stephen? / Visit his blog and peruse his may photos chronicling his trip on Flickr.

* Names have been changed to maintain anonymity.

Photos credited to Stephen Fabes; words are a mix of Stephen’s original writing for this article, excerpts from his blog, and with the odd editorial addition from Adventure Medic.