Quick note from Washington DC...

I arrived in New York on Monday a week ago...at about 2pm. My brother and a friend picked me up and we drove on to DC (a 6 hour drive). That evening Stefan and his girlfriend, Genae, took me on a quick sight seeing trip around the Capitol building and memorials around midnight. It was fun. The next day we hopped in the car and made the 9 hour drive to Kentucky- where we stayed overnight with friends. Then on Wednesday we continued the 14 hour drive to Texas. We spent a week in Texas. Christmas was amazing. We stayed with Genae's family- they were absolutely wonderful. It was a very busy but fun week. More later...

We left Texas last night at 8pm by car and just arrived in Washington DC; 21 hours later! Needless to say its been a long trip. After a quick pizza dinner here Stefan, Genae and I are heading out again- on a 6 hour drive to New Haven, Connecticut where we'll spend New Years eve before flying to Holland. It's been a lot of traveling...but a lot of fun too.

Dutch vacation almost over...

My time in Holland is almost coming to an end. I had a good three weeks here even though it took about a week to get used to life here; the cold(er) weather, the materialism, freedom, not working etc. I felt a little useless in the beginning (especially when thinking about patients waiting outside the clinic in Freetown) but quickly realized it is really nice to have some time for myself and not to have to do anything. I realized how tired I was (am) and that I really did need a break.

Coming here in the holiday season amplifies culture shock. People are frantically buying gifts: MP3 players, cd's, dvd players, perfume, cameras, designer clothes, books, etc. I’m not saying it’s wrong; I just find it hard at times to justify spending a lot of money when I know there are mom’s that come to the clinic that can’t even afford food for their children. I guess the inequality in the world just becomes a reality. I think what concerns me most is that there are people here who do not realize the great need and suffering in places like Sierra Leone.

On a more positive note- the freedom I have felt here has been wonderful; going places on my own, not being surrounded by a huge wall with razor wire, no guards around, etc. I’ve really enjoyed walking and biking to town on my own. Of course I've enjoyed seeing family and friends too.

Anyway, I fly to the USA on Monday for 2 weeks. Then I'll be in NL for 5 days before flying to SL.

New pictures can be found at: http://www.flickr.com/photos/sandralako

Waiting...

When I arrived at the post office yesterday to mail some packages I was confronted with a long line of people…waiting. I took a number from the little number machine: 534. Seeing as it was number 521’s turn I figured I’d wait. I found a bench and there I sat waiting.

While sitting there my mind wandered and travelled back to Freetown; to the mothers waiting all day at the clinic for their children to be seen by me. I realized again how fortunate we are in the West with our excellent access to healthcare (yet still we complain!). And also realized how fast-paced our culture is. We almost find it strange/frustrating to have to wait somewhere for more than 10 minutes. The reminder of moms waiting at the clinic in Freetown from as early as 5am until the clinic opens at 830am (and even then having to wait for hours to be seen by the doctor or wait for lab results) was enough to keep me from becoming irritated. So there I sat waiting…reflecting…until number 534 was called.

Spoiled by friends...

I had already been spoiled by various friends in Amsterdam a week earlier…with yummy dinners, wonderful company and genuine interest in my work abroad, but this past week I was spoiled once again by a group of friends in Arnhem.

It began on Saturday afternoon when I was warmly welcomed by Mirjam and her 8 week old son, Jafeth. What a cutie; within a few minutes he was snuggled up in my arms. Later that evening Mirjam, her husband Stephan and I made our way to Zwolle for a concert, where we met up with more friends of mine (both sisters of Stephan): Jacqueline (her husband is in South Africa for 2 weeks and her 2 sons were sleeping at her parents’ place) and Miranda. They decided to treat me to a Christmas concert put on by Inside Out (a black gospel choir) and Ralph van Manen. It was a fun evening and had a very Christmassy atmosphere.

On Sunday I went to Jacqueline’s church, where her sister-in-law, Carmen, and husband Sjoerd were leading worship. They are also good friends of mine. We spent the rest of the day hanging out together as a group and everyone continued to spoil me. We went to a pancake restaurant for lunch- a very Dutch thing to do- with a 101 different types of pancakes to choose from; delicious to say the least. After that we went for a stroll in Sonsbeek park (the park I used to live near). It was beautiful weather; so quite enjoyable and a bit nostalgic. Then we went back to Stephan and Mirjam’s place where we had a great pizza dinner! But slowly people had to leave to go home. Later Stephan, Mirjam and I watched a movie and talked some more. I really loved being able to cuddle with their baby often- he’s starting to chat a bit and is full of smiles!

On Monday, after a quick visit to the dentist (which only took 10 minutes thank goodness) I met up with Miranda at her place. And she then spoiled me once again by taking me out to a really fancy little place in Sonsbeek park for lunch. After a lovely lunch it was time for me to head back to Middelburg again.

It was SO GOOD to see friends again, but also a bit sad to know that I only see them 1-2 days out of the year. That’s one thing that would be nice to change!

Thanks Stephan, Mirjam, Jafeth, Jacqueline, Justin, Denzel, Carmen, Sjoerd and Miranda! You guys are amazing!

(You can find links to their blogs on the bottom right of my blog)

My first Christmas gift...

While sitting in the train on my way back from Arnhem yesterday my phone rang. This in itself is not very unusual. However, since about 5 people have my new number I was caught by surprise. And it showed up as an 'unknown number'. It was my mom, calling from Freetown with Skype. I got a little worried for a second but seeing as she sounded excited rather than distressed I figured nothing was wrong.

She called to tell me that the mom of a 1 ½ year old patient of mine arrived at the gate with Christmas presents for me and was wondering what she should do with them. Well, I figured she could just put the presents in my room and I’d see them when I get back.

I was wrong. These were not ordinary presents.

I have never received such unique gifts. I received a live chicken! And also a bag of produce- oranges, grapefruits, plantains & cassava root. I can only imagine how much of a sacrifice this gift was for my patient’s family. I am very thankful! Arrangements were quickly made to find a new home for Mr. Chicken and the bag of goodies were divided among the outpatient clinic staff.

Besides enjoying the fact that I was given a chicken, I love knowing that I am building relationships through my work in the outpatient clinic. I hope that what I do goes beyond physical healing and that I have a genuine effect on the lives of the families I meet.

Two choices...in theory...

Quite a few people in Holland have asked me if I really need to work as much as I do. “Can’t you just limit the number of children you see in the clinic?” My answer: “Yes, I can”.

You see, I have two choices at 8:30 am every clinic day.
1) Let in all of the children waiting outside the gate; sometimes up to 65 children, many of who have been waiting since 5 or 6 am.
2) Let in a set amount of children (which I sometimes set at 50) and send the others away.

Problem solved- choose option 2. But it’s not that easy.

In a country such as Holland with a very low child mortality rate of 5 per 1000 and good emergency services this is possible; simply tell the parents to come back in one or two days. (As if people in Holland are waiting in line with their kids at 5am to see the doctor, but you get my point.)

In Sierra Leone the reality is that every child you send away could potentially be dead 24-48 hours later. An all too common childhood illness in Sierra Leone is malaria- the leading cause of under-five mortality (20%). Every child that walks through the gate could potentially have malaria. My fear is that if 15 children are sent away, some of these children may have malaria and some of these children may die or suffer severe consequences because of it. The healthcare system is so poor in Sierra Leone that I am not convinced these children will receive proper treatment in time if I turn them away. Even if we ignore the malaria factor these children are still at greater risk of death. Think about the neonates with sepsis, children that have been sick for some time because they couldn’t afford to go to the doctor, malnourished children, dehydrated children etc. Of course some of the children I see only have a cough, a viral infection, an ear infection, etc.; common illnesses that don’t need immediate attention.

