Ignorance? Neglect? Cluelessness?...

Sometimes I really wonder why people do what they do here.
What are they thinking?
And why?
How can they take so much risk with the lives of little children?
I am shocked by the number of children abandoned by their parents here.
And frustrated that they sit at home so long with sick children.

Today I saw a 4 year old boy in the clinic.
He came with an aunt.
He was abandoned by his mother 1 year ago.
And now lives with his granny.
When I saw him today, he weighed 14 kg.
He looked like a skeleton.
And had a very sad expression on his face.
He had skin changes, brittle hair and oral thrush.
I was shocked to hear that his condition was pretty much like that for the past year.
Why had they not taken him anywhere?
Could they not see that his condition was only getting worse.
Apparently the granny was giving him traditional medicine.
Well, now he is acutely ill too, with a temperature of 39.3 Celsius.
Are they now thinking that with one visit to the hospital he'll get better?
I tried to make it clear that I would do what I could, but that they need to take responsibility.
Giving medication, feeding him properly, doing further tests, coming for follow-up visits.

I wonder what will happen to this child.
He is to go for further tests tomorrow.
And to come and see me again on Monday.
Will his family follow through?
Will they make this child's health a priority?
Will this child, after a year of being sick, finally get better???
I'll find out soon enough...

Saved by the guard...

I was very thankful to find out this evening that the security guard had already opened the valve on the water tank. Thank you guard. He spared me another trip up the steep steep ladder.




This is a picture of our gazebo on the left, main house on the right and my appartment block straight ahead with visibility of 2 out of 4 of the water tanks on my roof. It's the one on the left that is causing so much trouble. Fortunately I found out this evening that from standing at this point I can actually see the blue valve at the bottom of the tank- and see the position it is in - so I won't be making any unnecessary trips up the ladder!!!

Acrophobia...

Due to very random Sierra Leonean plumbing one of the four water tanks on my roof overflows regularly: every 3 or 4 days, usually between 8-10 pm. Seeing as the water tank is right above my room I am usually the first one to notice; it’s kind of hard to ignore the sound of a magnificent waterfall! Lots of water gets wasted and someone has to go onto the roof to close one of the many valves. Then, in the morning the valve has to be turned on again.

What does this have to do with acrophobia? Well, like I said, the water tank is on the roof of my building. It is very high. I’ve climbed onto our generator roof many times, but it’s not nearly as high. And I just haven’t been brave enough yet to climb up onto my roof. The ladder is very steep. Yes, I’ve always been a little afraid of heights, unless there’s a railing or something to hold on to. But with our maintenance man going on holiday I had to bite the bullet. Someone had to be told what to do in case of an overflowing tank (which was bound to happen). So, on Thursday evening before it got dark, up we went. He went up, I followed. He showed me the valve. I looked around a bit. I got a little nervous climbing down. Made it to the ground. Survived. No problem.

This evening, when I came back from a lovely dinner out, the guard told me the tank was overflowing. This happened to be the 1 guard (out of 3) that was not shown which valve to close. Ugh. You know what that means. I was the one that would have to go up and solve this problem. My options were: 1) brave it, climb up, pray I don’t slip, close the valve, and climb back down or 2) leave it, waste lots of water, and not get any sleep because of the loud sound of the waterfall. Basically, there was no option. Up I went.

With my sneakers on, flashlight in my pocket, I climbed up the steep ladder in the dark, making sure the guard came up with, so that he would know what to do next time this happened. And I figured if I freaked out and couldn’t climb down, or fell off of the ladder, etc. at least someone would know and could call for help : ) Well, I made it to the top, dodged the flowing water, closed the valve, showed the guard, and was ready to go down. I wanted to wait for a minute to make sure the tank stopped overflowing because there was no way I wanted to climb up again. As the guard climbed down and I stood on the roof looking at the ladder I thought ‘what if I panic and can’t get down’. I told myself to stop thinking and get moving. And climbed down.

Never a dull moment. Always something to do. And hopefully this will help me overcome my fear of heights a little! I guess in the morning I’ll have to climb up again to open the valve, because we’ll be out of water!

