Run-in with the police...

Two weeks ago, as Anna and I were going back to the center after paying a visit to some of the children we referred to Children’s Hospital, we had a little run-in with the police. Just after we turned right onto the main road, a police officer motioned for us to pull over. Our (local) driver was somewhat hesitant and asked what was wrong. The police woman was quick to say that we had driven up a one-way street the wrong way. Our driver said he didn't think it was one way but the police woman strongly disagreed. Hmmm. I can’t say I noticed a sign, but I also wasn’t looking out for it. She then pointed to our car insurance sticker on the windshield and said it had expired. She was right. Oh no, I thought. Is this happening? The woman demanded to ‘see’, meaning ‘take’, our driver’s license; he wasn’t too happy about that as he didn’t want to risk losing it. But he had no choice. He wanted to negotiate but she wouldn’t budge. She was going to take us to the Central Police Station. ‘Unlock the door’, she said, and then got in the car, next to me.

Driving down Kissy Road, heading towards the police station, I still didn’t know if we did or did not break the law. According to the officer we committed a ‘serious offense’. I wasn’t convinced. I decided to call our manager and check on the insurance. I soon found out we had renewed it but that seeing as our windshield was cracked and needed replacing, someone had decided not to stick the new sticker on the windshield. I quickly told the police woman that we had renewed the insurance. She wasn’t interested. We still drove up the one-way street the wrong way and that could only be settled at the station. As our driver and the officer were negotiating in Krio, thinking that Anna and I couldn’t understand, I was wondering what we should do. They were obviously talking about money. How much would it take for her to let us off? 10,000? 30,000? She said a minimum of 30,000. At this point I wasn’t sure what our policy was on these situations but I couldn’t call our manager about it, because I didn’t want the police woman to follow my conversation. So I called my mom, in Dutch, and we discussed the matter. This is one of the first times I was excited about being able to speak Dutch and no one else understanding it!

As we got to the Police Station, the officer did not want us (white girls) to get out of the car; only the driver. As they walked off I wondered to myself, ‘will this take seconds or hours?’ Well, within seconds our driver walked back to the car. My first question was ‘how much did you pay her’? ‘Ten thousand’, (=$3) was his reply. He then told us he had been instructed to tell us nothing about the money exchange, because the officer was afraid she might lose her job. Well, that told me enough. No offense committed. Just a police officer trying to make a few extra bucks. If she is so afraid to lose her job, she better think twice about pulling over expatriates. But I suppose she triple her day’s wage playing this game a couple of times per day. Needless to say, she disappeared quickly; possibly back to the same ‘one-way’ street.

Unfortunately, incidents like this occur; everyday, everywhere. And unfortunately, at times, it seems as everyone is involved. Poverty leads to bribery some say. But I would say it is happening at all levels of society. It all feeds into corruption. And again, unfortunately, there is a lot of corruption in Sierra Leone. It starts with the small bribes…

Why...

Why?
A question so frequently asked.
Especially when faced with death.
Today I am asking that question once again.
Due to the fact that a 1 year old passed away in the clinic today.
Unfortunately she came too late.
With an Hb of 2.3, glucose of 2.4 and a cardiac arrest we were up against a wall.
As much as we tried to resuscitate, the chance was small we would get her back.
We lost her.
Her parents lost her.

I don't find myself questioning God.
I do however find myself questioning the parents and the system.
Why do the parents come so late?
Why didn't the parents seek help at the NGO hospital or Children's hospital?
Why did the parents show up at an outpatient clinic with such a sick child?
Why are there so few places in Sierra Leone with decent pediatric care?
Why does the Children's hospital charge so much?
Why do pharmacies/private clinics do such a poor job (like still use chloroquine?!)
Why do so many innocent children keep dying?
Why did this little girl have to die?

Why? Why? Why?

Floating at Lakka...