This leaves me with the following question: “Do I want to take the risk, in a country with a child mortality rate of 283 per 1000- where 1 out of 5 children don’t reach the age of 5- and deny a child access to good quality medical care????”

I'm afraid there is no simple answer.

Vacation has begun...

Finally another post from me! It's been a little while I know and I'll try to post more frequently. You'd think that it'd be easy to post since I'm on vacation, however, internet has not quite been as accessible as I expected. But here we go...

I arrived in Holland Saturday evening after a 25 hour journey. There was no reason for it to have taken that long- we're talking an 8 minute helicopter ride, a 5 1/2 hour plane trip to London and a 45 minute plane trip to Amsterdam. However, it really did take me 25 hours. It started with a 5 hour wait at the Lungi Airport. However, I met a South African lawyer there and converation about poverty, corruption, legal aid (or lack of it), etc. in Sierra Leone was quite interesting. I arrived in London at 445am! There wasn't much else to do except find a bench and lay down and try to sleep. But the fear of waking up and finding out that I missed my flight or seeing that my bags were gone kept me up. I shopped around a little- but that's not the greatest with a suitcase either. At least there were interesting conversations taking place around me :) I was happy to finally board the Easy Jet flight at 1pm and make my way to Holland. On arrival in Amsterdam I was surprised to see my mom there to pick me up! She was in the area visiting her mom and thought she'd meet me so that we could make the 2 1/2 hour train journey to Middelburg together. It was nice to have some company. And she brought a 1 liter pack of milk for me- so I enjoyed lots of REAL (versus powdered!) milk on the train.

When I arrived in M'burg I was picked up by my almost 2 year old niece, Zoey, and her dad at the station. I have to say that Zoey was more interested in seeing the train, nevertheless it was fun to see her! She's so cute and quite the toddler now; very chatty and playful. And of course I met Esmee, my new niece. She is very small but precious. Obviously the picture posted is of me and Esmee. I'm sure I'll be posting more pics soon.

Anyway, I am having a good time in Holland. And I'll be writing more about that. I have to be honest- culture shock is a reality and I'm still trying to give things a place. More on that later.

A controlled experiment...

(click on pictures for larger view)

Introduction: A couple of weeks ago we needed to get some blood work done on one of the VVF patients and on one of our expatriate staff; tests that we can’t do in our smallish lab at the center. So, our local lab tech took blood specimens, put them in a ziploc bag with a request form and handed them over to the driver who then took the samples to a lab in town. Later that same day the driver drove back into town to pick up the results. Well, the results that came back weren’t quite what we expected. Both ladies had very low sodium levels; pretty much incompatible with life. We decided we better stick with bedside case management and not rely on the results. It made me wonder…can we rely on other labs to do our blood work? And that’s when it all began. Phase One of the experiment was instigated.

Phase One: I decided to have my blood tested at the same lab (picture:right arm). Since I was feeling fine, I figured the results would be normal. Wrong. Again the results were not what we expected; I too had a low sodium. Not as bad as the others but pretty close to putting me in a coma! All of a sudden I wasn’t feeling to well anymore. This led to Phase Two of the experiment.

Phase Two: Having checked one lab in town I thought it was only right to check both of our ‘referral’ labs in town. And we needed a control lab; a lab we can rely on. So I chose a lab that I was pretty sure would give accurate results. Being the sole investigator in this experiment made me the guinea pig, or should I say pin cushion! In phase two I again willingly provided some of my precious blood (picture:left arm). This time my blood was being scattered throughout Freetown- having to go to three different locations.

Results: Maybe we should just skip to the conclusion. By now I guess I should say that the results were what we expected as none of the labs gave the same results. Two of the three labs (one of which was the ‘control’ lab) pretty much concluded that I was near death (with a sodium as low as 113.2 mmol/l). The third lab however fortunately confirmed that my sodium levels were normal and that I would be okay; but can we trust this result?

Conclusion: Maybe it is not so wise to get your blood tested in Sierra Leone; at least not your sodium and potassium levels. No, seriously, if I would have been in a hospital here and the docs would have started treating me because of these results I would have probably died because my actually normal sodium and potassium levels would have been sky high because of treatment.

Final word: it was a fun experiment.

NB: Normal levels: sodium 135-155 mmol/l & potassium 3.4-5.3 mmol/l

Day on the town...

Going downtown Freetown is always quite the experience. The thing about downtown is that it is always very congested, the streets are somewhat narrow and there are a lot of one-way streets. The trick is figuring out which streets are one-way before it’s too late. Well, I made a wrong decision; I told Justin to take a street that I thought I’d been down before and sure enough halfway down the road we were stopped by a police officer; a one-way street. Oops. Fortunately for us we were in a Mercy Ships car. For your info: the name “Mercy Ships” is very popular in Freetown – this can be a real pain because when you’re walking around everyone yells ‘Mercy Ship’ at you. On the other hand, it can be quite helpful and work to your advantage. We told the officer we didn’t know it was a one-way street, that we would never do it again and that we didn’t see a sign. Luckily for us, he let us go; without asking us for money! I still think one of our local drivers has taken me down that street the wrong way before though.

Once in town we went to Crown Bakery- an expat hangout- nice but overpriced if you ask me. We did however enjoy a nice breakfast, which for me was an egg and bacon croissant.

After breakfast we went to an Exchange Bureau. I heard of this place before and people always made it sound mafia like. Really, it wasn’t. The only thing mafia like was that we had to go along a narrow path alongside the house to a flight of stairs at the back. Then we went up a few flights of stairs, which strangely enough seemed to get narrower and narrower. Then we were led through a corridor to a waiting area and ushered right into the boss’ room. From my chair I could peak into the room next door and see a monitor with live video footage- I quickly spotted the not-so-hidden video camera on the wall in the waiting area. We quickly did our transactions with a few phone call interruptions on the money changer’s side which did sound a little sketchy. Anyway, after turning down an espresso we were on our way. So it wasn’t your typical money changing place either but it wasn’t too dodgy.

Our next stop was the ‘Big Market’- a big covered market with a lot of colorful fabric (sold by the yard, as dresses, shirts, table cloths etc) and other souvenirs (wood carvings, necklaces, bags etc.). Our plan was to get some Christmas shopping done. I like the Big Market, but you definitely have to be in the right mood, otherwise you just can’t handle the pushy ladies, the people tugging at you to come and look at their shop, the feeling of being ripped off, the need to get ‘the best price’, the men hassling you, the potent smell of sweat etc. My mission was to buy some kids shirts and in the end I was successful thanks to the help of a little 2 year old Sierra Leonean boy who acted as a live model!

By the time we finished at the Big Market we were starting to get a little dehydrated and remembered we were close to Reda supermarket- which is where we buy goods for the Centre every other week (chicken, tomato paste, sardines, eggs, spices, cleaning supplies etc.). So we thought we’d run in and buy a drink. When we approached the counter with our pineapple juices the owner realized we were with Mercy Ships and we were given our drinks for free.

