Meet my referrals...

Last week I ended up referring 18 children with severe pneumonia, malaria, severe anemia, sickle cell crisis, Burkitts Lymphoma, abscess, sickle cell testing, hemangioma, malnutrition. 10 of these children were sent to the government-run Children’s hospital. So, on Friday I went there with my nurses to follow-up on my patients. Unfortunately one child wasn’t there; he had either been discharged already or never went. Out of the others 1 looked much better, 1 looked worse, 2 had literally just been admitted and the others were improving. So, overall I was satisfied.

On ward one I found 9 year old Mohamed with sickle cell anemia (Hb 4.5), malaria and a high white blood count. I saw him on Thursday but unfortunately rather late in the afternoon so he didn’t arrive at the Children’s hospital until about 8pm. Fortunately though, his mother was very on top of things, and he started receiving blood before midnight. Way to go mom!

Theresa was on the same ward, only 1 year old, but with an Hb of 3.9 g/dL. I had seen her on Thursday. Seeing her a day later was like seeing a different child, she was sitting and happy, having had received her blood the previous day. Mom seemed satisfied and I was very impressed with the doctor’s notes- very neat, very thorough and good case management. Well done doctor X!

Then there was Mohamed, age 1 year 8 months, weighing 5.7 kg. He was actually referred to the therapeutic feeding center, but since they had no beds, he is temporarily on the children’s ward. Not much improvement to be expected in one day. Hopefully he will be transferred soon because right now he is not receiving the free food supply he so desperately needs.

On to ward two where I found 3 of my patients referred due to chest infections, with respiratory rates between 80-90 per minute, subcostal recessions and on/off nasal flaring. Two of the infants looked a bit better and one of the fathers wanted to take his child home, to which I responded that he needs to wait until the doctor discharges the child. The question is: will the doctor see the child that day? One of the children, 5 month old Deborah, was admitted on Tuesday and actually looked much worse. After 3 days of iv antibiotics she still had a fever and wasn’t breathing well. The doctor last saw her on Wednesday. I was worried about her and hoped a doctor would see her soon.

Up to ward three. The other wards were extremely full, but this ward only had about 10 patients admitted. I guess Friday was their day to receive admissions because the 2 patients I found there were ones I had referred only hours earlier. Fatima, 5 years, with malaria + anemia had an Hb of 5.2 on Thursday but unfortunately when I reviewed her on Friday it had dropped to 4.5 so I sent her in. As I was talking to her mom the lab people came in with her pint of blood. Fatima had big eyes as the nurses attached the blood bag to her iv line and the red blood started making its way towards her arm. I assured her this blood was going to make her strong! And I made sure to let mom know I was very impressed she made it to the hospital so quickly. On the next bed lay 2 year old Eddie, also with malaria and anemia. His Hb was just above the level for transfusion (5.1) but had dropped since I first saw him on Thursday, plus he was quite lethargic and ill looking, so he also was sent only a few hours from our clinic to the Children’s hospital. He was still waiting for his father to arrive to donate blood for him.

After the wards I made my way to the Feeding Center, where in the previous week I had referred two patients. I had seen them both the previous Friday and they were making an improvement, but unfortunately 3 year old Mamadu weighing 8 kg and on TB treatment passed away only 3 days later. Sad.

All in all it was a good day at the Children’s Hospital. I know these families have had to spend a lot of money to mend their children, but better that then to lose their child. That’s what I always have to point out to them. And I was happy that most of the children were receiving adequate care. I just hope someone went in and looked at Deborah…

39+2+7=57...

The math doesn't always add up in the outpatient clinic.
In contrast to Tuesday, this morning there was NO chaos outside the gate.
The guard started handing out tickets early this am and by 7am all 40 were handed out.
There were a bunch of patients that arrived late, but they were told to go elsewhere.

When I arrived at 745 it was quiet outside.
We went along the line exchanging the temporary tickets with our official ones.
Seeing as there was a 15 year old in the line, he didn't get a ticket, so we gave only 39 tickets.
After handing them out there were another 10 patients hanging around.

Since I planned to hand out 40 tickets I thought I would give no. 40 to the sickest kid out there.
There were two very sick and undernourished kids, so I gave out 2 more tickets.
I knew I had 8 reviews scheduled of which 7 children ended up coming.
But somehow I still ended up with 57 kids today.

39+2+7 does not equal 57.
I don't know how we got the extra kids but in the end they all really did need to be seen.
They were quite sick; I had to refer about 5 and am seeing another 8 for review tomorrow.
We finished work at 745pm but it was a very good, productive AND non-chaotic day!

Absolute chaos...

Tuesday morning.
7:45
We drove by the gate and saw a huge crowd of people.
It looked like we again had 100 children at the gate.
I already knew I would have to send many away.
Especially since I am alone in the clinic this week.