Lunsar, Joshua, Beach, Chinese and more...

This week has been great. Busy, but good. A satisfying week. And it's not over yet!

Tomorrow I am heading out to a place called Lunsar- about a 2 1/2 hour drive from Freetown. I am going to an NGO run hospital to visit some patients I referred. Children with a specific tumor called Burkitt's Lymphoma. Fortunately the hospital there runs a special chemotherapy program for them! It's the only place in the country with affordable treatment. I think it's only available in 2 other places, but very expensive. I am looking forward to a brief trip upcountry, connecting with the doctors there and hopefully seeing 2 of my patients responding to chemo.

Afterwards I will be picking up Joshua David - who is now 6! And he'll be spending the weekend with us. I'm excited about that. He's always fun to have around. It's been a little while since I've seen him (February). His caretaker/granny is very sick and so we've been asked to look after him for the weekend. It'll be good for my Krio!

And then Saturday we'll be celebrating my birthday a bit more. A possible beach trip (weather permitting...it's rainy season!) and going out for dinner to a very posh Chinese restaurant.

All in all...a fun filled weekend! Hope you enjoy yours too...

Busy birthday...

Another birthday come and gone. This one was busy; filled with patients, 4 songs, 5 desserts, phone messages/calls and friends. A great day!

It started at 6am...with a text message from home.
Then b-day wishes from my house mates.
A happy birthday song in the car on the way to work.
Then more singing by my mom and Terri in their office.
Followed by yet another song from my staff in the outpatient clinic.
Then the work started; lots of follow-up cases.
A roll of chocolate cookies that appeared on my desk! : )
Very busy, no time for lunch (but ate the cookies) and finally done at 4pm.
Satisfying day with the patients.
I had hoped to take staff out for ice cream at 3, it was 430 instead.
We piled into the landcruiser and went to Montana's.
I happened to meet a friend there who had just bought me a little cake.
She was going to drop it off at work. How thoughtful!
After ice cream I headed to my parent's place.
We talked, I opened some gifts, we shared the little cake I had received.
And after 30 minutes it was time to head off again.
Only then did I hear my mom had made a cheesecake! (we'll eat it tomorrow!)
Rushed home, ate dinner, had a shower and headed out again, to Bible Study.
Seeing as that's where my friends would be, it seemed like a logical place to hang out.
Mind you, I did hop out at one point because my brother called from the States.
After Bible Study I was surprised with more dessert...not 1 but 2, and more singing.
One friend made a chocolate cake, another made a killer mint-chocolate pie!
Delicious!
By this time it was almost 10pm...but it's never too late for chocolate.
I ended the day spending some time on skype- talking/chatting with a good friend
And reading emails and facebook messages.
It was definitely a great birthday!

Mother listens to advice...

A mother came to the clinic with her 2 year old today.
He had been sick for a week.
With the standard history of fever and cough.
They were the first in line when I went out to the gate this morning.
Arriving at 530am waiting for clinic to open at 8am.
When I checked the child, he looked very pale.
So I gave him an ORANGE priority ticket even though he was first in line.
Because I was sure we would prioritize more children and I really wanted to see him first.
15 minutes later, after checking all of the kids in line, we all went inside.
While the nurse checked the boy's vital signs, I took his history.
Then we went off to the lab (just around the corner).
Hemoglobin, malaria smear, glucose.
I hung around to see the first results.
Glucose 8.8 mmol/L = good.
Hemoglobin 4.4 g/dL = not good.
I already knew I would have to refer the child for a blood transfusion.
We then walked back to my office, for me to examine the child.
After which we got the results for the malaria smear: positive.
Malaria and Anemia.
A frequent combination.
A frequent killer.
Time to refer.
Meaning time to make some phone calls.
Unfortunately, the NGO referral hospital was out of beds.
So I had to once again refer to the government-run Children's Hospital.
Which meant money was needed.
Le 15,000 ($3) to see the doctor (compared to Le 1,000 at our place)
Le 30,000 ($10) for a blood tranfusion.
And money for medication.
These are vast amounts of money for the average person here.
Fortunately the mother had been given a decent sum of money from the uncle.
This would cover most costs, but not all, so I topped it off a bit.
It sounded like this mother would actually take her child there for admission.
Only time would tell.
Fortunately she had a had a phone number we could call, which we later did.
When we called, the mother told us they had just started transfusing the child!
So, he had been seen by a doctor and was on treatment already.
Good news.
He is on the road to recovery.
I'm happy to post a happy ending to a consultation this time.
A mother that takes our advice and goes where we tell her to go.
Many times it's these initial steps that are so difficult for them to take.
Due to financial constraints, traditional beliefs, family pressures, etc.
Hopefully this child will get well quickly.