While Harriet and Justin were doing an errand, Morgen and I figured we’d walk down to the fabric street to find some fabric to take home as gifts. We went to one of the shops the Centre frequently does business with to buy material for patient dresses and greeted our friend, the Lebanese owner. We talked a little about our vacation plans and looking for gifts. I think we outdid ourselves at the ‘Big Market’ because both Morgen and I had lost interest in shopping. Our friend noticed this and suggested we follow one of his workers to another shop to choose some fabric there. So, we did what everyone would say not to do in a place like this and we followed a stranger to an unknown place in downtown Freetown. Well, 100 meters later we stopped at a shop and they really did have the most beautiful fabrics. We chose pieces of fabric which were once again given to us free of charge, again thanks to the name of Mercy Ships.

I would say we had a very successful and eventful day on the town.

Some pictures...

The top pic is of me and 8 month old Fatmata, daughter of one of the VVF patients. Fatmata was on the ward with her mom for about 3 weeks. She came in with malaria and bullous impetigo (a bacterial skin infection) but soon got better. I visited her on the ward everyday and was always happy to find her smiling. What more could a doctor ask for. Besides another episode of impetigo she was quite healthy. And she learned to wave while at the clinic!

The other picture is of my parents, Stefan and me; taken just before Stefan was leaving us to go back to Connecticut. It was sad to see him go but fortunately I’ll see him again in about 7 weeks. I love my brother! It’ll be fun to hang out with him in the USA and to meet Genae, his sweetheart.

My Protege...

Yesterday and today were busy days. I left the house at 7:30am, started work at 8am, finished work at about 7pm and arrived home at 7:30pm. I saw a total of 111 patients. I must say, between 2 and 4 pm I got a little frustrated/irritated/quick tempered when I realized how many patients I still needed to see. That’s when history taking in Krio gets a little annoying and I realize how little patience I have at times. Once the clock struck 5 I realized it didn’t even matter anymore; I just knew it was going to get late, everyone else has gone home already and I just had a little more work to do. Besides, by that time it’s fun to socialize with the patients/parents a bit as they’re waiting for the last lab results and medication. After all, they’ve been waiting all day too.

The day's best moment was with Emmanuella- who first came in August 2005 and is now 1 year 4 months old. Let’s just say she’s my protégé. While I was listening to her chest with my stethoscope she decided to take the other end of it and listen as well! Bright child! It was a welcome moment of laughter!

What I love about my job...

Someone asked me this week what it is I love about my job. You’d think it would be easy to answer that question, however, it wasn’t. My first thought was “do I really love my job?” I guess my answer is yes and no. Some days yes, some days no. Some days are just awful and make me wonder what I’m still doing here; days with tough cases, having to send patients away because its too busy, hearing that a child died, questioning decisions I’ve made etc. In summary, when I feel like I don’t know what I am doing or when I have reached my limit, I get frustrated and feel bad. It’s those days that make me feel like I’m not good at what I do and make me wonder if I want to stay. However, more often I do enjoy working here and I love it.

This week has been particularly good and I can’t imagine being anywhere else. I had a number of very interesting cases this week and I was able to get good follow-up information on patients I referred to Emergency (thanks to Andy- a doctor from the UK helping out at Emergency). But what I liked most was that a number of patients showed up this week that I already know. And I realized that’s what I love- I love getting to know my patients and being able to build a relationship with my patients. I like it that the parents trust me to take care of their children. I love seeing the children when they're better with smiles on their faces.

Take 5 year old Elizabeth for example. I first treated her little brother in August. Then in September Elizabeth came to the clinic with her mom. She was very sweet. I treated her and she left again. Then in October she showed up again. She had fallen down a week earlier and hurt her arm. When I saw her she had a very swollen and painful left arm. It was pretty obvious that she had a fracture so I sent her on to Emergency Surgical Center. Two days ago she came back to the clinic to say thanks and show me her cast. She was more than happy to pose for a picture. And her little brother got quite excited about the camera as well, as did mom! It’s moments like this that make it worth it.

Running in SL...

I am in no way a die hard runner like my mother. However, I am attempting the sport. Last year I had a 3 month membership to the UN (United Nations) gym located 5 minutes walk from our center. It was a decent gym with weights, treadmills, steppers, bikes etc. most of which actually worked. But after the first month I didn’t make much use of the gym; some call it laziness, I think I just had other priorities, like resting!

Anyway in February of this year we (me, Gisela and Morgen) decided we should start exercising regularly. We decided to run after work. Our center is close to Lumley beach- a perfect location. We started slowly…alternating walking and running. We would drive a car to a beach bar, then run/walk along the beach for about 30-45 minutes and then hop in the car and drive home. Slowly we worked our way up to running 15 minute stretches, which seemed like a nightmare in the beginning. It really is quite enjoyable (most of the time); I think the beach setting helps!

I am still running, although sometimes only once or twice a week due to clinic running very late. I am proud to say I did my longest run this past week. I ran from the beginning of the beach (Family Kingdom) to the other end (by Atlantic Beach Bar) non-stop; I guess it was a 4.5km run. Sounds pathetic to a lot of people I guess. But it was a running milestone for me.

One of my favorite parts of the run is when we walk from our center to the beach to start our run. That is when we see Mariama and Mohamed. They are the cutest kids. They live in a small shack with their mom and dad, situated between the UN headquarters driveway and the heliport entrance. Every time we walk past their shack, Mariama or Mohamed run up to us with big smiles on their faces. They don’t have much but they have their personalities! They’d make anyone laugh! They have managed to brighten up my day a number of times! Okay, so they’re not smiling for the camera but they’re still adorable!

Pictures online...

You can now look at some of my photos online! I hope to update them regularly. Click on the link under 'View My Photos' in the righthand column or click here: http://www.flickr.com/photos/sandralako

Fun times...

Taken last weekend at River number 2. Fun times!

TOP: Joella (from Canada here for 2 months working with an organization involved in literacy) MIDDLE: Me and Morgen (works at our center teaching the VVF surgeon's daughter) BOTTOM: Justin Wallace (teacher at the American school), Justin Hane (Mercy Ships communications guy), Cecily (physical therapist at New Steps).

Brother in Salone...

Monday two weeks ago I was on my way to the heliport to pick up my brother. He flew in on a late Astreus flight and then had to take the helicopter from Lungi to Freetown. (Like everyone does.) Anyway, he ended up arriving at the heliport later than expected but that too is not unusual. It was great to see him again. It had been over a year since I had last seen him. Needless to say it’s been good catching up and it’s been great having him around here. It’s been fun introducing him to people I work and live with and taking him to various places. It’s been entertaining having him around as my brother is always telling funny/exciting stories. He makes me laugh which is very refreshing, especially after a long day at the clinic. He also brought along the tv show “Arrested Development” which has made many of us here laugh! Stefan will be here for another week and a half. It’ll be sad to see him off again, but I know I’ll see him during my Christmas break, so it’ll be more like a “see you later”.

Hmmm...holiday time...

So, I’m not so sure what to write. It seems like lately I either write about work or the beach. Hopefully that doesn't bore you. I guess that is a lot of what I do here. Mainly work of course…but also fun times on the weekend. I’m not very good at planning ahead so all I can say now is that my weekend will probably consist of food, sleep, beach and movies.

Speaking of planning ahead; I booked my ticket to go home for the holidays. I fly out on December 1st and arrive back on January 8th. I am looking forward to an extended time away. It will have been almost a year since I have been in Holland, so it will be great to see family & friends again. I am especially excited to see my niece, Zoey, again, who will turn 2 while I am there. And for those of you who don’t know, my sister is expecting her second child in December, so that makes it extra fun! It's hard to believe that exactly 7 weeks from now I will be at the airport in Lungi waiting to board my flight! Crazy. I’m looking forward to it. Meanwhile there’s enough to keep me busy here.