7:55
One of my nurses and I made our way outside the gate to hand out tickets.
Many mornings we've had large crowds and it often took time to form a line.
This morning however, it was more chaotic.
People just weren’t lining up; they were on the sidewalk, on the road, everywhere.
And they were loud.

One granny who often comes with her grandson, told me ‘boys’ are ‘selling spaces’.
They come early and tell moms that arrive that they are too late, that the clinic spots are full.
Apparently they line up rocks on the side walk saying those spots are spoken for.
They tell moms that if they still want to get a spot, they need to pay.
I couldn’t believe what I was hearing.
But by the looks of things, this explained the madness.

Finally the first ten people were lined up so I started handing out tickets.
I got to number 24 but then stopped.
On all sides I was surrounded; by men, women, children.
Yelling, screaming, pushing, shoving.
Children were knocked over, being passed along the line screaming.
Others were being squashed.

I felt like I was in a zoo.
These people were behaving like animals.
Handing out the tickets was like throwing meat to a pack of wolves.
I couldn’t believe what was happening.
I felt like I was watching a movie; such chaos.
I ducked behind the gate again for some security.

I tried to talk to the people.
But talking at the top of my lungs I knew only a few people could hear me.
I felt I was yelling at those few at the front and thought 'this isn’t working'.
I needed to pause, to think, to find a solution.
I let in the first 24 patients with tickets and then closed the gate.
As I walked to the courtyard I was overtaken with emotion.

I went back to talk to the 24 patients; to hear their story.
They acknowledged the buying/selling, although none admitted paying to get in.
I told them how sad it was to see people act this way.
That I absolutely love working here, but not when it comes to this.
Such madness, selfishness, anger, frustration.
My next thought was: what now?

Some staff said to close the clinic, but I had 24 inside and wanted to see more.
I didn’t want the children to suffer because of their parents’ madness.
We went to the gate to hand out more tickets.
A difficult task in all the craziness.
Every time the gate opened to let a patient in, the whole crowd pushed forward.
Much like a stampede, squashing little sick children.

We tried to hand out tickets fast.
Once 45 patients were inside we closed the gate.
Done for the day (with handing out tickets that is).
A few minutes to cool down, and then work would start.
Unfortunately we did turn away about 50 kids.
Some lingered at the gate till as late as 11:30, I could see them from my window.

To sum it up; it was a stressful start.
The ‘system’ we’ve used for 3 years obviously does not work anymore.
The challenge now is finding out what will work.
We have a new strategy for tomorrow; we’ll see what happens.
Unfortunately it seems like whatever system you use, people will find a way around it.
But rest assured, we will keep trying.

Insights to Lumley destruction...

Here's an article that gives a little more information as to why the beach bars along Lumley beach were destroyed. I do agree, some of the bars were quite ugly and not frequently visited. But Ramada's and Bunkers should definitely have stayed!!! It was their rustic wood and thatch structures that DREW people there. It is sad to see a structure like Bunkers taken down just over a year after it's opening. People worked hard on that place. I guess I should not feel so bad that we don't have a beach bar to go to on a Friday evening but rather feel sorry for the 394 people mentioned that now have to find income elsewhere.
See: Beach bars demolished in tourism revamp

See previous posts: Ramadas destroyed & More on beach bar destruction

Man of the year service...

Today we decided to go to a church in Wellington that is attended by a few of our employees. Little did we know, when we planned this outing that today was also the ‘Man of the Year’ service. Once we found that out we knew we were in for a long day. We left our house at 915 assuming we would probably reach the church just after they started at around 1015. Well, much to our surprise, the land cruiser wouldn’t start, so we ended up taking my friend Vez’ car. No problem. We were a little scrunched up in her land rover but it only added to the adventure. We then picked up our 6 year old friend Joshua on the way and headed to the east of town. Traffic was worse than expected so we didn’t make it to the church until 1100, having encountered a couple of wrong turns as well. However, not to fear, of course the service hadn’t started yet!

When we drove up to the church we met many people outside the gate who, as we approached, all made way for us to enter the compound yelling ‘mercy ships’. They were quick to come to us with ribbons- colored according to the group we were supporting, at the price of Le 1000 each of course (=30 cents). We were pinned with pink ribbons, showing that we were supporting group A. The group A candidate is one of the employees out at New Steps, which is why we were in that group. We soon found out that the aim of the service was to raise money for the church. How? Well, it was a competition between the two teams. Whoever raises the most money wins and their candidate becomes man of the year. Interesting concept and an interesting service it was.

