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.