I can't wait to see Zoey again! Isn't she a cutie?!

Made it to Shepherd's pie night...

On Sunday evenings I start to wonder what the week will bring. How many patients? How sick? Will I cope?

So last Sunday evening I already felt overwhelmed. When I looked at our menu I noticed that shepherd’s pie was on the menu for Thursday’s dinner. My favorite! Seeing as I have clinic on Mondays, Tuesdays and Thursdays my first thought was ‘I need to make it to shepherd’s pie night because that means I survived another week of clinic’. Well, today is Thursday and I enjoyed some amazing shepherd’s pie. I made it!

To be honest it was a busy week. The hardest was having to send people away.

On Monday morning there were about 90 children outside the gate! This meant I had to turn children away at 830 in the morning already. In the end I saw 60 children which took me until 7pm. On Tuesday there were 60 children outside the gate- I let them all in, and again worked till 7. Today I had to send 14 children away again as there were too many. I ended up seeing 59.

I struggle with the desire to help all of the kids versus knowing I can only handle so many on one day. It is horrible to stand on one side of a locked get, look into a parent’s eyes on the other side of the gate and tell them “sorry, tickets don don”. Some of them really have nowhere else to turn to. It’s hard to send someone away when you know that in many clinics the child will not even be examined and will probably walk away with a couple of random injections and bottles of medication. The health care system here just doesn’t work.

I guess I have to set boundaries for myself if I want to stay here for some time. 40 kids = a good day. 50 kids = busy but manageable. Over 60 kids = hectic, feels like factory work, impersonal. So, I have set my limit at 50. At least for now. Well, 50 plus a few (few usually being up to 10) extras if they are waiting at the gate when the clinic opens.

Another amazing day...

Today was wonderful.

A group of us got together at the house and had ‘church’. It was great to talk and discuss life issues based on a teaching we watched. We’re watching a series by Andy Stanley called ‘The best question ever” which is pretty much about making wise decisions. It’s quite interesting. Good food for thought.

After that 6 of us headed out to River no. 2. The one hour journey was fun- good music, lots of chatting, and many bumps. There were a few ‘road blocks’ on the way. Road blocks on the way to the beach usually consist of kids pretending to work on the road and sometimes (young) men. Occasionally they really are patching up some of the pot holes but generally speaking they’re just standing around. Two of them stand on either side of the road holding up a rope which they will lower after you pay them some money. Or- they lower it when they realize the car is not slowing down! One of the kids made a costume out of branches and leaves and was dancing in front of the rope. We decided the ‘tree dance’ deserved a couple of blocks. (1 block = 100 Leones = 3 US cents).

When we got to River 2 it was amazing; as it always is really. The beach was absolutely gorgeous. We had a great time swimming in the ocean, walking along the beach, climbing some rocks, sitting around chatting, sheltering from the rain (which only lasted about 10 minutes), laying on the sand etc. Good company, beautiful surroundings, great food, fun conversations and plenty of time to relax.

Creatures...

Living in the tropics exposes one to a wide range of creatures. I can’t say I have seen many exciting creatures here in Sierra Leone but I have definitely seen my share of bugs. Just the other day I had an ant invasion in my bathroom. I left my room for about an hour, came back, went into my bathroom and was faced with hundreds of ants on my bathroom floor. There were so many of them in so little time it was scary! And disgusting. Where did they come from??? Plus some of them were moving, some weren’t. Were they slowly dying or were they just at the beginning of their life cycle and hatching???!?!!! I don’t even want to know.

Besides ants we have many other small but frequent visitors. The termites shed their wings everywhere, colored and see-through lizards scale the walls, an occasional cockroach wanders across the floor, fairly big spiders seem to make their way into my room, huge snails crawl along the ground pretty much waiting to be stepped on, praying mantises hop around. Plenty of wildlife here!

And not to forget the bigger creatures…dogs in the street that bark all night, our cat constantly begging for attention, chimpanzees that manage to escape from the chimp reserve. And snakes- actually I have only seen one live snake and two dead snakes. Both freak me out. And last but not least mice. There’s still a mouse hiding in my consultation room somewhere. I guess as longs as it stays out of sight I’ll let it stay!

Not quite your East African wild life but still interesting enough to capture some of the images on camera.

Trip upcountry...

A few weeks ago 5 of us went on a road trip to Makeni to visit some friends, Annekoos and Bastiaan. They are from Holland but currently work at Magbenteh hospital in Makeni; she as a tropical medicine doctor and he as an engineer. They’ve been in Sierra Leone for a couple of months now. Annekoos has cleverly managed all sorts of medical/surgical cases and Bastiaan has done an incredible amount of work around the hospital which includes setting up the water system (a big task!). Needless to say they are kept very busy. However, they graciously opened up their home to us and we were happy to go upcountry (or 'upline' as the locals say) for a visit.

So on a Saturday morning we hopped in to a Terrano and made our way to Makeni. It took us a little time and some patience to get through crazy Freetown traffic, but once on the main road we were fine. There is actually quite a nice highway from Freetown to Makeni and three hours later we arrived at the hospital compound.

In the afternoon we were shown around the hospital. There were only 3 pediatric patients at the time. And most of the other wards were only half full. Which is good as the hospital is still in the initial start up phase. My favorite part was the feeding center. My heart goes out to those children. And it amazes me time after time to see how much of an effect food (or lack of it!) has on a child. Some of the children who had been there for some time looked great. Like Mohammed. He was admitted a month earlier and was now a chubby happy little guy. He sure brightened up my day! Of course there were a few new arrivals that were still pretty critical. Only time can tell.

In the evening we had the most amazing African dinner with about 4 or 5 various dishes. We were definitely spoiled. Later that night we went to an NGO party and met some of the other expats working in the Makeni area. We made sure we left by 11pm due to the recent curfew that had been set in Makeni due to increased crime.

On Sunday morning we were adventurous and hiked up the hill behind the compound. It was amazing to sit on the hill overlooking the countryside and enjoy our breakfast. What a beautiful country. It’s a shame that so many things are mismanaged here. If only we could change all of that.

The weekend was a success. It was fun to be up-country…what a difference. It is so quiet and peaceful. No traffic. No noisy neighbors. Few barking dogs. A lot of space. No walls around the house (although this is being worked on). It was a nice change.

Pics from last weekend...

I'm not very inspired to write at the moment...so here are some pictures from last weekend's beach trip.

Yesterday versus today...

Two days couldn’t be more different. It’s amazing and scary that one or two incidents can have such an affect on me and my day.

Yesterday I had an awful day. Honestly the day was terrible and it wasn’t because it was so busy- I didn’t even have clinic. I had some follow-up cases, children for vaccinations and administrative work to do. However, a few things happened that made me feel awful.

On Monday I diagnosed a 7 month old with malaria and mild anemia. Since the child was feeding fine, tolerated the first dose of anti-malarials, and mom didn’t want to be referred, I let them go after warning them that if the child wasn’t any better in the morning, they had to go to the referral hospital. The child died Wednesday morning! To say the least, my mood changed when I heard this. Apparently, on Tuesday morning, instead of going to the referral center the father took the child to a traditional healer. And on Wednesday morning the child died at home. I heard this Wednesday mid-morning and felt awful. I tried to help this child but failed (that’s what it feels like anyway). At the time I did what seemed right. Looking back, I don’t know. All I know is that looking back won’t help anymore.