The service focused on this whole ‘Man of the Year’ competition. There was some worship to start off with, and a short sermon based on the fact that we are all winners, and that we need to remember we are raising money for the church etc. Pretty soon, the rallying began. It’s hard to describe the rallies. It really was a bit crazy but a true African experience. Group A would get a turn to raise money and then group B would get a turn. A lot of singing, people coming up for each candidate with money, a string of people going forward putting money in a basket for one group, followed by a string of people going up to give money to the other group, pinning ribbons (pink or blue) on the candidates shirts, etc. For us this meant going forward at 4 different times putting money in a basket, 3 hours of sitting in a church pew, listening to loud music, playing with the kids in the row behind us, and in the end leaving the service at 2pm, after a good 3 hours and just before they announced the final results. It was just taking a bit too long. All in all though, it was fun, and the church did raise a lot of money.

We then had to make our way back to traffic. We were delayed a bit longer when we were pulled over by the police due to an expired insurance sticker on the windshield. (oops- it was renewed last Friday, but the sticker hadn’t been stuck yet). We stopped at a small café to enjoy some lunch (at 4pm by this time) and then made our way home, dropping off a few people along the way. We made it home just before 6pm. Ready for a relaxing evening...

More on beach bar destruction...

I am still not sure what the logic was behind tearing down all of the beach bars on Lumley beach. Apparently the Ministry of Tourism thinks that they will not attract tourists. Well, our favorite place Ramada's certainly would have. It was very much African Beach Hut style with palm trees, thatched roof, etc. Now all that is left along the beach road are a few finished and many half-finished concrete buildings on the other side of the road; not quite as tropical and touristy in my opinion. But I'm not in the Ministry am I.



On Saturday while driving along the beach road we saw a lot of army trucks and soldiers. The soldiers were burning up the remains of the beach bars. As sad as it is that the bars were destroyed, I am glad to see that the remains are being taken care of so that the beach won't continue to look like it was struck by a hurricane!

Ramadas destroyed...

On Friday afternoons at around 530pm our expat team can frequently be found at Ramadas Beach Bar on Lumley beach- just a walk, run or drive from the clinic. That was, until this week. Because just today, almost all of the beach bars were destroyed. Apparently they were given a 30 day warning- and the reason they were destroyed had to do with the tourist board not wanting them there, and whether or not they own the land legally etc etc. Apparently it was quite chaotic on the beach this afternoon. I'm not suprised. It's hard to get to the bottom of it. But the bottom line for us is "NO MORE RAMADAS".

It's a shame really because what better way to end the week? Starting the weekend with a stroll along the beach and then ending up at Ramadas to sit, relax, enjoy a pint of coke, savour the roasted peanuts, chat with each other, watch the vendors go by, admiring the impending sunset. I guess we will find another way to welcome the weekend, but it won't be quite the same. Maybe a swim in the local pool, or a drink at one of the 2 remaining beach bars (if they stay up!) Or we may just end up taking a cooler with drinks to the old Ramadas site, and protest a bit while we're at it. I'm sure we'll find someway to finish off our Fridays well...

Military walk...

Last Saturday I decided to be adventurous and join the group going on the IMATT walk. IMATT is an international military group who advise the Sierra Leone military and they also happen to organize hikes every Saturday morning. Seeing as they meet at 9am on a Saturday morning I often bail out and stay in bed instead. But last week’s walk sounded exciting; the WHALE RIVER walk. So at 840 in the morning a group of use went up to the IMATT base in our land cruiser to join the rest of the expats. We then headed towards John Obey beach, an hour and a half through the hills to the starting point of the hike.

We were with a group of 30 and on arrival at John Obey quickly got started on our walk. Off we went into the jungle, in the rain, until we reached Whale River itself which is when we noticed that the usual bridge had been swept away. Not a problem, we were with the military and there happened to be a lot of wooden planks lying around. We would build our own bridge. The first attempt was unsuccessful. In the end we ended up using two planks to get across. I am sure an engineer would not be impressed, but hey, we got across. We continued through the jungle and soon arrived at the river’s edge again- near the waterfall! We decided to cross a very shallow but fast moving part of the river, which was quite adventurous. As long as you took small steps, it wasn’t a problem. The fast paced walkers were more likely to slip and slide; I took it slow. Once we were on the rocks at the top of the falls we had time to admire the spectacular view; beautiful. Meanwhile our leaders were trying to find the best way down, but in the end we turned around and headed back the way we came. Only to get back to the first crossing and realizing that our bridge had disappeared; I guess someone needed the wooden plank. Well, like I said, there was plenty of wood, so the bridge was quickly erected once again. I decided however, that since the river was only knee deep, I would just walk across; easy and more fun, besides I was already soaked!

After a pleasant but very wet walk we reached the cars again and then headed off to John Obey beach; a beautiful beach (although I am very partial to River no. 2), with no other people around. We enjoyed the waves, walking to the far end of the beach, crossing a river with ‘quick sand’ sinking knee deep into the sand at parts, and scrambling over rocks taking silly pictures. A great ending to the day out!

More rain clips...

Unfortunately I can't get the other video clips to upload properly, but I think this is enough evidence of the torrential downpours! And more recently the downpours are accompanied with loud thunder and impressive lightning !