To float = to rest on the surface, to drift on or through a fluid

At 915am on a Saturday morning I found myself in a car on my way to Lakka. It wasn't early, but seeing as it was a Saturday morning, it seemed early. A group of friends and I were planning to join the IMATT (international military advisory and training team - mostly British army) weekly hike. We would drive to Lakka, start our hike on the beach, head into the jungle, walk around the area, and end up on the beach. I thought if anything, maybe this walk would give me a little more energy. Well, the walk was very pleasant. And it was fun to meet a few new people. It did start raining really hard at one point which I didn't think added to the walk but never mind. We arrived back at the other end of the beach 3 hours later, drenched, but with energy. I was ready for an afternoon at the beach.

In the past we used to come to Lakka beach 'resort' all the time. But in the last year or two it has become somewhat run down. Never mind. Beach is beach. And they still had a choice of two things off of their 4 page menu! I never liked swimming at Lakka cause of the steep drop off, huge waves and current. But to my surprise it was lovely this time.

I spent a lot of time floating. It was lovely. What an amazing feeling really. Somehow it felt like it was easier to float at Lakka than other beaches. I know, sounds silly, must have just been me. Anyway, it was very relaxing. I was seriously 'resting on the water' and felt like I could fall asleep and I was convinced I'd remain afloat. The only problem was, I needed to pop my head up every now and then to make sure my friends weren't about to attack me! Of course the occassional wave added to the fun as well. All in all, I felt like I was on a different planet. I felt like I could float for hours. And just rest. You should try it. Speaking of floating, and resting, maybe it's time for bed...

PS: I don't think I looked as uncomfortable as Eeyore does in this picture.

Faith in parents restored...

On Tuesday a 1 month old boy showed up at the clinic with a fever and cough. Apparently he was having great difficulty breathing the previous Saturday, but his parents didn’t take him to see a doctor. When I examined the child, his breathing was fine but he definitely had crackles in his chest. I decided to treat him for a chest infection with an initial intramuscular injection and then have him continue with oral antibiotics. Because he’s so young I wanted to be sure to see him again after 48 hours of treatment. On Thursday when he came for review I asked the mom how she thought the child was doing. She said he was better. However, after talking to her, I found out the baby had started vomiting that morning and having diarrhea. When I proceeded to exam him, I noticed his respiration had gone up from 48 to 80 per minute and he was recessing; signs of labored breathing. I decided I wasn’t going to take any chances and wanted to refer the child but unfortunately there were no beds at the free NGO hospital, so I would have to refer to Children’s Hospital. The mother decided she wanted to call the child’s father first, to see what he advised. Great I thought, this is a working father, who will make sure his child gets admitted.

I was caught by surprise however when the father said bluntly that he didn’t have the money to admit the child at the Children’s hospital and then hung up the phone. That made me mad. I immediately had a nurse call him back and explain that this child really needed admission and he would have to meet them at the hospital downtown. I then sent the mom off with a referral letter and a little bit of money for transport. Why was I upset? Here I was trying to help this child and the child’s father (employed, credit on his phone) was telling me he didn’t have enough money to have his own son admitted? What’s wrong with this picture? I felt like if the father didn’t care about his son, why should I bother? It sounds harsh, I know. But I was pretty frustrated by the situation.

The next morning (Friday) I had to go down to the hospital to sort out another one of my patients at the feeding center (yes, even when referring a patient, somehow I remain somewhat responsible, more so than I would like to be!). We also went to the ward to find a patient that Anna referred. While we were up there I saw this mom looking at me. I didn’t recognize her at first. I asked if she knew me and then it clicked; the mom with the 1 month old from Thursday afternoon. I was so amazed that they were there. And my faith was restored in these parents. I felt bad for thinking so negatively about the father, for being so frustrated with them, for telling my colleagues how ‘stupid’ some people are. I was so wrong this time. I totally misjugdged this family. (who am I to judge anyway?) This was for once a family, who, in the end did have their child’s health as a priority. I was so happy to see that he was alert and feeding well, and although still breathing fast his breathing was definitely less labored. And, he was on iv antibiotics; just what he needed. And to top it off, the mother did not ask me for money at all, unlike so many of the families we refer. This family deserves a star and I am put to shame a bit for my assumptions! I hope and pray this little guy does well.

Another 11 hour clinic day...

