Monday, May 18, 2020

A clinic day during the COVID19 pandemic…


It’s 6:45 am on a Monday. As I head out the door, I put on a cloth mask and make my way to the paediatric outpatient clinic at the Aberdeen Women's Centre. Unlike many places in the developed world where outpatient services have switched to telemedicine, here in Sierra Leone due to limited connectivity we are still doing in-person consultations. It is the only way to keep essential health services going, which is vital in a country with some of the highest maternal, child and infant mortality rates in the world. 

It goes without saying, safety is our priority: personal safety, colleagues’ safety and that of the patients and caregivers. This is not an easy task and takes considerable planning and resources. Hand hygiene, screening, personal protective equipment (PPE) and social distancing occupy my mind throughout the day. Psychologically it is challenging. Everyone I come into contact with potentially has COVID19. 

On arrival I wash my hands and go through the screening process. Once screened, I enter the hospital compound and make my way to the children’s clinic. I wash my hands. After changing into my scrubs, I wash my hands again before I don personal protective equipment (PPE): head cover, mask, apron, face shield, gloves. Now I am safe, as long as I don’t touch my mask or my face and I wash my hands frequently.   

I walk out of the clinic’s side gate and meet the line of patients waiting to be seen. Our first priority is triage and screening. Triage to ensure that the sickest children are seen first, and screening to identify any potential COVID19 cases to isolate them for testing. During this process we have to ensure that patients are socially distanced and masked up. Although it is made somewhat easier due to painted markings on the sidewalk and chairs placed at least a meter apart, it can be chaotic, requiring a lot of patience. 

Screening takes time but eventually the patients enter the clinic; all wearing face masks. Next, one of the nurses does a health talk, using the time to educate the caregivers about corona virus and how to prevent it. Meanwhile I attend to very sick children in our observation room or, if there aren’t any emergency cases, I prepare my consultation room; disinfecting the table and chairs and making sure I have gloves and hand sanitizer. Finally, I start the general consultations. 

Consultations are carried out as usual except that I consider every person to be a suspect case. Although we screen at the gate, we will miss cases, in particular asymptomatic caregivers. So, I make sure the caregiver and child are sitting at least a meter away from me and I keep my mask and face shield on, using gloves for every patient contact followed by hand hygiene. This process repeats itself until every patient has been seen, either by my colleagues or myself. 

After all of the patients leave, I remove my face shield for disinfection and reuse, wash my hands and attend to administrative tasks, trainings and meetings. My mask is kept on, because even those I work with are suspects. Anyone could be an asymptomatic carrier. 

It’s time to clock out. I doff any remaining PPE, wash my hands, change my clothes, put on a cloth mask and make my way home. On entering my compound, I wash my hands before heading indoors. The workday is done and I can only hope that I kept myself safe today. 

All across Sierra Leone, healthcare workers continue to provide essential health services, as well as COVID19 care. Please pray for courage, safety and perseverance. 

#TogetherWeCan #EndCorona #ProvidingEssentialHealthcare #ChildrenMatter

Sunday, April 12, 2020

An unexpected Easter in COVID-19 times...

I am writing to you from mandatory quarantine; all is well. I am currently healthy. Spending time in isolation has given me the opportunity to reflect and although this Easter has not gone as planned, it is probably one of the more meaningful Easter’s I’ve had. 

Over the past few weeks, the following words have become all too real to people all over the world. Isolation. Chaos. Confusion. Fear. Death. Suffering. Loneliness. Pain. Hurt. Loss. Doubt. Distress. Uncertainty. Despair. We are confronted with the reality of separation, disease and death. Our world feels like it has been turned upside down. Maybe it’s not so crazy that this pandemic happens to coincide with Easter.

