Monday, March 31, 2008

The joys of Lungi if you're stranded...

12 hours in Lungi airport can seem to drag on forever but actually it can be amusing and educational. Let me give you an accuont of the 12 hours I spent there...

4pm Arrive at airport. Hope to check in for 8pm flight. Hear flight is delayed 5 hours. Told to add my suitcase to the long line of baggage, “I’ll watch it”, one of the Sierra Leoneans says. “Sure you will I think”, as I sit down within 2 meters of my suitcase. Glad to be joined by an MSF lady. Chat about working in Africa.

425pm I find out that the plane hasn’t left Brussels. Not a good sign. Another passenger is on the phone with friends in Brussels, who are supposed to be on the flight coming to Freetown. They are still on the ground. A de-icing truck hit one of the wings. Extent of damage? Who knows. What to do? Read. People watch. Send text messages.

5pm Good news. Plane left Brussels. New departure time 130am. Still waiting. Keeping an eye on my suitcase. Chatting with MSF lady.

6pm Check-in. At least there’s some movement. My luggage doesn’t need to be opened because the guy recognizes me as his daughter’s doctor. Nice. Receive a voucher for a meal worth Le 40,000. Also nice.

630pm Sitting upstairs in waiting hall. With MSF lady, business man and EU man. Had a lovely dinner- after convincing the waiter we really did want the meal worth 37,000 Leones and not the ‘cheap’ hamburger he was trying to get us to order. We wanted to spend our voucher on a big meal, not have him pocket half of the money. Nice try though. Made some calls. Continued discussions. Still waiting.

1030pm Bored in waiting hall. Decide to sneak into business lounge. No problem. Lady sitting by door is sleeping. Finally, comfortable chairs. Hear plane will go to Dakar first, then come to Freetown. Means we can go straight to Brussels. But plane not in Dakar yet. Still waiting.

Midnight No news. Hungry. MSF lady, business man, EU man and myself decide to do some investigating. With passport & boarding pass in hand we go downstairs, in reverse through the deserted security check, through immigrations where the officer is sound asleep, through the check-in area and out to where the offices are. Poor airline manager. He can’t have been too happy to see us. But he handled us well. We heard the flight was to land in Dakar in 9 minutes. Good news. We also managed to convince him that we really did need some more free food. Chicken sandwiches anyone???

1230am Enjoying sandwiches. Decide to go back to business lounge, where we all left our hand luggage unattended. Only at Lungi airport, after waiting for 8 hours with the same people would I do that.

3am Plane arrives. Still waiting… but with more hope.

4am Boarding. Finally. Within 15 minutes we take off. I have a window seat and no one next to me. Bliss. By this time I had been traveling for 16 hours, of which 12 hours were at Lungi…

The moral of the story is that you too can survive reasonably at Lungi airport if you keep in mind the following: make sure you get the most out of your meal voucher, sneak into the business lounge, don’t worry about hand luggage too much, sneak back through immigrations to get to the airline office to ask for more free food, make sure you have enough credit on your phone, meet some interesting people who also have nothing better to do than sit and chat, be thankful that the flight is only delayed and not cancelled.

Saturday, March 29, 2008

Planes, trains & automobiles, oh, and a ferry…

Wow. What a trip. The flight was all of 5 hours and 45 minutes but the trip ended up taking 27 hours. Multiple modes of transport and many hours of waiting were involved. To sum it up:

3 hours in the airport shuttle van, 1 hour on the ferry, 12 hours at Lungi airport, 6 hours on the plane, 1 hour at Brussels airport, 3 hours on 3 trains, 1 hour on a bus, 15 minutes in a car.

Initially I thought it was the trip to Lungi airport that would take forever. In case you don’t know- to get to Lungi from Freetown you have to cross the river. Of course, there’s no bridge. And with the helicopters being grounded and the hovercraft not yet recovered from its near-sinking experience, the only option was taking the ferry; the ferry that is on the other side of town and often overcrowded. Fortunately there’s a new Airport Shuttle- a minivan that picks you up at home/work and takes you to the ferry terminal, on the ferry, and to the airport. This ended up being the quick part of my trip! Although they did show up at the center early and I had to rush around saying bye to the staff. There was little traffic through town so we got to the ferry quickly and amazingly enough, it left within 45 minutes of our arrival. I actually stayed in the van on the ferry- and enjoyed the open windows, with the see breeze and keeping distance from the hundreds of others on the ferry! I even managed to fall asleep…some of the only sleep of my 27 hour trip. It wasn’t until we got off of the ferry and drove to the airport that I found out this trip was going to take longer than expected. I heard from a co-passenger that the flight in Brussels was delayed. The wait in Lungi airport merits a blog entry of its own…so more on that later. Anyway, 27 hours later, I arrived in Middelburg…

Saturday, March 22, 2008

Day with/at IMATT...

