What to do/say/think/pray...

I saw 3 year old Abdul again today.
I felt a bit rushed seeing him at the end of a long clinic day yesterday so had him come back today.
Unfortunately he has a chronic, probably lethal condition.
He was diagnosed with a type of cancer of his eye over a year ago.
It was only months ago that he came to our clinic.
We managed to help get him to an eye doctor to remove his right eye; probably too late.
Last month he started getting strange swellings on his skull.
In the past month these have increased a lot.
Unfortunately his appointment for a biopsy fell through.
I have nothing left to offer him.
No means for a diagnosis.
No means for treatment.
Even in the West this looks like it would be difficult to treat.
If this is what I think it is, the cancer has spread too much.
He has lost 2 kg, is anemic and weak.
The only good thing is that his mother is doing her best to care for him.
He is receiving the love and comfort he desperately needs.
What more can I do for him is what I wonder now?
How can I support this family in their time of need?
I know we need to trust God in this.
But it's hard to know how to pray.
Pray for healing?
For God's will to be done?
It's hard to pray these prayers when so often people are not healed.
All I can do is keep bringing this back to God.
Ultimately, He is in control.
That's all I can hang on to.

Hopeless...

Clinic went well today...up until my last 3 patients.
Then things became a bit discouraging.
I felt hopeless.
3 of my patients came for follow-up and were worse.
And unfortunately their conditions are difficult if not impossible to treat here.
A 5 year old with a nasalmaxillary tumor, now with multiple large lymphnodes.
A 3 year old with previous retinoblastoma needing removal of his right eye and now has large swellings over his forehead and scalp that are likely metastases.
A 3 year old with possible tuberculosis and major complications (hemiplegia) due to a prolonged convulsion this weekend and family not taking him to the hospital due to traditional beliefs.
So many problems, so little I can do.
I can only hope and pray that somehow I find ways to help these kids.
But right now the situation seems hopeless...

Salone's frustrations...

This week has been rather frustrating in the medical world of Sierra Leone; frustrating to the point that I have wondered if healthcare here will ever improve. But surely it has to improve. How much worse can it get? The country is already at the bottom of the list with the highest maternal and child mortality rates in the world. There are so many changes needed; big and little. Change for the good, because believe me things are changing but not necessarily in a good way. Don’t get me wrong- of course I always have positive stories too and I still love my work here BUT sometimes it’s discouraging. I wonder if the Ministry of Health needs to open their eyes to what is really going on. Maybe everyone knows what goes on and no one knows where to start. How do you start to change a system that has crumbled to pieces? Which pieces do you put together first? I don’t have answers, but let me share with you what has frustrated me this week…

An adult patient (one of our staff in her early 20’s) with a respiratory rate in the 50s and saturations less than 80% (!) needed to drive around the city to find a hospital with a bed, oxygen and x-ray facility. The MAIN TERTIARY government hospital had an ICU with Oxygen but no bed and another ICU with a bed but NO oxygen. They offered her a temporary bed while waiting for space in the ICU with oxygen, but when you can hardly breathe, that’s just not an option. She ended up in a small private hospital, with oxygen, but the cost of admission is more than a month’s salary! And she still had to go elsewhere for an x-ray

Prices for x-rays are sky rocketing; from one day to the next the price increased from Le 30,000 to Le 50,000 (Le 3,000=$1). Most people couldn’t even afford them at the initial cost due to high unemployment and an average daily wage of $3-5 per day

Patients I refer to the Children’s hospital are charged Le 30,000 for a doctor’s consultation instead of the official fee of Le 15,000

Standing at the gate at 8am having to send away 15-30 patients because the clinic is already full, not knowing if the kids will find decent healthcare elsewhere that's affordable.

Treating a child with Burkitt’s Lymphoma in a government facility is almost impossible due to lack of needed drugs for chemotherapy and high costs and unfortunately the NGO run program has to stop as of this week

One of my kids died; a 6 year old, sick at home for too long, partially treated for malaria by some nurse (given wrong dose of malaria meds), showed up in the clinic on Monday, looked terrible, referred by me to the hospital (no space in the NGO one, so went to government one) but unfortunately died only 5 hours later

One of my referred kids discharged from the hospital on Monday was sent home with drugs that should NOT be taken as an outpatient: a vial of Lasix, a vial of quinine, a vial of powder without a label, an already used 2-day old vial of chloramphenicol. The granny was told to ‘find a nurse near her house and have her give the drugs’. Praise God the child was better, and thank God the granny did not give these potentially dangerous drugs. We threw them in the trash and prescribed the 2 medications he needed in tablet form.

That was just a glimpse of the frustrations & challenges of my work here in Sierra Leone! By God’s GRACE I carry on, and thankfully there are many bright sides to life here as well.

Update on Deborah...