The moments leading up to Jesus’ death were full of turmoil. Jesus was distressed and troubled in the garden of Gethsemane. One of his very own, Judas, betrays him. Peter disowns him. Soldiers mock him. Those who pass by the cross hurl insults at him. And at noon, complete darkness fills the land. Jesus cries out “My God, my God, why have you forsaken me?” How many of us have asked where God is in the midst of this COVID-19 pandemic? The earth shook. The temple curtain split in two. Unprecedented. A day like no other.

The good news is, resurrection Sunday came. The angel said to the women, “Do not be afraid, for I know that you are looking for Jesus, who was crucified. He is not here; He is risen, just as he said.” (Matthew 28:5-6)  Death did not hold Jesus. The darkest moment in history transformed into the greatest love story the world has ever known. Amazing grace. Through His death and resurrection, we are brought out of the darkness and into the light.  He does not promise us an easy life but He promises us a life with Him. In the middle of our current unexpected storm, He is our anchor. He is our light and our strength in these dark times. He is our peace. Hope is not lost. 

Christ is risen! Let’s rejoice today as we celebrate our Lord and Saviour – our hope and our strength! May you have a deeper awareness of His love and peace today. 

Friday, April 10, 2020

Good Friday: in the midst of chaos and uncertainty

On Good Friday, I am reminded that in the midst of the chaos and uncertainty in the world, and despite Easter weekend looking very different this year than we may have imagined or hoped due to the COVID-19 pandemic, Jesus is the same yesterday, today and forever. 

Our circumstances change, but He doesn’t. We feel like we’ve lost control, but He hasn’t. We may feel alone, but He is with us. He is the same yesterday, today and forever. 

Today I reflect on the amazing sacrifice He made, the outrageous love He displayed and the grace He extends to me over and over again. May we rejoice in the hope that we have in Him. And may we remember that He is the same yesterday, today and forever. 

Tuesday, March 31, 2020

Whirlwind Weeks: COVID19 confirmed in Sierra Leone

The last few weeks have been quite something; it's hard to even put it in words. The whole world is consumed by COVID19 with daily increases of cases, deaths, lockdowns, overwhelmed health facilities, shortages of personal protective equipment and pretty much every headline focussed on the disease. Meanwhile, Sierra Leone was amongst a small group of countries in the world yet to confirm a case. However, as the President of Sierra Leone stated on the 24th March 2020, when he declared a State of Public Emergency, it was not a matter of 'if' the coronavirus would come to Sierra Leone, but 'when'. 

Sadly, today is that day. The first COVID19 case was confirmed in Sierra Leone. The index case is a national who traveled from Europe back to Sierra Leone. Symptoms were experienced during quarantine and the index case went to an appropriate health facility for isolation and testing without first going home. Confirmatory tests were positive. Thankfully, the person is in stable condition and measures have been put in place for contact tracing in a systematic manner. We all hope and pray this disease will be contained. 

The government has made good efforts during the preparedness phase to try to prevent/contain COVID19 from coming to/spreading in Sierra Leone. The big shift came on the 19th of March when the government announced that flights would be suspended for a period of 90 days. Within hours and days a myriad of measures were put into place including no large gatherings, closing of mosques and churches, schools stopping by the 31st March, stopping the LUMA markets upcountry, restrictions of passengers in public transport, closing the land borders and declaring a State of Public Emergency. Now that we have a case in country, additional measures will follow.

While the government plays its part, and the various pillars at the Emergency Operations Centre work hard to contain COVID19, it's important that we as individuals take ownership and make sure we prevent spread of this disease.

Wash your hands with soap and water frequently for at least 20 seconds.
Cough and sneeze into your elbow.

Do not touch your face. 
Avoid contact with sick people.
Keep physical distance from each other. 
Call 117 if you are sick.
Follow local health advice.

Let's pray for Sierra Leone and for the world.

Saturday, August 10, 2019

Wake up world: stop tolerating harmful medical practice...

