Calling from Africa...

The plan was to talk to my parents on the phone using skype tonight.

Me in Sierra Leone and my parents in the USA.

Unfortunately it was not an easy task.

First of all we have had national power all day but it has been cutting out every 10 minutes.

I tried to watch a movie in the afternoon but had to restart dvd every 10 minutes.

I decided to request 2 hours of generator time so that I could use internet.

And planned to call my parents during that time.

However, that’s when my computer started acting up.

First of all my headset gives me trouble- skype does not recognize the microphone.

So when I call someone, they cannot hear me.

After about 30 seconds into the call I get a signal to change a setting and then it works.

So, I got that sorted but then next thing I know though, my computer freezes and I have to restart it.

It stayed frozen for an awfully long time and I wasn't able to restart it initially.

Twenty minutes and a bit of worrying later I try to call my parents again.

We managed to get it about 7 minutes of conversation of which I could only hear every other sentence.

Highly frustrating.

I hung up and tried again.

4 minutes into that call, in which the connection was still very bad, our power goes off.

The guards switched off the generator and we were back on National Power.

I tried calling again.

At least this time I could hear my parents but then the power fluctuations started.

From that moment onwards the power went off and then on again about every 2-3 minutes.

So, in the end I actually called my parents 9 times.

Basically in a time span of 22 minutes I made 7 calls with an average of 98 seconds per call.

The shortest call was 8 seconds, the longest was 2 minutes and 23 seconds.

Not much time to get a whole paragraph or words in there.

So, despite many efforts, in the end, we still haven’t really talked.

We will try again tomorrow!

Hopefully we will be on generator or national power will be better behaved.

(PS: I will be impressed if I can get this entry posted on my blog tonight!)

Why oh why...

I ask myself this question over and over.
I also ask my patients’ parents this question over and over.
Why oh why do they not take their children to a decent hospital sooner?
The most common answer: no money.
Other answers: aunty said to try syrups first, father said to go to the pharmacy, the father was upcountry and so the mother was waiting for his return to get money, decided to go to a nurse’s house first, and the list goes on.
Basically there’s never really a good reason.
Granted, many clinics are not great here.
And the city is overloaded with pharmacies who love to do business.
But it’s still not a great excuse.
There’s our clinic, a few other decent clinics, a Children’s hospital and NGO hospital.
No need to sit around and wait till the child is ‘sick past mark’!

Today a mom came with her almost 2 year old.
She’s brought her to the clinic at least 2 times previously.
They had gone upcountry for a month and returned to Freetown exactly 3 weeks ago.
On arrival in Freetown the child became ill.
How long did it take her to come to the clinic?
Three weeks.
Why?
Because she had no money to come to the clinic.
What did she do instead?
She went to a pharmacy where the child got half the dose of malaria treatment needed!
Now, after being sick for three weeks the child has an Hb of 4.0 g/dL.
She is ‘white past mark’ and needs a blood transfusion.
How much did the mom spend at the pharmacy?
At least Le 5,000, if not more like Le 15,000.
How much would she have spent at our clinic for consultation, lab, medication?
About Le 2,500-3,500 - total!

Another mother came with her 5 month old.
He has had boils and a fever for some time now.
Why did she not come to the clinic sooner?
The aunty said to go to a pharmacy first and try syrups, so she bought ampiclox.
The child’s fever continued so she finally came to the clinic.
And yes, the child had a few boils left, but surprise, the blood also showed 3+ malaria!
Again, why didn’t she just come to the clinic to begin with.
Do these people not realize that the pharmacies here are run like business.
The more medications they sell, the better.
No prescriptions are needed here, basically the employees decide what meds to sell!
So, yes, the syrup from the pharmacy can sort out the boils.
But in the meantime the malaria parasites are increasing by the day!

Why oh why do they wait so long?
They end up wasting so much money on medications bought from nurses and pharmacists.
When what they actually need is a decent consultation, lab tests and specific medication.
It’s no wonder so many children die here.
Parents keep them at home so long trying all sorts of things at home until their child is ‘sick past mark’ and then rush to the hospital, often too late!
They wait so long that either they end up spending a lot of money once the child is admitted or they wait so long and the child is dead.
When will they learn?

Makes you wonder...