Later on Wednesday I saw a 3 week old child with a cleft lip and palate. I see him once a week to monitor his growth. Unfortunately he had lost weight and developed jaundice. Blood tests showed a very high white blood count. It was one of those situations in which I had to make a decision but wasn’t sure what to do. In the end I sent him to the referral center. I didn’t want to take any chances.

These two incidents made me feel really bad and left me feeling inadequate, inexperienced and like a failure. It made me wonder what I was still doing here?!!?

Today on the other hand was much better. Even though clinic was really busy and I worked non-stop from 800 till 630pm it was a good day. What was good about it?

I survived for one! I made it through another day.

Two, I saw familiar faces. A couple of today’s patients were ones that have been to the clinic before. Ones that I am starting to build a relationship with. It is fun to recognize them as they walk through the door. It’s fun to know them by name, as I have seen over 4000 children from the Freetown area in the clinic by now. And because I know the children it is even more rewarding to be able to help them as I see and feel like I am making a difference in their lives. It is these parents that show their gratitude and I am happy I can be here for them.

Three, I was reminded again about why I am here and realized that I would miss this place if I were to go. I would miss the children I have gotten to know. I would miss joking around with my staff. I would miss attempting to speak Krio and realizing that I was actually pretty good at it. I would miss helping these children that have so little going for them.

Every day is different. Whether good or bad, it moves me forward.
I try, I succeed, I fail, I laugh, I learn, I cry, I try again, I move on.
On to the next day.

Weekend...

After a long week I was happy for it to be weekend again. I sometimes get tired of having to make so many decisions during the day, especially decisions concerning the lives of other peoples’ children! Anyway, this weekend didn’t call for a lot of decision making. The only ‘dilemmas’ I faced were: “Do I stay up and watch a movie or go to bed?” “Do I go to the beach or stay at home?” “Do I eat another cinnamon roll or not?” Not a tough call!

I did decide to go to the beach, for the first time again in three months, and it was the best decision of the weekend. I had such a relaxing time and the surroundings were amazing. I actually went on Saturday and Sunday! It rained a little, but that didn’t spoil the fun. I enjoyed nature, wading through the water, crossing the river while sinking in the sand, feeling the breeze on my skin, drawing in the sand, etc. To sum it up, I had a great weekend.

Meet Miracle...

In August about 5 children came in with burns. Burns are a common form of injury here, usually due to immersion in hot fluids, such as water, porridge, oil and sometimes due to open fires. A lot of these burns could be prevented by proper safety measures in the home. Fortunately none of the burns were too severe and we could treat them all on an outpatient basis.

Two year old Miracle lives in Aberdeen with her grandmother and arrived at the clinic on August 15th. Apparently Miracle had accidentally stepped into a big bowl of porridge that had just been taken from the fire. Although Miracle was quite cheerful, the burns on her left leg looked pretty painful. We were able to clean and dress the burns and Miracle continued coming for follow-up dressings. She was very brave throughout the dressing changes and her burns healed nicely (see picture).

Thursday's cases...

Here’s a peak into my world. I know this is a long entry but my clinic days are long. Stick with me and read about some of the patients I saw last week Thursday…

Clinic opens.

I picked my first patient out of the waiting room as soon as the patients found their seats because I knew I would have to refer him. 3 year old Solomon had a very swollen painful right eye. Apparently he had fallen down a few days earlier and dad thought it was time to take him to the clinic. Because of the possibility of a fracture I referred the child to the Surgical Center.

Next was a child my nurses prioritized…a 3 week old boy with fever and labored breathing. This plus mom saying the child was not breast feeding well, again ushered me to refer the child. He was too young to take any chances.

My next patient was 1 ½ years old. However, he could not sit, he could not crawl, he could not walk. His mother told me that this child’s development was definitely different than that of her first two children. A pediatrician told her 6 months ago that her child was fine. I soon found out that the child was born 2 months premature and that since birth his milestones had been delayed. He couldn’t even hold his head up. It seemed to me that this child had cerebral palsy. It was difficult to explain this to his mom and tell her that there is no cure. Her response was that it was okay, God gave her this child and she would take care of him. She said ‘nothing is impossible for God’. All I could do was encourage the mom and refer the child for physiotherapy. I was amazed by her optimism and dedication to her child.

9:15 am.

A few patients later it was 5 year old Mukeh’s turn. A very cute kid who was quick to tell me he wasn’t feeling well. This was quickly confirmed after he threw up in my office. He had been sick for 3 days with a fever, vomiting and abdominal pain. Besides the vomiting and a palpable spleen on examination he seemed alright. An hour after sending him to the lab I got his results back – malaria. Not a surprise. Fortunately while waiting, he managed to drink oral rehydration solution and when we gave him his first dose of antimalarial medicine, he was able to keep it down. I’m sure within a few days he’ll be feeling a lot better.

Nannah came in with a high fever, swelling of her limbs and a drop foot. The drop foot was a bit unusual, but made sense in the end. Nannah had been sick for 4 days. 3 days ago she went to a nurse who gave her an injection in her buttocks. Now Nannah has a drop foot due to the poor technique that was used. Besides the drop foot, I diagnosed Nannah with malaria and anemia (Hb 5.3g/dl). Many of the patients that come to the clinic have been elsewhere first (usually someone’s house) and gotten a number of injections. No one ever knows what kind of injections or what for…but they all seem to believe in them! Unfortunately in my opinion, they usually seem to do more harm than good.

Noon…

A mom came in carrying her 1 ½ year old girl. For three months now she has had a rash. The poor child had severely infected scabies- her feet were covered with open sores, lots of pus and crusts and just moving the feet made the child miserable. Needless to say, the child was not walking. Why the mom waited so long to come, I don’t know. Hopefully an anti-scabicide and course of antibiotics will help her feel a lot better.

More children with ear infections, coughs, fever, etc.

6 month old Memunata came in with her mom. Because the main symptom was diarrhea I drilled the mom about the child’s intake and was surprised to hear that she wasn’t breastfed. When asking why, her mom said the child was never breastfed because mom was trying to get a visa to go to America. The plan was to leave her child behind. I told her I was surprised and she just smiled. I asked her if she was married, she said no. I asked her if the pregnancy was planned, she said no. I told her that if she wasn’t planning on taking care of this sweet little girl, she better think twice about have more children. She smiled again. The focus quickly turned from Memunata’s illness (she was actually very happy and well) to mom’s social problems. In the end it turns out that mom is going to America to see her own mother, who left her when she was 4 years old. I asked her how she felt about growing up without her mother. She said she didn’t like it. I pointed out that her daughter would grow up without knowing her. She didn’t answer. In the end mom left with nutritional advice, vitamins and ORS for her child. And I was left wondering if little Memunata would ever get to know her mom.

I ended the day with a couple of follow-up cases…a 1 ½ year old boy who was malnourished but is slowly starting to gain weight…a 4 year old with chronic ear infections who still has discharge coming out of her ears but also ended up having malaria which I could treat…a very adorable 3 year old who I diagnosed with malaria and anemia a week ago and is slowly getting better.

5pm. 45 patients later. An early finish compared to the rest of the week. Time for a run on the beach and to reflect on the day’s interactions.

Meet Zainab...

Zainab is almost two. She first came to my clinic over a year ago and was the first to complete her childhood vaccinations at our center. Mom takes her up-country quite a bit these days, so we see a little less of her. This picture was taken during her last visit to Freetown. She's still as cute as ever!