Sierra Leone drug issues and latest bust...

Cocaine-filled plane ditched at Sierra Leone airport

July 13, 2008 - FREETOWN, Sierra Leone - A passenger plane loaded with 1,540 pounds of cocaine was found abandoned at Sierra Leone's main airport Sunday, police said. Airport officials discovered the craft, which was registered to a South American country, along with a handful of guns apparently left behind by a two-man crew before dawn, said Francis Munu, a police official in the capital. Munu said police had organized a search party to try to find the pilots of the plane. With cocaine prices in Europe surging ahead of prices in the United States, drug smugglers in South America are increasingly ferrying cocaine to West Africa, from where it is parceled out to hundreds of individual traffickers who carry it north. Major seizures have been made in Guinea-Bissau and Ghana, and it is widely believed that other countries along the coast are also being used by drug runners. AP article

Also: How the drug trade operates in Sierra Leone

Unknown ending...

On Thursday a mother came to the clinic with her three week old child. Her firstborn. She came into the consultation room just after 9 am. Her child had started convulsing. Guido and I stopped the work we were doing to tend to this child. Fortunately within minutes the convulsion stopped on its own before needing to give diazepam. The child was not febrile or hypoglycemic, so we couldn't find an immediate cause for the convulsion. We decided that a neonate who has just had a convulsion should not go home, but rather be observed in hospital. We don't admit. So it meant referring. The NGO hospital was full. So it meant government hospital. We wrote a referral letter, talked with the mother, she said she would go and off she went. What happened next? Unfortunately the child was not at the hospital on Friday. No one had seen her. Did she go there? Was she sent home? Did she go home directly from our clinic? Who knows. Hopefully her baby is alright. This is another one of those cases without an ending...

Few hours of POOL craziness...

Saturday.
A day of relaxation.
Started off with breakfast.
Then a trip to Lumley beach to watch Amputee Football.
Unfortunately 5 min before arrival it started raining.
No players to be seen on the pitch.
So we continued to Lumley Craft Market.
I was thankful to the lady that met us at the taxi with the umbrella.
So I bought some "culture" (= necklaces) from her.
The rain stopped.
We went out and finally (after some walking back and forth) found the players.
They were not going to train anymore.
Oh well.
Off to the swimming pool.
Cape Sierra here we come.
Fortunately Guido, Emilia and I were the only ones there.
After lounging around on the beds, talking small, embracing the rain drops,
it was time for a swim.
Somehow the camera was also unveiled.
And the result was many crazy shots.
Diving.
Diving and smiling and looking at the camera.
Falling into the pool sideways.
Walking on water.
In other words- lots of loud laughter!
And an awesome day out.
Which ended with lunch at Family Kingdom.
I must say I felt like I was on vacation for a few hours.

Goodbyes...

Goodbyes are not something I really get used to.
Does anyone?
Living here long-term means seeing many people come and go.
Most people stay for less than a year.
And people coming through our house often stay for less than a month.
Yes, we have a lot of visitors stopping in.
That means meeting a lot of new people, all the time.
And I must say, I protect myself at times, not to get too close.
Fortunately some people do stay longer.
Which means getting to know them better,
A good thing.
But it also means that when it's time for them to go, it's harder to say bye.
So we'll just say "see you later".
We had a goodbye thing for my friend Justin a little while ago.
And now he's gone.
I'll say it was more of a see you, than a goodbye.
Cause with some people, you know you'll likely see them again.
Anyway, here are some pictures of me and my Salone friends.