Another Saturday.
Hiking day for Sierra Leone’s walking group.
A group of expats that gathers at IMATT at 9am every Saturday to hike.
I usually find this too early and opt out, preferring to sleep in the one day I can.
Today I decided to join in.
I figure I can sleep in on Monday, since it’s a day off!
So, off we went at 835 this morning, making our way towards IMATT.
IMATT stands for International Military Advisory and Training Team.
Basically a group of mainly British army here to train/advise the Sierra Leone army.
Anyway, the hike starts from their ‘compound’ (which is huge) and a number of them join in.
Today was a small group and a short hike.
Two weeks ago when I went there were over 60 of us, for a 4 hour hike.
Our hike today was the Gloucester, Leceister, Regent loop.
Basically around the IMATT area, which is also close to where my church is.
It was fun to at one point ‘run into’ one of the girls in my Sunday school class.
She walked with us part of the way, as she was on her way home.
And we chatted a bit.
A little later we passed Dove International orphanage.
Some of those kids also attend my church and Sunday school.
As I was half-way up a hill I could hear yells ‘Aunty Sandra, aunty Sandra’.
I looked down and could see the kids from the orphanage yelling up!
At the end of our 2 hour walk we arrived back at IMATT.
We enjoyed a drink and breakfast/lunch at the Africa Bar.
And then us girls headed for the big IMATT pool.
It was great to sit in the sun, swim, and do some diving!
I could do this more often…

Friday, March 21, 2008

Song on Good Friday...

I could live a thousand years.
Never earn a moment of your grace.
Even in my darkest day.
You shine on me.

The greatest of all gifts.
From the greatest of all givers.
Jesus there upon the cross.
True love displayed for all to see.

And out of the Darkness.
You brought me into your glorious light.
Saved from the death I was facing.
Rejoicing in the future.
A hope that is mine.

And your grace runs after me.
Runs after me.
Everyday of my life.
And Your mercies they never fail.
They never fail.
Everyday of my life

“Out of the Darkness” – by Tim Hughes

Thursday, March 20, 2008

Wrist worse due to too much admin...

So, for about two weeks now I have been slightly bothered by my left wrist. I noticed it when I was watching LOST with a friend; I was moving my hand around a lot and he asked what was wrong with my wrist. Good question I thought, I'm not really sure. Anyway, since Monday it has been acting up and since last night much worse. Could it be because of all of the extra admin work I am doing this week- using my computer more...straining my wrist? Who knows. It is true I am doing more computer work- with two doctors covering the clinical work, it gives me time to catch up on admin - statistics, proposal writing, annual staff reviews, staff charts, HR medical reviews, solving lab problems, etc. Lots to do, especially before going on holiday next week! Anyway, I decided to take up the advice of one of my colleagues and try out (her own) wrist brace. I must say, a brace is not the most comfortable either, but hopefully it will give my tendons some rest. Maybe a longish weekend (Sat-Sun-Mon) will help too :) Maybe a few beach trips will provide the rest I need. Unfortunately I do have another days worth of admin to do...

Wednesday, March 19, 2008

Easter gift from a patient...

I was surprised this afternoon when the mom of one of my patients showed up with bags of 'stuff' and no child. I had been treating her child for pneumonia and he was doing much better. She was so thankful, she came bearing gifts! For Easter. 2 pineapples, 1 papaya, a bag full of small cucumbers and 'black tumbler'... which I had never tried before - small black seeds on twigs is what it looks like. You eat the furry sweet outside bit and then spit out the seed. It was tasty in a somewhat interesting way. I was happy to give the black tumbler and a pineapple to our local cook :) But very thankful. It always amazes me that people with so little, still give what they have, out of appreciation! Sometimes I think we have so much to learn in the area of giving and sacrifice...

Monday, March 17, 2008

Trying to get home on a crazy Monday...

After 11 hours of work I was ready to go home.
All I needed to do was call 'my' driver who lives across the street.
And ask him to walk over to the center and drive me home.
Easy enough.

The driver did come within 5 minutes.
But he didn't have car keys.
So I borrowed someone's keys to the office to look for the key.
No key to the Land Cruiser.