Shopping...

Today we went shopping. Well, not really. We actually didn't buy what we set out to buy. And just so you know, shopping in Freetown isn't quite like shopping in the West. The store names might make you think otherwise but it's really not the same.

Walmart is a fastfood service and Target is an electronic store. I guess they have big hopes that the chain names will bring success! Well, to expats it's rather disappointing when one is in the mood to shop. When we go shopping- it's either at the "Big Market" or at a few fabric shops or at one of the smallish Lebanese run supermarkets.

This morning we went to the “Big Market”; a huge warehouse where locals sell fabric, wood carvings, baskets, necklaces and other souvenirs. The reason we went was to pick up table cloths that we had pre-ordered over a month ago. Well, surprise surprise they were not finished. Actually they were still non-existent. Apparently business in the rainy season is so bad that the vendors can’t take huge orders (read: 12 table cloths) without having a cash deposit. Why weren’t we told that a month ago?
After leaving the market we went to “Crown Bakery”. Definitely an expat hangout as most locals can’t afford the expensive commodities. I was really looking forward to their fried chicken. However, upon entering the café, there was no chicken in sight and I remembered that a few months ago the government had put a ban on importing chicken due to the bird flu scare. Too bad for me. I settled for a not-so-expensive plate of French fries (which I could have gotten anywhere I guess).

Later in the afternoon 4 of us headed out to Lumley beach to sit, swim, read, talk. A relaxing afternoon once again. Fortunately it stayed dry so we could soak in the sun and enjoy the sea breeze. Needless to say it was an enjoyable Saturday, even though I didn’t get my fried chicken and it wasn't a shopping spree at Walmart!

Meet James & John...

James & John came to my clinic for the first time last month. As I met them, together with their mom, I realized that it was a pretty significant meeting. With Sierra Leone having the highest maternal mortality rate in the world, it was amazing that mom made it through childbirth- delivering a set of twins. And with the highest child mortality rate in the world I guess it is amazing that both boys made it to the age of 5!

I have seen various sets of twins in the clinic. However, often I see a child that is a twin but the mom is quick to tell me the other twin died, often within the first year of life. Fortunately that is not the case for James & John.

July newsletter...

For those interested, and for those who didn't receive "Sandra's Latest" in July- here's the link: http://lakomission.org/cms_exodus/images/stories/sandra/san200607.pdf

Links to other documents can be found at the bottom right of this blog. Also, I’ve changed the comments settings on my blog- so you should be able to leave comments again (until I get too much spam and have to change the settings again!).

See ya.

Light-hearted visit...

One of my most frequent patients came to the clinic again this week. The first time I saw her was in May 2005, just after the clinic opened. Since then she has come to the clinic about once every 1-2 months; with various illnesses- cough, malaria, ear infection, dysentery, ring worm, boils. Today she came in, first of all with a big smile and a high five, and second of all, with a history of a cough and cold. She was quick to ask for my stethoscope and squealed with delight when I placed the stethoscope around her neck! It was fun to hear her laugh. She then sat very quietly through the examination, pointing out to me where to place my stethoscope. I guess maybe she has come in one too many times. However, I would rather have my patients come in a few times too many, than one time too few or too late. It’s fun to be able to build a relationship with some of my patients!

Sad but true...

Eleven days ago I treated a 6 year old girl with pretty bad malaria and anemia. (Hb 6.3). She tolerated oral medication well but because she had so many parasites in her blood I asked her to come for follow-up two days later. Although she was feeling a bit better on review and there were no more parasites in her blood, her hemoglobin was dropping (now at 4.6). Since she made a somewhat lethargic impression I thought it was better to refer her for a blood transfusion. After calling the doctor at the (NGO run) referral center I sent mom and child there with a referral letter, assuming the child would quickly improve after receiving a unit or two of blood. Sadly, I found out today that she died 4 days ago. She never went to the referral center, she never received blood. Instead her mother took her to some small clinic and the child only received iv fluids.

In a country where the child mortality rate is the highest in the world, I guess this shouldn’t take me by surprise. However, this child had passed the age of 5, supposedly suggesting that she had survived the worst. I guess not. I guess this explains the low life expectancy in Sierra Leone too. If only the mother would have taken the child to the referral center. If only the small clinic would have realized that the child needed a blood transfusion. If only we had reinforced the fact that without blood, this child just might die. If only children would stop dying from preventable and curable diseases.

If only…

Enjoyable day...

Thanks to those who remembered my birthday last Sunday. I had a very relaxing day, enjoyed a lunch out, ate cake at the house and had a fun time at Lumley beach watching the sun disappear over the horizon. One of the best parts of the day was hearing my 1 1/2 year old niece sing parts of the Dutch Happy Birthday song to me over the phone! Anyway, thanks for the birthday wishes.


Lumley beach sunset..............never too old for candles!

The Star Thrower...

The following story is inspired by the writing of Loren Eiseley. I came across it recently and have been reflecting on it. I'm sure many of you will recognize it, but here it is again.

Once upon a time there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work. One day he was walking along the shore. As he looked down the beach, he saw a human figure moving like a dancer. He smiled to himself to think of someone who would dance to the day. So he began to walk faster to catch up.

As he got closer, he saw that it was a young man and the young man wasn't dancing, but instead he was reaching down to the shore, picking up something and very gently throwing it into the ocean.

As he got closer he called out, "Good morning! What are you doing?"
The young man paused, looked up and replied, "Throwing starfish in the ocean."
"I guess I should have asked, why are you throwing starfish in the ocean?"
"The sun is up and the tide is going out. And if I don't throw them in they'll die."
"But, young man, don't you realize that there are miles and miles of beach and starfish all along it. You can't possibly make a difference!"

The young man listened politely. Then bent down, picked up another starfish and threw it into the sea, past the breaking waves and said- "It made a difference for that one."

His response surprised the man, he was upset, he didn't know how to reply, so instead he turned away and walked back to the cottage to begin his writings.All day long as he wrote, the image of that young man haunted him; he tried to ignore it, but the vision persisted. Finally, late in the afternoon, he realized that he the scientist, he the poet, had missed the essential nature of the young man's actions. Because he realized that what the young man was doing was choosing not to be an observer in the universe and watch it pass by, but was choosing to be an actor in the universe and make a difference. He was embarrassed.That night he went to bed, troubled. When morning came, he awoke knowing that he had to do something; so he got up, put on his clothes, went to the beach and found the young man; and with him spent the rest of the morning throwing Starfish into the ocean.

I guess everyone is like the young man- we all have purpose, we can all make a difference. We just need to realize it, set our minds to it and take action. Making a difference takes effort. Likewise, everyone is like the starfish. We all need help at times; some being in more desperate need than others, but sooner or later we can all use a helping hand. And every one one of us, like the starfish, is worth being helped. Every person counts. It’s about each and every individual person, not the numbers.

A mother's perseverance...

Three weeks ago a 12 year old girl came to the clinic with a one month history of fever, cough and chest pain. She didn’t look too sick and examination didn’t show anything abnormal, so I decided to put her on a high dose of antibiotics for a week. One week later her mother brought her back for review: no improvement. I suspected she had tuberculosis and sent her for a chest x-ray asking the mother to return with the results. It wasn’t until 12 days later that she showed up with the x-ray. When I asked her why she didn't come sooner the mother explained, on the verge of tears, that it had taken her that long to raise the money for the x-ray. She had to plea with some of her extended family to help her. I felt bad about not giving her the money up front. However, I also know that in many cases, giving the money up front is not wise, as the parents often use the money for something else. Anyway, the child's x-ray showed lesions consistent with tuberculosis and the only thing I could do was refer her to a TB specialist.