Long day today.
Left home at 730am.
Arrived back at 745pm.
Then rushed off to a movie.
Now have some work emails to write.
Then the day is over.
It was an interesting day however.
Many sick children.
More of the children needed more attention than usual, lots of check-ups.
Lots of infants breathing at 70-80 per minute (fast!)
A child with a very bulging fontanelle, but actually quite happy. However, as this is usually a danger sign, and a sign of serious illness (like meningitis) I did refer the child.
A child that had surgery on the ship that has a wound infection now.
A 9 year old with a tumor of his left eye, desperate for help that we cannot give.
A 2 year old weighing 7.2kg, with malaria, needing referral to the feeding center.
A 5 month old with a persistent cough and weight loss and a mother who is not quite sure what to do.
In other words, enough to do.
But now, it's off to bed...

Words from a 6 year old...

Sunday school today was fun.
The kids have been learning about the essence of God.
We've taught 5 characteristics so far.
Justice. Righteousness. Eternal Life. Love. Sovereignty.
Since we've covered half of the teaching so far, we decided today was QUIZ day.
2 teams. Boys versus Girls.
Various questions. A memory verse puzzle.
Great fun.

After church there was an extra 'meeting' planned.
I was planning on going to the meeting.
But there were about 15-20 kids running around outside, a couple of which were under 5 years.
So I figured I'd best go back out and keep an eye on the kids.
Because by this time the older boys were way up in the mango trees.
And the little kids were wanting to join them.
So, it was time to teach them games like 'Duck duck goose'.
That was great fun too, although we were told we were making too much noise :)

Towards the end, a little girl wanted to play with me.
After swinging her around a couple of times she kind of clung to me.
She wanted to sing.
"Lord I lift Your name on high" was the song she chose.
And this little girl could practically sing the whole song in English.
I would sing the verse and she would do little echo's. So sweet.
She had such a big smile on her face.
It's really something I need to get on camera some time.

Then I asked if she had any brothers or sisters.
She pointed to a little girl and said that's her sister, she is 3.
Later I found out it's actually her cousin.
But here, cousins really are more like brothers and sisters.
Then she said she had one other sister.
But she died. She was 2.
I wasn't sure if I was hearing correctly.
Is this 6 year old girl telling me that her little sister died?

At first I wasn't sure if I was hearing her correctly.
Was a 6 year old girl telling me her sister died?
She was.
Open and honest. Telling it like it is. Down to earth.
Very sad.
I almost felt bad for asking about her siblings.
But that is how it is here. Many children die.
But this was the first time I had heard it from a child.

10000...

There was a little bit of excitement in the Mercy Ships outpatient clinic this morning,
As the staff realized that today was the day that we would register the ten thousandth patient.
Which child that would be wasn’t clear yet as we were still busy prioritizing the sickest children.
Sure enough at around noon time I called in a patient and noticed his ID number.
10000.
A 4 year old boy, from downtown Freetown.

Of course, to the mother and child, this meant nothing.
All they wanted was for the child to be healthy.
They waited at the gate like every other patient.
They would wait in the waiting room like all the rest.
They would be seen like any other child.
The number meant nothing.

So although, the mother and child were not aware of it, the staff was.
To us, it did have some significance.
It means we have registered 10,000 children since opening 3 years ago.
That’s a lot of children!
Many of which have come to the clinic multiple times.
And of course we all know that the new registrations will continue…

My voice on BBC radio...

I was a bit surprised to receive an email last week from some friends in Kenya, who emailed to say they heard me on the BBC. I had totally forgotten that about 10 months ago I was asked to read one of my blog entries for a special BBC Woman’s hour program on International Bloggers. Seeing as it took some time to actually air the reading, it had slipped my mind. But here it is, on the radio. A story about a patient I saw in Freetown, who would have surgery on the Africa Mercy. I have to admit I find it a little bizarre to hear my own voice on the BBC radio! But it is kind of fun too. You can listen to the reading at: http://www.bbc.co.uk/radio4/womanshour/05/2008_18_tue.shtml Happy listening!

Entries about recording in Freetown and the patient's story can be found at: http://www.sandralako.blogspot.com/2007/08/sandra-on-bbc-womans-hour.html AND http://sandralako.blogspot.com/2007/04/last-weeks-highlight.html

OPC up & running for 3 years now...

