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.