"Survived another week"...

This evening I was at a friend's house, sitting on the balcony with a couple of people watching the most amazing sunset, while we were talking about this past week. Honestly this week has been VERY GOOD but also VERY TIRING. I guess with the amount of patients we've been seeing in the clinic this week, that's not a surprise. One of my friends looked at me and said "Sandra, you survived another week". Strange comment? Well, it's true. It's Friday evening again, I made it to the end of the week. However, this comment made me think. Here I am, 'called' to do this work; work that is challenging but also very rewarding. However, sometimes, at the end of the week, it really does feel like a relief to have made it to Friday and I am so glad it is weekend. And I really do feel like a survivor. Having said this, the same strange feeling pops up on a Monday morning. When my alarm goes off and I know I have to get out of bed to get ready for work; to start another week. At that moment I would really rather stay in bed. Crazy thought. Why would I want to stay in bed when I am doing amazing stuff out here?! Work that I dreamed of doing. Well, I guess it's only human nature. To look forward to weekends and dread Monday mornings, no matter what kind of work you do! At least, I kind of assume that lots of people have these same notions. So, even though I look forward to weekends and dread Mondays, just know that I really do love my job! And I have had some great times with my patients this week...

Where in the world is...

Yes, it's been awhile since I've written.
But here I am.
Still in Sierra Leone.
Still seeing lots of kids!
More posts to come soon...

Sierra Leone's Local Council Elections...

July 5, 2008 - Wilberforce, Freetown, Sierra Leone

It is the morning of elections; so far, so good. No commotion to be heard. Mind you, I’m not expecting much of anything to happen; besides a lot of people going to the polling stations.

There wasn’t near as much publicity for these elections (in my opinion) as for the Presidential elections, however, some people do feel very strongly about them. So the necessary warnings/precautions are always given.

Earlier this week there were a number of party demonstrations in town and even some in Aberdeen, passing by on the road outside the clinic. From my window I could see groups of people wearing green and white or red and white, marching, making lots of noise, dancing, etc. It all sounded rather upbeat and joyous and drew out the patients in the waiting room to watch what looked like a parade!

The local elections are held in Sierra Leone for the first time since the Sierra Leonean Civil War and word has it that following this election, the United Nations political mission UNIOSIL will withdraw.

News about the 3 week old...

One of my nurses told me today that the 3 week old I wrote about on Tuesday did indeed die.
She happened to see the child's mother last night at church, who told her what happened.
Yes, she went to the NGO hospital.
Yes, she was told the child would be admitted.
She then, for some reason, changed her mind and did not want the child admitted.
Apparently something to do with thinking her child was under influence of witchcraft (?)
She left the hospital.
And then ended up taking the child to a pastor that night.
I'm not sure what happened there.
But on Tuesday morning, her child died.
Apparently she has given birth to 7 children (not 4 like she told me).
And only 1 child is still alive.

What happened to the 3 week old...

Yesterday something rather unfortunate took place.
Firstly, there were more than 80 children at the gate in the morning.
So we let in 60 and turned away 20.
However, we did let 2 of those 20 children in, because they just didn’t look good.
One of these was a 3 week old girl.

She was febrile, breathing at 82 per minute and not breastfeeding well.
Bad signs.
I took her to the lab rather quickly to check her hemoglobin, blood sugar etc.
And then I examined her, noting the many boils and her swollen upper arm.
This seriously ill child needed to be referred for iv antibiotics.

I called the free NGO hospital nearby to see if they had a bed available.
To my surprise they had a bed and told me to send the child.
I asked the mother if she had money for transportation.
She said no, but she would go home to get it.
I told her there was no time for delay and gave her Le 5,000 (< $2) for transport.

As she walked out she asked me “Do you think my child will be okay?”
I answered confidently “As long as you go straight to the hospital and admit your child, I think she will get better”.