On the 19th of October I wrote about patients I referred that week to the Children’s Hospital. Fortunately most of the patients recovered. At the time however, I mentioned that I was worried about 5 month old Deborah with a chest infection that was just not improving. She had received 3 days of iv antibiotics already since being admitted on the 14th but still had a high fever and respiratory rate. She had not been seen by the doctor in two days. When I left the ward that day I asked a nurse if she could make sure a doctor saw the child. The nurse wasn’t too convincing; I could only hope.

Well, on the 31st of October on my Friday visit to Children’s hospital I was very surprised when I walked into the therapeutic feeding center to see Deborah lying on one of the beds. Her mom was quick to get up and greet me. Unfortunately, now almost 2 weeks after admission, she was still having a fever and breathing fast. But at least she had been transferred to the feeding center and was receiving nutritious food. The doctor requested a chest x-ray a few days earlier but it had not been done yet because the mother lacked the money. I gave her the necessary funds to get it done but seeing as it was Friday afternoon she would have to wait till Monday. Hang in there Deborah.

This past Friday, the 7th of October, I again went to Children’s. I met up with Deborah and her mom in the feeding center once again. The chest x-ray had been done and the diagnosis of pulmonary tuberculosis had been made. Thankfully she had been started on anti-tuberculosis treatment already and guess what? Deborah no longer had a fever when I saw her and was looking better already. Although she is still admitted, she’s on the mend. As long as mom continues giving her the treatment for the next 6 months, I think she has an excellent chance of full recovery!

July's snake...

Fortunately we don't see that many snakes here. But seeing as I recently blogged about a snake we killed not too long ago, I thought I would post a picture of the snake we killed in July. Any idea what type of snake? I really can't stand snakes. Part of the problem is not knowing if they are poisonous or not...but even besides that I just don't like them!

Snakeless nights...

Alright, just to add to my previous 'Snake' post...
The snake was actually found in the roof of my good friend Vez' room.
Scary thought, to have a snake living above you.
Pretty much above her bed, to say the least.
Even scarier, since 2 shed skins were also found.
I guess Vez was harboring a snake for some time.
Fortunately she never knew it was there until the day the snake was found.
She has been very clever and checked her ceiling for holes. : )
The 1 hole in the ceiling has been stuffed with a piece of paper (or was it tissue paper?).
That should do the trick!?
Let's hope for many more snakeless days and nights.
Meanwhile, we're scaring ourselves with Season 4 LOST episodes...

Snake...

This event took place in October of this year. After hearing that a snake had been spotted at the team house, some of our maintenance guys geared up and prepared themselves for the snake hunt. Long sticks, coveralls, goggles. They were ready.

After fixing the machete to the end of a long pole, making sure the camera man was ready, the kill began. I actually wasn't there but heard from a friend that the guys were pretty nervous. I don't blame them. How do you go about killing a snake? Well, a long pole with a machete at the end did seem to do the trick. And before long one of the guys moved closer to see if it was a done deal.

He then held up his prized possession, for the others to see. Seeing as I was busy saving childrens lives in the clinic, I missed all of the excitement at the team house. However, just a few hours later, one of my consultations was interrupted by one of our local staff saying, "Doctor, you need to go to the gate. There is a snake there." To which I questioned whether or not it was alive or dead, and upon hearing it was already dead, said it could wait." Of course, after finishing my consultation I made my way out to steal a glance at our kill.

To this day the question remains: what kind of snake was it? and was it poisonous?

US elections in SL...

Often I feel detached from the outside world. Take the US elections for example. It wasn't until I was driving home from work today that I heard a little bit about it on BBC World News. And of course my local staff was discussing their political views wrt Obama and McCain. I've missed the whole campaigning and work up towards today- maybe I should be thankful. I'm not much of a political person anyway. But still, I am intrigued. Elections are interesting. I suppose with the Sierra Leone elections last year we were more worried with respect to violence, corruption etc. Thank God all went well. I actually don't have much more to say except to post a piece that was emailed to me today - Sierra Leonean thoughts on the US elections. FYI: Bo is the second largest city in Sierra Leone, Makeni is a city about 3-4 hours drive from here. Enjoy...

"By Tia Miyaama (Political Correspondent)

It has been reported that the people of Bo Town are preparing to celebrate the victory of Barrack Obama, should the Illinois senator capture the White House on November 4th. The reason, the Paramount Chief announced, is that Barrack Obama's initials, B.O. represent their town and what they stood for. Bo (BO), the report continues, will fly the CHANGE flag all weekend and replace the green and orange flags with BLUE to represent the Blue States that voted for the African-American senator.

Meanwhile, it is reported the the people of McCaine-ni (Makeni) are planning a riot should their own candidate lose the US election."

Lack of blogging...

Seeing as I am starting to get comments about my lack of blogging I thought I better post something. What can I say? Life has been busy. Yes, there has been plenty to blog about, but little time to do it in. Too much has been going on. No explanation needed. But rest assured there will be more blog posts to read later this week. Coming soon: snakes, carrot costumes, beach trips, patient stories and more. In the meantime, if you would like something meaningful to read, why not try Luke 15. That's what I did my Sunday School lesson on today... "The Father who Waited"...