The mother was obviously worried about her child, so I explained that TB can be cured as long as the child takes the medication every day, for six months. I also made sure she knew that TB treatment in Sierra Leone is free. The fact that the mom raised money for the x-ray and came back with the child gives me the impression that she really cares. I'm pretty sure that she will do everything she can to help her child. Just before she left I gave her Le 30,000 (=$10) and told her it was a refund for the x-ray. I figured this mom should be rewarded for her perseverance!

According to the World Health Organization, TB infection is currently spreading at the rate of one person per second. The disease kills more young people and adults than any other infectious disease and is the world's biggest killer of women. Each year, an estimated 8-10 million people contract the disease and about two million people die from it. TB is one of the top four infectious killing diseases in the world. Fortunately there is hope for this 12 year old!

Kids...

Water crazy...

Okay…so I’m a little water crazy right now…posting about water shortages and rain all the time. I guess that shows you how real this ‘scenario’ is. Here are two pictures of last years rainy season…just to give you an idea of how much rain we can get. Hard to believe that this is what we’re praying for now. Anyway, as I am writing this it’s pouring again outside. Maybe the rainy season has finally started…

It's raining...

Wow, right now there is nothing like waking up to a major rain storm when you know a country is in dire need of water. The rain is coming down hard. For the past 2 hours it has sounded like I’m sleeping under a waterfall. There are bright flashes of lightning that brighten up my room and loud thunderclaps that echo into the distance. We desperately need the rain right now. However, my heart also goes out to the many people in Freetown that don’t have decent shelter. It seems it’s never a win-win situation here. Let’s just hope it’s raining over Guma Valley dam!

Water shortage part 2...

The water situation in Freetown is a serious concern. Only time can tell what will really happen.

At the health task force meeting this past Wednesday it was confirmed that without significant rainfall the current water stock will only last for another 15-20 days! It was also mentioned that there are only two water tankers in the city- hardly enough to meet the city’s demand. And in the meantime commercial water prices in the market are soaring. The price of a 1.5L bottle of water has gone from Le 2000 to between Le 2500 and Le 3000 (Le 3000 = 1$US). Water packed locally is becoming scarce, its quality is deteriorating and its price has doubled.

The state-run Guma Valley water company announced on Wednesday that there was only six feet of water in the Guma Valley river reservoir built 100-feet deep, the lowest level it has reached in 39 years. Various reasons have been given. Inflow into the dam has dropped drastically as the rainy season just hasn’t really been that rainy yet. Deforestation around the dam area has also contributed to the water crisis because when it does rain, most of the water is lost as run-off. Also the dam was originally designed to 'serve' 300,000 people, however, over the years the population in Freetown has more than doubled, reaching over 1 million people today. I guess it was only a matter of time.

To stretch the little available water, a water rationing system has been introduced so that on alternating days various areas of the city will get water. Needless to say, people are already short on water and the water they are receiving is of poor quality. Fears of a cholera epidemic have been voiced. And the government and various NGOs are trying to come up with solutions. I just hope and pray that something happens quickly.

At our house we are trying to conserve water and going to introduce a rainwater catchment system. We need to collect every drop of water we can. We will do the same at the center. Meanwhile, in the clinic I am daily trying to get the message across to the moms and dads that they need to be boiling their drinking water and using ORS if anyone gets diarrhea. I only hope that I can play a part in preventing serious disease and possibly death.

Weeks frustrations...

It’s Friday again and although I enjoy work, I’m glad it’s weekend! This week has been especially busy and at times challenging and frustrating. I saw about 140 patients this week, which in itself can be quite tiring. However, the most challenging and at the same time frustrating thing this week has been my discussions with people regarding various aspects of life in Sierra Leone.

Today I was at the Feeding Center again and ended up in a discussion with one of the nurses. I was basically faced with the question of whether or not I am helping the families by paying various expenses (admission, doctor’s fee, chest x-ray, etc) for the malnourished children. Is it better for me to pay the fees and by doing so know that the child will receive the treatment he/she deserves? But also realizing that by doing so they will become dependant on me for money? Or should I ‘make’ the caretaker take some responsibility and expect them to come up with the money? That way they will learn that they are the ones that need to take care of their children.

According to the nurse the caretakers won’t let the children die- they will find the money somewhere. The extended family is the support system- if your child is sick, you should be able to get the money together. She said “Do you think that if you weren’t here these children would be left to die?” Her answer was “No, of course not”. Well, to be honest, I am not so sure.

I do realize that if we do everything free of charge people become dependant. That is why we have a small fee at the clinic, so that the parents will take responsibility for their child’s health. Easier said than done, because I know that children are often not the priority in the family. Remember, the child mortality rate in Sierra Leone is the highest in the world. 286 out of 1000 children do not reach the age of 5! It seems like the death of a child has become ‘normal’ here, it almost seems like it is an accepted fact. Because of that I am not convinced that parents will necessarily go out on a limb for their child.

I also realize that some of the patients I refer to the Feeding Center can pay for their admission etc. But I think there is a fair amount of them that really don’t have the money. Remember, we’re talking about malnourished children. Often the reason the child is malnourished boils down to a poor social/family structure, where there is a shortage of means, lack of education, neglect etc. Not exactly the type of family you would expect to have ‘extra’ cash laying around. However, according to the nurse, only about 1 in 100 cannot pay the fee. Well, then why does it take some of the patients I refer over a week to see the doctor? I guess either they don’t have the money, or they really are waiting for me to come and pay the fee for them!.

Anyway, enough to think about as you can see. It’s hard to know what to do. Ultimately I am here for the child. Yes, I think people need to take responsibility. And if I was seeing adults it would be a lot easier for me to tell them they need to take responsibility and come up with the money for their medical care. But I am dealing with children- a vulnerable group, dependant on their parents, no voice of their own. I suppose I can tell the parents to take responsibility and come up with the money for their child. But, if they don’t do it- it’s the child that suffers. Do I want to take that chance?

64...

...is the record number of patients I’ve seen in one day…and I have to admit…I hope that stays the record. It was quite a day as we worked straight from 830am till about 630pm. The fact that I did not eat or drink anything since breakfast didn’t really phase me until I went into the admin area after finishing up and saw some chocolate laying around. It’s amazing how chocolate can revive one’s body! Fortunately when I got home at 715pm dinner was ready, cold by now, but ready. Anyway, I better catch some sleep, who knows what tomorrow will bring!

Water shortage...

Last Wednesday we received a phone call from our landlord warning us that there would be a water shortage in Freetown. Guma Valley – the main water supplier – decided to shut off all water supply to the Freetown area as of Thursday morning, for three days. No reason was given. It is now Sunday evening, and there is still no water coming out of most taps in Freetown.

Our first response was to find every bucket, tub, water bottle etc. we could find and fill it up before the supply was cut off. I quickly told my staff the news so that they could phone their families and ask them to collect water at home. However, in some places in Freetown, it was too late, the taps were already dry. The people were given no warning.

Fortunately we have big tanks at the center and at the house. Also it does seem like we have had some water coming in to one of our water tanks. However, for many of our staff, there is no water. They now have to walk miles to get water from a stream. One of the ladies said to me today that after drinking the stream water her stomach hurt and so she is now boiling the water. Sounds like a good idea to me.