I called our Maintenance Man to ask where the keys are.
He was quick to inform me that the Land Cruiser is broken.
"Oh", I said, "what about 286?" (one of our Nissan Terrano's)
Also broken, was the reply.
Now what?

There happened to be one other car at the center.
But it was one of the New Steps cars (the other Mercy Ships program)
I called our Director to ask for permission to use it.
"No problem", he said.
Great, I thought.

Just as we were comfortably seated in the car we noticed something.
The gas tank was EMPTY.
Not a surprise.
The cage with the fuel was locked.
And of course the person with the keys was gone.

We decided to bite the bullet and go for public transport.
Don't like taking taxis with my laptop in the dark.
But what do you do when you are stranded?
So, we grabbed our bags.
And headed to the gate.

Just as we were going to go out, a car pulled up.
It was one of the ship's cars (we have 2 engineers from the Africa Mercy here).
The driver had left his phone at the compound and came back for it.
Lucky us.
We were finally on our way home (at 730 pm)

Sunday, March 16, 2008

Mother delays child's treatment...

A couple of weeks ago a mom came to the clinic with her 7 month old son. Happy but breathing at 84 breaths per minute. Too fast! He was treated elsewhere 2 months earlier and recovered fully according to mom. I continued to prod for info - to no avail. Because there were no beds at the NGO referral center I had to make a decision. Send him to Children’s Hospital with the risk that they won’t go (due to expenses, reputation of poor care) or treat him as an outpatient with follow-up and the risk that he gets worse at home. I chose the latter, seeing as he was quite content; even though his chest sounds were terrible and he was recessing! After giving him an initial intramuscular injection of a strong antibiotic and a bottle of an antibiotic syrup I sent him on his way. I just waved off a child that you would have admitted at home in a heartbeat. You have to push your boundaries a bit here…

The next day he showed up bright and early. Same condition: happy, recessing and breathing fast. I gave the same injection and the same instructions: “if he gets worse go to x place, if he’s the same or better, come back tomorrow”. We did that for 4 consecutive days with no improvement. Time for a chest x-ray. Too make a long story short, the place I sent him for an x-ray charged more than usual, so they came back empty handed. I managed to arrange for a free x-ray at the referral center. It was then that the full story came out. The child had been referred to the TB center 2 months ago, but didn’t go. And his father has been on TB treatment since November too. His x-ray was typical for TB so my next decision was an easy one- refer to the TB center, after explaining that anti-TB drugs alone are going to help her child.

So again a child’s treatment was delayed. First of all the child should have gone to the TB center two months ago. Second of all, the mom should have told me the truth on day 1. But she didn’t. I am not sure why. Many reasons probably. And this isn’t the only time it’s happened. What to do? Continue to treat the child to the best of my ability…with the information and resources I have! I haven’t heard from the child since sending him to the TB center, so unfortunately I am not sure how this story ends…

Cardboard crosses, tongue depressors and the Holy week...

Yesterday I spent a couple of hours cutting & pasting paper symbols onto cardboard crosses & making small wooden crosses out of (recycled) tongue depressors…all for the sake of Sunday School. I didn’t really mind doing it, although the option of going to the beach for the day was tempting. I did start to wonder why I was doing more of the craft than the children; time constraint during Sunday school I suppose. Anyway, I got it done and the kids were pleased this morning and could carry on with today’s craft.

Our theme for the past few weeks has been the ‘holy week’ – the week leading up to Easter. Talking about the crowds waving palm branches on Jesus’ entry, the expensive perfume poured out onto Jesus’ feet, Jesus washing the disciples’ feet, the Lord’s supper, the cup of suffering (Gethsemane) and today the crucifixion and burial. The children have really enjoyed it and using the symbols on their own crosses really has helped them to remember. It’s great to teach them how to apply things to their own lives – thinking of ways they can serve others, thinking about what they can give to Jesus, etc. It also gives us teachers the opportunity to reflect on the significance of each of these events. Of course, everything leads up to His resurrection. Next week Sunday we’ll finish the craft and then the children will present them in church. What else can I say? Working with the children continues to inspire me…

Friday, March 14, 2008

Tears of a child...

Earlier this week I walked along the beach with a friend, after work.
Half way down the beach we passed a child, going the opposite way.

Tears streaming down his cheeks.
He was about 8 years old.
I turned around and looked at him, but kept walking.
As we passed him, I felt as if I should go back, but didn’t.
I remember feeling sorry, guilty, that I didn’t stop to help.
It wasn’t until later that the child (happened) to pass us again.