A few hours later I received a text message on my phone.
“Your child arrived and then left to try traditional medicine instead! Sorry!”
I called the NGO hospital to find out what happened.
The child was about to be admitted and then the mother disappeared.
Apparently she told moms in the waiting area she was going to try traditional medicine.

What happened?
Why would she come to our clinic early in the morning if she didn’t want her child to be treated?
Why did she ask me if I thought her child would get better if she wasn’t going to follow through?
Why did she use the Le 5,000 to go up to Emergency only to leave again?
What made the mother change her mind?

Unfortunately, the ending of this story seems all too obvious.
I cannot imagine this child would have survived without proper medical treatment.
I can only assume that this child has died.
Why does this keep happening?
What has to change in this country, in these people's way of thinking, to stop this?

Laundry in Sierra Leone...

Tuesday and Friday nights is when I do a load of laundry. So, that's what I am up to tonight. And so far, so good. Fortunately tonight has been rather uneventful laundry wise. This is not always the case. Sometimes doing laundry here can be quite the ordeal. Yes, we have washing machines. And yes, we have dryers. But they don't always work as they should.

First of all, we can only use them on the big generator. So, if that's broken, you can forget it for the night, try again when the generator is fixed.

Secondly, the doors are broken, so you have to pull on a string to open the doors.

Thirdly, the water pressure is so low, you have to fill the machines with water using a hose, which is not a problem, as long as there is water in the water tank. If the tank is empty you first have to ask the guard to pump water into the tank. Then try again a little later.

Once you've filled the machine with water, the cycle begins. If you're unlucky, however, the machine may dump out all of the water and you have to refill it! Back to square one.

Half way through the cycle - about 20 minutes - you have to add water again, for the rinse cycle. If you are late and miss this, the machine stops. Then you have to manually put it to the rinse cycle and add water. After a good 40 minutes it's dryer time, which usually goes smoothly.

The funniest experience I've had here doing laundry occurred last week as I was showing one of our guests how to use the machines. I was only on step 1: how to open the doors when the craziest thing happened. As I demonstrated to her how to open the doors I was hit with a flood of water. I am serious it was a flood. I didn't know the machines could hold so much water! My jeans were soaked in minutes, as water continued gushing out of the machine, onto the floor. The guest was also caught by surprise and I was worried she might fall off of the steps! She didn't. Anyway, apparently someone had run a test cycle on that machine and forgot to turn off the water tap in the back, meaning that the machine had filled up. Welcome to laundry adventures in Sierra Leone...

Paracetamol hunt...

Two weeks ago I realized (a little late) that we were going through our paracetamol (tylenol) syrup much quicker than planned. I guess when you have different doctors working in the clinic, medication is prescribed in different ways. Makes sense. However, it caused somewhat of a dilemma. The supply that was supposed to have lasted until October, was almost finished. We had enough for 2 more clinic days at the rate we were going. What to do?

Seeing as we order our drugs months in advance, our September order had already been placed with a company in Holland. I knew I could try to add to the order, but these drugs wouldn't be shipped till September anyway, so this would not solve our immediate problem. Yikes. What to do? The only thing left to do was to go on a local paracetamol hunt.

So, that's what I spent part of a Saturday doing. Fortunately I had a contact for a guy in country selling drugs from the same company we use in Holland. So, I called him. Although he was at home that day (as should be on a Saturday) his colleague was working in the pharmacy. So I called her and we talked shop.

Yes, they have paracetamol syrup- but it would cost $70 for 5 Liters (compared to about $30 from Holland). I then thought of a better solution. Smaller dosed tablets. Sure enough, they also had 100mg tablets. These were 'only' $6 for 1000 tablets ($2 in Holland). So basically we could treat the same number of patients for $6 using tablets, as for $70 if we buy the syrup. I chose the tablets! It does mean that all kids over 6.5kg are getting tablets (so even babies) but these can be crushed and mixed with a little bit of water, and will be as effective. The remaining syrup will be cherished for the infants under 6.5kg! And luckily we were able to get 5L of syrup from another NGO here, which I will replace in October when our container comes.

Oh, the joys of running a clinic in Sierra Leone :)