As you likely know, I am a qualified and registered medical doctor working alongside national staff in a facility that is run by a UK foundation and supported and registered by the Ministry of Health and Sanitation, providing outpatient medical care to sick children below 16 years of age. The severity of illness we deal with ranges from a child with a runny nose to a child who is unconscious due to severe malaria. Regardless of the situation, our team acts based on our training and experience. Yes, we are forever learning, but through years of training, we have been equipped to handle such situations. I cannot even begin to imagine managing critically ill children with no medical training.

I am shocked but not too surprised to read the story of Bach, who according to this article, went to Uganda as a 20 year old highschool graduate with no medical training, and ended up running a centre for children with severe acute malnutrition for five years, performing medical procedures herself. If these facts are true, this is wrong on so many levels. And sadly, stories like this are a reality in many developing countries. 

This would not be the first time a possibly well-meaning, but na├»ve or ignorant, individual sets out to help others but puts lives at more risk. Some might call it the White Saviour Complex. Whatever you call it, it is appalling and needs to stop. Whether it is foreigners coming in to “help” or nationals "helping" their own people, if they are working outside of their realm of expertise or doing more harm than good; STOP THEM. If the facts are accurate, it is also infuriating that Bach's friends, family and Board did not intervene but applauded from the side lines.

I don’t have more details than what is included in the article linked above, but I know this is a global issue and I believe we can and must do better. We owe it to ourselves and we owe it to those we care for. The world needs to wake up. So, here are some reminders...

Common sense: 
  • Don’t do what you’re not qualified to do.
  • Always make sure that what you are doing is legal.

Responsible humanitarian aid: 
  • Don’t think YOU can save faulty systems or the world for that matter.  You may be able to help, but you are by no means THE solution. 
  • Work alongside local authorities and nationals on a long-term sustainable and coordinated response. 
  • Do not do your own thing.

Appropriate support and sponsoring:
  • Know who and what you are supporting.
  • Make sure the charities you support are law abiding.
  • If you know that someone is working in a capacity overseas that would not be acceptable in your own country, strongly advise them to stop.
  • Advise people you support overseas to work alongside nationals who know far more about their setting and context than a foreigner ever will.

Wake up call for local authorities in developing countries: 
  • Supervise and monitor all of the so-called health facilities and professionals. Put clinical governance systems in place. I know that in Sierra Leone, there are “clinics”, pharmacies and healthcare workers working outside of their legal boundaries, providing potentially harmful care. Some do more harm than good and should be shut down. Why tolerate it at someone else's expense? 

Building a good health system does not only mean improving standards and ensuring high quality care but it also entails regulation, which means shutting down illegal and/or unsafe health facilities and revoking licenses of those who do more harm than good.

#wecandobetter #sierraleone #healthcare #clinicalgovernance #healthsystems #partnership #collaboration  #regulation #moreregulationneeded #ethics #healthramblings #commonsense #dogoodnotharm #supervisionandmonitoring

Monday, January 07, 2019

Ongoing journey of gratitude...

During the beginning of the Ebola outbreak, which was one of the most challenging times for me both personally and professionally, I embarked on a journey of gratitude. Everyday I paused, focused on the positive and wrote down one thing I was grateful for. I ended up with 365 moments of thankfulness. This journey helped me grow in gratitude and have a more positive outlook on life. At the start of 2019 I decided to continue this journey. Here’s week 1 of my moments of thankfulness! 

Day 1. Thankful to catch up with my friend Anna over a New Year’s dinner
Day 2. Thankful for fresh fruit, yoghurt and a blender = delicious smoothies 
Day 3. Thankful for my parents, 45 years of marriage and their ongoing commitment to each other 
Day 4. Thankful for a friend who came to visit when I wasn’t feeling well - thanks Suzanne
Day 5. Thankful for inspirational people in my life who encourage me to live and love better
Day 6. Thankful for a luxurious overnight in a hotel that was gifted to me
Day 7. Thankful that the National Emergency Medical Service (NEMS) is up & running and their ambulance was able to transfer two infants to the Children's hospital for us since our ambulance is temporarily out of service.