I was almost relieved to see him.
This time I wasn’t going to let him walk on.
I stopped him.
We exchanged words.
He was still crying.
Someone had stolen his money.
He was on his way home.
He was afraid that his aunty was going to beat him.
I’m almost ashamed to say I wondered if he was telling the truth.
It wouldn’t be the first time someone tries to get money out of an expat.

But the tears were real.
This seemed genuine.
The tears of a child cannot easily be ignored.
Although I suppose I did ignore it at first.
In the end I helped him out, it wasn’t much, but it was something.

I realized again how easy it is to walk on and ignore the reality of life.
To mind my own business and let others sort things out for themselves.
I felt once again the heartbreaking reality of the cruelty towards children.
People steal from them.
Beat them.
Ignore them.

Unfortunately that is the world we live in.
All I can do is reach out where I can.
And stop ignoring.

Friday, March 07, 2008

Newsletter excerpt April 2005...

Since today marked my 3 year anniversary in Sierra Leone I thought I’d dig up some former newsletter material. Here's an excerpt from April 2005; shortly after I arrived in Sierra Leone, but shortly before the outpatient clinic opened on May 10th…

"scope of the clinic (at least initially)
Since I am starting a new clinic and don’t know how many patients will show up, I’ve decided to start on a small scale and expand if possible (rather than starting big and having to scale down!). The plan is to start with an out patient clinic for children twelve years old and under which will initially be open three days a week. The other two days will be spent training the community health nurses, going out into the local community and focusing on prevention. And of course there’s always the administration that needs to get done, statistics etc. And various meetings to attend! After three months we’ll evaluate our services and possibly expand.

The child mortality rate in Sierra Leone is the highest in the world at 286 deaths per 1000 live births, meaning that almost 3 out of 10 children die before reaching the age of 5. 70% of these deaths are due to diarrhea, pneumonia, malaria, malnutrition and measles; all preventable diseases! As you can imagine, these statistics are hard to tackle, especially when you are in one of the poorest countries in the world. In the out patient clinic I hope to be able to combine curative and preventive care, to make an attempt at improving the health/welfare of the people in the local community. Some of the preventive measures I hope to implement are the provision of childhood immunizations, growth monitoring, provision of bed nets, health education, etc. Although I know that my work here will be limited in scope, I want to be optimistic. Instead of looking at the millions of people that I can’t help, I want to focus on the individuals that I can have an impact on. I hope that during my time here I can make a difference in the lives of the Sierra Leoneans in our area. Sometimes it is the drop in the bucket that counts!!! “Love in action” is a motto we often refer to, that is what I hope to do- to share God’s love with others by reaching out to them as Jesus did."

So there you have it. Those were my initial thoughts. I guess I was on the right track. Why I ever even thought we might need to expand I don’t know because there is definitely no shortage of pediatric patients. Unfortunately the child mortality rate remains the highest in the world. The children are vulnerable. I want to make a difference. The work continues...

Three years ago I arrived in Sierra Leone...

...and I'm still here!

It is crazy to think that exactly three years ago I entered our teamhouse compound for the first time. A place that is home to me now, was so strange to me then. The high walls 'decorated' with razor wire and two security guards on our compound seem very normal now. I'm the only one who has lived at this house for 3 full years! I'm the most permanent person here! (mind you my parents have been in country longer but they live elsewhere)

This evening I went to the heliport to pick up Jo - a doctor coming to work in the clinic for 2 months - covering for me while I am away. Driving back from the heliport to the house this evening made me think back to March 7, 2005. The day I left Holland. Flew out of Brussels. Met Dr. Josette and her twin boys, and their teacher James. And flew to Freetown.

I remember arriving at the airport and meeting Pastor Mark. I remembered the hassle of changing money and getting helicopter tickets. I remember the heat as we were waiting at the heliport. I remember arriving in Aberdeen. My dad picking me up. And then arriving at the team house. Familiarizing myself with my new home. Meeting my new team. Sharing a room for the first month. Wondering what I was going to be doing work-wise.

The center was nothing like it is now. Only half of the structures that are up today were there. We've done so much additional building since the beginning! The wards were only big rooms filled with boxes that had been offloaded from a container that had just arrived. The first weeks were spent getting the place set up, cleaning hospital beds, unpacking supplies, cleaning the operating room, interviewing Sierra Leoneans for jobs, ordering drugs, going through inventories, sorting through some problems with the community, visiting other hospitals, etc. A time of challenges and blessings. A time of learning - about self, work, community, life, God.

3 years and 18,251 consultations time flies!

Thursday, March 06, 2008

Long clinic days this week...