Sometimes the cases I see make me wonder what is really going on.
They're definitely not all straight forward.
These are just 2 examples.
The picture on the left is a little girl who had swollen hands and feet 2 months ago.
After a month or so the swelling on her left foot 'burst'.
A week later the mother noticed a bone protruding from her foot.
I wondered if it was her bone, or a foreign bone.
Her own bone that has protruded due to osteomyelitis?
Possible a piece of bone stuck in her foot to heal it traditionally???
The picture on the right is the xray of a 7 year old boy.
He has had 'piss problems' for over 2 years now.
This boy is in severe pain every time he urinates.
To the point of having to lay on the ground in agony as he pees.
He had a very bad urinary tract infection which I treated.
But his symptoms remained.
I could only think there was some sort of obstruction.
I referred him to the urologist, or 'piss doctor'.
His next step was an xray.
Is this very round object the cause of obstruction?
The father was told this was a coin.
I'm thinking maybe bladder stone, but it's awfully round???
Again, is it something put there by a traditional healer?
We'll see next week what the urologist had to say about it.
Everyday definitely has it's unique cases!

My pets...

A gift from one of my patients- Namina with cancrum oris.

I've known Namina since January and seen her a couple of times a week.

I was very surprised when I heard that she and her mom had come with a gift.

2 chickens.
The chickens now live at the team house.

Sometimes tied up, sometimes free to roam.

I must say they really are 'chickens' seeing as they scatter anytime I come near.

I'm not quite sure what they are so afraid of.

But then again, maybe they are worried about ending up in a pot.

And to be honest, if they keep making such a racket in the morning waking me up,

That is just where they might end up...in the pot.

Only 32...

Yay.
Clinic re-opened today.
And although I only saw 32 patients, it's better than none!
Not as many as usual of course, but it's still more than I saw all of last week.
It was good there weren't as many kids waiting outside because it gave us some time.
Time to make more entries into various record books.
Time for me to enter my prescriptions into the computer after each patient.
Time to cross-check the dispensary and reception entries at the end of the day.
Time to count the money in the cash box at the end of the day.
It will take more time however to mend the heart and build up trust again.
But for today I am satistfied.

Sunset & Shrimp...

The week was long.

The weekend was more than welcome.

Although lots of work needed to be done, there was also time for play.

We went and watched the kids at the SOS disabled village play football.

And then headed to Alex's for a meal.

Deep fried shrimp and chips.

Yum.

And a beautiful sunset to top it off.

Yay for some time to relax.

May day...

For the past week now I feel like I am calling out 'may day may day may day'.
Yes, this is a time of distress.
Exactly a week ago I was in my office checking up on some of the record keeping.
To my surprise, actually I was shocked, I noticed false entries in the medication book.
Much more medication was being written down than I was prescribing.
May day may day may day.
This was cause for alarm.
Sure enough, records were being falsified.
Not once, not twice but many times over and over.
Sometimes numerous times on one day.
It was a good cover up.
Taking drugs and making sure the books reflected the deduction as if I prescribed them.
Adding medications in the book for a patient who I only gave a few meds to.
Changing the amount I prescribed for a patient.
Writing medications under the ID of patients I sent elsewhere without meds.
Or under the ID of patients I hadn't seen in the last 1-2 years.
Clever.
And it has been going on for a long time.
After confrontation, dismissal and catching meds in someone's purse it was not yet over.
More people were accused of being involved.
Everyone denied.
Who to believe?
How can you trust, when someone you have trusted for 4 years has betrayed you?
Why do so many people here seem to think it is alright to steal?
Because we are white?
Because we have more than they do?
It's definitely a different set of ethics here.
Anyway, it's been a tough week.
Here I am supposed to be treating children and I am stuck writing warning letters and cross-checking records.
I have seen less patients this entire week than I usually do in one day.
Just think of all the children that have been sent away at the gate this week.
There must be a reason for all of this.
In the big picture it must make sense.
But I just don't see it right now.
However, I know that God will work through this and I will grow because of this.
But it is not easy.
Not easy for me.
But then, it's not about me; it is about Him.
And even through this, He can be glorified.

“Not to us, O Lord, not to us but to your name be the glory, because of your love and faithfulness.” Psalm 115:1