It was three years ago today that the Mercy Ships outpatient clinic for children opened in Aberdeen, Sierra Leone. After much planning, organizing, hiring of staff, sorting through containers, praying, discussing with the local authorities etc. we were ready to go. Mind you, we didn’t have everything we needed. We only had adult formulations of drugs, since we were not specifically planning on doing pediatrics initially and only a part time lab technician. And of course, I didn’t have any experience in setting up and running a clinic. But all would be okay with time... I hoped. Here is an excerpt from a blog entry I wrote on May 23rd 2005.

"The out patient clinic opened on Tuesday, May 10th. On the first day I saw 3 patients- a slow start I know, but at least it gave us the chance to make sure that the clinic, lab, pharmacy etc. were functioning as they should. On Thursday the numbers increased, and I saw 16 children and 2 of our employees. Today [Monday May 23] I saw 27 patients- actually it was a bit too busy. But at least we know there is a need for the clinic! It’s good to have started the clinic. However, I realize even more how challenging it is. And at times I feel very inadequate for the job. Especially being the only one to see the children and make the diagnosis etc makes it difficult. It would be a lot easier if there was someone else to bounce ideas off of!"

So here I am 3 years later. Still in Sierra Leone. Still running the Mercy Ships pediatric clinic. Still knowing there is an obvious need for the clinic since unfortunately Sierra Leone still has the highest child mortality in the world. I still love the work. Love helping the children. And am thankful for the experience. I feel much more confident in the work. But the challenges remain; trying to refer very sick children, dealing with the inadequacies in the healthcare 'system' here, children coming too late, ignorance of parents, having to turn patients away, etc. 3 out of 5 of my local staff have been with me since the start. All 5 of them are great! They have helped turn this clinic into what it is today. It's been great to work with such an excellent team.

Interesting how 3 years ago I thought 27 patients was a lot when for the past 1-2 years I have had between 50-65 on average per day. Seeing up to 69 on my own on one day. And still having to do the management side of things too- running the lab, worrying about supplies, human resource management, etc. Fortunately I now have a 2nd doctor to help with the clinical side of things. Even with 2 of us, seeing 55-65 kids can be a full days work but it's so much less stressful and so much more enjoyable!

"Safe" ferry ride home...

So, why did I take the ferry? Well, it was the only way to cross the river to Freetown. Is it safe? Well, I’ll let you decide...

Someone had arranged for the shuttle company to meet me at the airport, which they did. Once another passenger and I were seated in the van, we drove, very speedily I might add (welcome back to Africa), to the ferry terminal. We heard that only 1 ferry (out of 2) was running which meant chaos; everyone trying to get onto 1 ferry. So much for the little safety there is. Anyway, at the terminal it was hectic; cars, people, luggage, yelling, screaming, arguing, running. There was no room for our van on the ferry but fortunately the shuttle company had another van that had made it onto the ferry. So after some persuading we were allowed to walk onto the ferry with our luggage and join up with the other van.

Once on the ferry I had to find a place to stand. Not so easy, even though I had a first class ticket in hand. As I approached the first class lounge all I could see was a room full of bodies, all I could hear was a blaring tv, all I could smell was sweat and all I could feel was heat. I wasn’t even going to attempt to find a spot. I was advised to go to the top deck. Well, that wasn’t much better. There were people everywhere. As I stood by the railing at the top of the steps I got a near-panic attack and thought ‘if this ferry goes down, I’m going to have hundreds of people pulling me down with it’. That’s when I saw a huge box with “Life Jackets” written on it and wondered if there was even anything in the box. I suddenly didn’t feel safe at all and thought I better go downstairs again. So, I ended up standing near the car deck on the little passageway by the railing. I was relieved to have at least a square foot of space to myself.

My view to the left was about 30-40 cars crammed onto the deck, with maybe a foot in between the cars at all sides, people either sitting on the cars or trying to climb over them to get up to the deck, women walking around trying to sell peanuts, juice, water, cigarettes, men handing out flyers to concerts, children tied onto their moms backs etc. My view to the right was of the river, with the sun setting over the water. Chaos versus peace. Talk about 2 totally different pictures!