Unfortunately many people in Freetown are now relying on unclean water sources for their drinking water. And many of them do not know the consequences that this can have. I am sure lives will be lost as a consequence of the water shortage. Just the fact that diarrheal disease is one of the top 5 killers of children under 5 years of age says enough.

What can I do? What can I say? I just hope that someone takes action quickly. I have a health task force meeting this Wednesday at the Ministry of Health and will definitely look for some answers/explanations there. I will keep you posted.

Meet Foday...

Miserable, weak, swollen feet, wasted, sores on his skin, sad.
That is how I first met Foday.
Three weeks later he was a changed boy.
Now he is healthy and happy.

To read more about Foday see the latest Mercy Ships Sierra Leone newsletter at: http://www.mercyships.org/site/apps/nl/content2.asp?c=agLOI4OFKrF&b=1479911&ct=2689361

Holland don don...

Well, as of tonight the World Cup is officially over for Holland. It’s don don. Too bad they didn’t make it past the second round. I must say it was quite the match tonight, however I don’t think we can be proud of holding the World Cup record of the most bookings!

Watching the games in Freetown has been interesting. And it’s been fun having something new to do! I’m not usually a football fan year round, but when it comes to the European or World Cup- I’m there.

I think the number of satellite dishes in Freetown probably doubled, if not tripled, at the start of the World Cup. Everywhere you go, you see chalkboards with game times and fees written on them. We often watch at Mamba Point restaurant, 10 min walk or 3 min drive away. It has comfortable seats, a big screen, many expats, good food etc. It’s a pretty nice getaway. We’ve watched one or two games in another restaurant. But by far the best place to watch a game is just outside our gate…

You step outside of our gate, walk about 10 yards up the road, walk across a wooden plank, past the small generator and towards the canvassed tent with a lit light bulb over the entrance way. Actually from our compound you can already hear the excitement of the football match. At the entrance a fee of 500 Leones (equivalent of 15 US cents) is paid and the entertainment begins. I have been there three times now. Twice with a female colleague (escorted to the tent by one of our security guards), once with two white guys. After being shown to an empty spot on one of the wooden benches, we’re ready for the game.

It’s a unique experience…wooden benches, a tent made of wooden poles and canvas over the top, two tv’s at one end, great sound, 40-50 local guys, temperature of about 30 degrees Celsius, the 'aroma' of sweat and of course no other women. The best is that the local guys really get into the games. It’s almost more entertaining to watch them cheer their favorite team on, get annoyed with the refs, dance when goals are scored etc. than it is to watch the game! It’s definitely the liveliest place to watch football.

Anyway, now that Holland is out of the Cup, I’ll have to find another team to support!

Container arrival...

This past Friday a container from Holland arrived. Always quite the event (3-4 times per year). First the container is shipped to Freetown. Then it sits in the port, for an undetermined length of time, waiting to be cleared by customs. Then once it's released it makes its way to the center. Before hand, we get word that the container will be released from the port on a certain day, however, the release is often delayed. Once the particular day is set, we end up waiting around for the container to come; often said to arrive at 4pm but always arriving after 7pm. So, on this Friday evening we received a phone call saying the container was 'on its way' - a famous phrase in Sierra Leone, meaning the container is either really close by, somewhere in traffic, or still waiting to leave the port. We were lucky- this time it came at 730pm- not bad really.

I always expect to have to help unload box after box, always forgetting that there are many local guys who would gladly help us offload the container, for a small fee. So, in the end, I actually didn't do much at all, container-wise. I did however spend the evening playing with 2 year old- Abdul- a VVF patient's child who arrived two days earlier. He is a bit undernourished and has malaria, but what a fun kid. Anyway, we discovered a HUGE teddybear in the container...and couldn't pass up the chance to play with (or on) it.

It was a successful container offloading night!

Day of the African Child...

There really wasn’t a whole lot I felt I could do yesterday for the ‘Day of the African Child’ besides showing some children that they are special and that someone cares. So when I went to the government’s therapeutic feeding center downtown to check on a patient I referred, I brought along stuffed animals to give to the malnourished children. I know it amounts to nothing in the grand scheme of things but it was fun to be able to give them something small to show them that they matter and to brighten up their day. It brightened up my day to see some of the children smile.

See below for more information on the ‘Day of the African Child’ and it’s importance in Sierra Leone.

Taken from article “UNICEF: Children are Africa’s greatest resource”

NEW YORK, 16 June 2006 – UNICEF celebrated the Day of the African Child today, calling on the world to recognize that children are Africa’s greatest resource. “On this Day of the African Child, we celebrate children as the future of Africa,” UNICEF Executive Director Ann M. Veneman said Friday. “But we also recognize and address the considerable problems they face – from extreme poverty and conflict to malaria, malnutrition and HIV/AIDS.”

The Day of the African Child is celebrated on June 16, the day in 1976 when thousands of black school children in Soweto, South Africa, took to the streets to protest the inferior quality of their education and to demand their right to be taught in their own language. Hundreds of young boys and girls were shot; and in the two weeks of protest that followed, more than 100 people were killed and more than 1,000 were injured.

The theme of this year’s Day of the African Child is violence against children, which threatens the physical, emotional and psychological well-being of children. Violence is a particularly pressing threat to the current and future well-being of Africa’s children because of the continent’s disproportionate burden of conflict, extreme poverty and HIV/AIDS.

http://www.unicef.org/media/media_34578.html

Taken from “Coping with a legacy of violence in Sierra Leone” by Sarah Crowe, UNICEF

MAKENI, Sierra Leone, 15 June 2006 – The decade-long war in Sierra Leone, which left 50,000 dead, was one of Africa’s most brutal. Atrocities against women and children were commonplace. The war turned children into drugged killing machines, giving them power beyond their age.

As countries around the world mark the Day of the African Child tomorrow, this year’s theme – ‘Stop Violence against Children’ – will have a special resonance for the children of Sierra Leone.

During the war in Sierra Leone, 10,000 children were forcibly conscripted as porters, fighters or sexually abused ‘bush wives’. Soon after the war ended in 2002, the full scale of the terrible legacy was revealed at Sierra Leone’s Truth and Reconciliation Commission (TRC), modelled loosely on South Africa’s panel on apartheid crimes. The TRC does seem to have healed some of the wounds, but the real scars left on children cannot be seen.

Today in Sierra Leone, peace signs boldly declare a new era – ‘War don-don. We love peace’. But violence against children still lurks in the shadows. Roadside cinemas showing extreme violence and rape scenes proliferate in the busy alleys of Freetown and other cities. Admittance costs just a few cents, so the shacks are full of small children.

For the first time in Sierra Leone’s history, however, some help is at hand for these children. Hidden discreetly in hospitals, new centres have been set up to help young victims of sexual abuse – though funding for the centres is fragile.

http://www.unicef.org/infobycountry/sierraleone_34552.html

Thank you Dr. Rick...

Many people ask what happens to the clinic when I take a break…well, work goes on as usual. The patients don’t stop coming! So, I’m happy that there are docs willing to come out here to cover for me while I am away. For the past month Dr. Rick Rogers, pediatrician from Tyler, worked in the out patient clinic. Fortunately this time, there was a lot of overlap and we could work together for almost 2 weeks before I headed off. It was great to work alongside an experienced pediatrician- seeing patients together, bouncing ideas off of each other, learning new drug regimes etc. I am also thankful that Rick was able to cover for me for 10 days, so that I could join the Anastasis crew for the ship’s final sail. Thanks a heap Rick!