So, it's been a long week once again. Leaving home at 730 am. Patient assessment outside the gate starting at 8 am. Clinic itself beginning shortly after that. Seeing lots of patients. Then going home.

However, the going home bit was somewhat later this week. On Monday I arrived home at 745 pm. On Tuesday I wasn't home till 645 pm. And today I got home at 730pm. Needless to say I am somewhat tired.

We did have quite a lot of patients this week. Over 60 today for example. I think one of the reasons the days are longer is because some of my staff is sick. One of my nurses has been on sick leave all week. Then my second nurse and lab tech were unwell today. Yes, that does explain why things took a little longer. 3 out of 5 staff unwell!

I guess the hardest part isn't even the long days. It's having to turn people away. Obviously with such long days it means we are seeing a fair amount of children. And obviously we can't help every single child in Freetown. But still. I had a mom in tears at 10 this morning because we told her we were full. And I told her If I let her in I needed to let the lady that was standing next to her with a sick (yet well looking) child in too. At some point you reach your limit. Then at 11 am a mother that has been here with her child twice already showed up. She too was told we are full. She wasn't very happy, but really, she should know better. She lives in the area and knows the clinic is full by 8. If she would have been in line at 8, she would have gotten in. The first time she came after 10 but her child was quite ill and she was lucky to somehow get in (child was referred for inpatient care). The second time she came on time, at 8 am & before the child was too sick. This time she was pushing her luck again, showing up late. I guess they try. And some learn the hard way. For some moms, doing house work first, or selling some goods, is more important than getting to the clinic by 8 to ensure entrance and good treatment for their children. Enough said, time for bed...

Piglet don don...

Oh no.
Is he really gone?
I can't find piglet.
Is piglet really don don?
Don don is Krio for finished.
Piglet was last spotted on Monday.
One of my patients must have run off with him.
I'll have to thoroughly clean my office tomorrow and see if he turns up.
If not, I hope whoever has him will immensly enjoy him.
I'll have to find another squeaky toy to amuse my patients.
(and get them to stop crying!)

PS 1: Lu - I had to rescue the squeaky orange bear today. He was found outside of the lab in a little boys hands!
PS 2: On a more positive note - the supermarket has chocolate milk again :)

Wednesday, March 05, 2008

Got milk?

As you can see, I am not the only one who likes my milk products :)
Our kittens are 4 weeks old tomorrow.
Mama cat - Kit - was a bit strange last weekend...
Not eating, hissing at her kittens, sleeping all day, etc.
So I had to start giving them food.
Milk and leftover-mush were the options.
Just as I was wondering if they were drinking the milk,
they had to prove to me that they LOVE it.
Today, just after I put the milk out, one kitten climbed onto the plate.
She spent a good 5 minutes there, slurping away.
I guess they like milk.
Hopefully they'll start eating the food soon too.
PS: Kit isn't hissing at them anymore,
but she's not really taking care of them either.

Sunday, March 02, 2008

Reflection on launching of Child Health plan by President of Sierra Leone...

"A newborn in Sierra Leone has the lowest chance in the world of surviving until age 5. In 2006, the latest year for which statistics were available, Sierra Leone had the highest child mortality rate, with 270 deaths per 1,000 births."

This past Friday I went to a launching held at the Bintumani Hotel here in Freetown. There was a whole variety of people represented; the President, various Ministers, UNICEF, DFID, WHO, EU, Irish Aid, various NGO’s, press, etc.

This day marked a crucial moment; the launching of the National Reproductive and Child Health Strategic Plan for 2008-2010. Basically, it meant that all parties recognized and openly acknowledged that Sierra Leone is at the bottom of the list on the Human Development Index, with the highest maternal and child mortality rates in the world. It was humbling to hear the Minister of Health admit that Sierra Leone is in the spotlight because of its horrific figures; to admit that the healthcare in this country is poor. It was encouraging to hear the earnest desire for change.

All parties pledged to address maternal and child health in such a way so that we would see a dramatic change in the health of Salone’s women and children. The Millennium Development Goals were mentioned over and over. They will only be reached if something in this country changes. “We as government have the responsibility to lift ourselves from the bottom of the Human Development Index”, said President Koroma. As a woman from DFID stated: “It is no longer business as usual. Business as usual is not enough. It is not bringing about change. We all need to get our acts together and work together if we want to meet these goals.”

So, as interesting as the meeting was, it’s now left to all parties to implement the plan. And only time will tell how successful this plan is! For the sake of the women and children, I pray that change will come about sooner rather than later...

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