The craziest thing that happened took place as we pulled away from the dock. First of all, they almost forgot to let one of the lines loose as we were pulling away. Then while we were only inches away from the dock, someone lowered a 5 year old girl onto the dock who, understandably, started crying the instant her feet touched the ground. There was a lot of confusion as to whether or not she was supposed to be on the ferry or on the ground. Within seconds the ferry was about a meter away from the dock and I was hoping they wouldn’t try to pull her back up. They didn't. A 10 year old boy was summoned from the terminal to come and get the girl, which he did. And hopefully she made it home safely well. All I could think was ‘only in Sierra Leone’.

When we got to the Freetown side things remained chaotic; people everywhere, baskets of goods on the ground, little children running around, cars trying to inch their way out of the terminal, the sound of honking horns. Fortunately I found my shuttle van quickly and after waiting in traffic for another 20 minutes, we were on our way. To the safety of my compound.

Back in Sierra Leone...

So, on leaving Sierra Leone I had a very pleasant, quiet, breezy ferry trip to the airport but a very long wait for the flight (8 hour delay!). On arriving in Sierra Leone, however, the plane actually arrived 30 min before the official arrival time, but I had a hot, busy, crazy ferry ride back to Freetown. (More about that in the next blog entry!)

In the end I made it safely home to the team house just after 9 pm. Early enough so that I could catch up with friends, get caught up on sleep and then head off to the clinic at 730 the next morning. It’s good to be back. It is so good to see the staff at the center, especially my own clinic staff and it has been great to see patients again. I have already seen a number of kids that I’ve come to know in the past few years, and all I can say is that I absolutely love them and feel privileged to continue reaching out to them.

Hiking in Colorado...

Hiking in Eldorado Springs, Colorado in the beginning of May.

With family& friends.

Enjoying the fresh air and breathtaking views.

Amazing...

Missing Harper...

Friends had a baby boy last December and I was happy to finally be able to meet him on this trip. Harper. 4 months. And what a cutey. He is full of smiles all the time. I spent lots of time with him seeing as he lives in the same house as my brother. And I must say most of the time he was very content. And if he was in a fussy moment, I could usually get him to smile again within a few minutes. Unless of course it was time to eat or he was fighting sleep! But really, he is one of the happiest kids I know. And I miss his cute little face. Strange to think that next time I see him, he'll be walking around!

Boulder...

The day before leaving Clorado, my friend Liz took me to Boulder. A spot people kept saying I needed to see. So off we went. It was a fun afternoon, with a nice lunch at the Cheesecake Factory- talk about an extensive menu! Multiple pages of soups, salads, sandwiches, pizzas etc. And then it ended with another two pages of various cheesecakes! We had a delicious meal. Pearl street was decorated with many tulips and lined with exquisite stores on either side. It gave the impression of a European shopping street. There were a number of musicians out on the street, others doing little acts for money and overall a very interesting collection of people walking the streets of Boulder that day, and probably every day! It was a fun place to check out!

Home of the Rockies...

Me, Stefan & Genae with a view of the city.
The Rockies playing and in the background.
Genae & I enjoying the game.
Despite the nachos, cheering & lots of fun they lost.

Loving the outdoors...

I am loving the outdoors. It's great to be able to go out wherever, whenever. This was on a nature trail just outside of Stefan's house. I think it was called the 'Dutch Creek' Trail. Jax (the dog) loved the walks too.

Jax the dog...

One morning I walked into the living room and saw a half-chewed up flip flop on the floor. Who could have done that? None other than Jax the puggle! (Stefan and Genae's dog) This was the first time I'd actually seen him eat something he wasn't supposed to, well, except for grass and wood. The next day, he came rushing in through the dog door with something in his mouth. He seemed excited. It looked like a golf ball, only larger. But as he spit it out onto my hand I saw a huge hole in the top. This was not a ball, but what was it? Liz, was sitting nearby, and realized what it was. Jax had managed to 'steal' and eat baby Harper's suction bulb!!! Crazy dog. Actually he's quite sweet, all be it a little smelly too. But he is a dog after all. So I guess this is all to be expected. I think Jax is happy about the move- he now has a backyard to play in!