#2019 #makingitcount #gratitude #momentsofthankfulness #alwaysanadventure #ihaveamazingfriends #ilovemyfamily #livelovelaugh #actjustlylovemercywalkhumbly 

Friday, October 05, 2018

Happy 40th Mercy Ships...

Congratulations Mercy Ships!  40 years ago, on the 5th of October 1978, the first Mercy Ship was purchased.  As a 1 year old at the time, I was oblivious that this ship would one day become my childhood home. However, just a year later, my family joined the M/V Anastasis in Greece and I had the privilege of spending the next 14 and a half years onboard. To date, the Anastasis is still the place I have lived the longest, surpassing The Netherlands. However, Sierra Leone is catching up with 13 and a half years and counting.

I was the first child to go all the way from nursery through 12th grade onboard and although it wasn’t always easy, especially when I was the only child in my grade, I am so grateful that I grew up on the ship. What an amazing experience. From playing sticks, foursquare and sardines on the ship to swimming in the pool, playing basketball on the dock and roller-skating on the Aft deck. From sleeping outside during sails, watching dolphins swim alongside the ship, life boat drills and star gazing to having ‘fun nights’, ball room dancing, helping in the snack bar and watching movies in the lounge. I had the privilege of meeting so many people but also the heartache of constantly saying goodbye. The opportunity to visit over 40 countries was amazing, but also means some of my childhood memories are a bit of a blur in terms of where (in which country) a particular memory occurred. Being a part of community outreach including painting schools, building a playground, assisting in community clinics and spending time on the ward with patients coming for surgery, were defining moments.

Sierra Leone was one of the countries I visited as a child in 1992-1993. In our school yearbook that year I reflected on my time in Sierra Leone and ended with the following memory:

“I remember sitting down under the little palm-branch covered hut among the sick children and their hopeful moms. The sight of those children tugged at my heart. Holding a hopeless and suffering, measles inflicted child in my arms, after watching two other kids die from the same thing, made me realize how fortunate I really am. I also know that with God's strength I have something great that I can give to the dying children in the world today."

I know this was very idealistic, but that experience along with the life changing surgeries I witnessed on the ship, inspired me to pursue medicine. I was exposed to people who genuinely cared about others and one of my life heroes is still onboard, extending compassion and humility to the patients that come his way. In just a few days Dr. Gary will meet 7 patients that I am sending from the clinic I work at in Freetown to the Africa Mercy in Conakry for cleft lip/palate surgery. It is an honour to help these children on their journey and to partner with Mercy Ships. Although the M/V Anastasis was retired in 2007, the Africa Mercy and the Mercy Ships community still feel very much like home.


Wednesday, August 01, 2018

Another year...

Today marks the first day of another year at Aberdeen Women's Centre! Yesterday, I completed my first year working as a doctor in the outpatient paediatric clinic. There was a lot of transition at the start, including a move to a new home, resuming clinical work and starting my online Masters in Public Health and at times I wondered if I would make it to the end of the contract. Thankfully, I did and I’ve decided to stay put for another year.  

Although there are parts of my work that are frustrating and challenging, like any job I suppose, the work I do in Aberdeen is also very rewarding. I have the unique opportunity to help children get better and advise and encourage the caregivers to provide healthier environments for their children, whether it’s through nutritional advice, encouraging them to bring their children for immunisations or teaching them how to prevent illness. It’s a privilege to work alongside a Sierra Leonean team and provide healthcare that makes a difference in the lives of children and families in Freetown.

Now that the rains have started, the clinic is even busier than usual and in the past three days alone we’ve treated over 400 patients. We are seeing more diarrheal disease, respiratory disease, as well as cases of severe malaria, in children of all ages. At times it’s scary to see just how sick these children can get but on the flip side, it is amazing to see how so many of them recover. I’m hoping for ongoing wisdom and energy for our team as we strive to help as many children as we can despite the craziness and long days. Here’s to another year at AWC.  

~ Act Justly. Love Mercy. Walk Humbly. micah 6:8 ~