Saturday at Bureh...

Flying...

No, I am not flying anywhere at present. Although a trip back home to some snow sounds great. No, this has simply been a weekend in which I feel I am flying from here to there.

It started on Friday, leaving work at 4 pm (early for me!) and getting to the Spur Road office at 5 pm (traffic-free ride home!) After a few minutes of (slow) internet I walked the ten minutes to get home. I quickly changed and then headed down to Mercy Ships so that I could make it for their 630 pm dinner. Fortunately the taxi driver was going from Wilberforce to Aberdeen, meaning I did not have to change taxis at Congo Cross. Convenient! Traffic was crazy but I got to Aberdeen on time. After a lovely dinner (thanks to Aunty Fatu) it was time for a meeting. Six of us were meeting to discuss a Sunday school program for Sunday afternoon. We have invited 30 children from the Aberdeen community to come for Sunday school. So we had to rehearse a play we are doing and discuss songs, snacks, games, coloring sheets, etc. We were done by 830 pm. I chatted with some people and then headed off to the shower (since we still don't have water at our house). And at 930 pm my driver came to pick me up. I was so tired I was asleep by 11.

This morning I got ready and was out the door by 830 am. I took taxis down to Aberdeen and hopped into the Mercy Ships Landcruiser with 9 others and headed to Bureh beach. We decided to take the peninsula road meaning we drove through Lumley, Juba Hill, Goderich, Lakka, Hamilton, and past beautiful beaches like River 2, Tokeh and John Obey until we finally turned off at Bureh, 1 hour and 30 minutes later. The day was amazing even though there was a large beach 'outing' - busloads of Sierra Leoneans, loud music, lots of beer, and so very little privacy. We managed to find a spot that was a bit further away from the massive speakers. And we spent plenty of time in the water/sun.

I arrived home at 640 pm with just enough time for a quick bucket shower and turn around to head out the door again by 725 pm. I had a lovely dinner at Roy's with Hannah and Tim from the Africa Mercy Advance Team and was home by 1030 pm. It's now time for bed since tomorrow will be a crazy day.

I'll be flying from here to there again. First to church to help with Sunday school. Then to a supermarket. Then to Aberdeen for Sunday school there. Then to meet the family who lost a child at the hospital last week to pay my respects. Then to catch up with Thomas, my former lab technician, along the beach somewhere and then finally home.

Yeah, it's another busy weekend. But it's good. I definitely can't say I get bored here.

Happy Thanksgiving...

I’ll end the day with a list of 10 things I am thankful for today.

1. The lovely Thanksgiving dinner at the Aberdeen Women’s Centre this evening including turkey, mashed potatoes, gravy, cranberry sauce, stuffing and pumpkin pie!
2. The opportunity to work with Sierra Leoneans and join them in making improvements in pediatric care at the Children’s Hospital.
3. The little bit of water supplied by Guma Water Company every third day or so since it’s better than nothing.
4. Being able to use the Internet connection at the Aberdeen clinic in order to send the 12 MB hospital database to someone in Canada for reporting purposes.
5. Having an excellent driver who takes us to and from work and who I can always call in the evenings or weekends if I need a ride (for a little bit of extra cash).
6. The patients in the hospital that made me smile today.
7. Thankful for cell phones and text messaging.
8. That although my niece has been admitted to hospital, she is in Holland and not in a hospital here where I would worry about her even more. (Hoping she gets well quickly)
9. For my family.
10. And finally, for a network of friends here in Sierra Leone, both expats and Sierra Leoneans.

A difficult week...

This week is not over yet, but already it has proven to be a difficult week. One day this week 4 children died within a 5-hour period. It was a difficult day. I was actually only involved with two of the patients, and only towards the end. Still it was emotional. The magnitude of death was overwhelming.

As I walked through the corridor towards the Emergency Room I passed a mother and aunty wailing. They were frantic. I assumed that either a child was dying, or had just died and thought I better check if anyone needed a hand. I went into the very low-tech ‘intensive care’ unit with over 30 patients and saw the VSO doctor and nurse resuscitating a child. After checking the blood sugar and getting an airway for the child we assessed what could still be done; unfortunately, not much. The child was on appropriate medication, on oxygen and receiving emergency care at the level at which it can be offered at the Children’s Hospital. What more could we do?

Silently the father sat nearby. Watching. Waiting. There was nothing he could do either. We soon realized we had to come to terms with the fact that we could not save this child. He died. As we went over to condole the father, tears welled up in his eyes. He was speechless. The aunty, who had been looking on during the resuscitation, started wailing again. Another 5-10 minutes later the child’s mom came in. Her wailing was ear piercing. I cannot begin to describe it. It was pure, raw emotion. It was the sound of a mother losing her beloved child. Watching the mother grieve over her child and seeing the father in a trance brought tears to my eyes. On the bed opposite the patient sat a mother cradling her own child, tears rolling down her face. Other mothers were trying to encourage the distraught mom. And as I listened to what the mom was crying out I sensed her desperation. “I have given birth to two sons, and now I am left with none.” This mother had already lost a child. Today she lost another. Heartbreaking.

Around the same time, a mother and child came to the Emergency Room. Two months ago the child was referred to the hospital due to severe malaria but made a quick recovery. This time the child was referred due to convulsions and pneumonia. He was seen by the doctor in the Emergency room and commenced treatment. Four-hours later I saw him again, looking worse. His breathing was very labored and he was very irritable. It was worrying. The doctor reassessed him and the care available was continued. I left there that evening not knowing if he would pull through or not. Sadly, the next morning I found out he had passed away. I felt awful. I knew that another family was grieving the loss of their child. And I felt it even more since it was a family I knew. I questioned everything that had been done, wondering if we could have done things differently. I do not know that we could have. For some incomprehensible reason, this child passed away.

Working at the Children’s Hospital is tough. It is challenging to deal with the constraints, difficult to cope with the deaths and frustrating managing the slow pace. There is still so much to be done. Yes, the hospital has improved greatly since I first arrived in 2005, but the road is still long. Fortunately, working here can also be rewarding. We have some great projects underway, such as the development of the laboratory services and starting up a postgraduate training program in pediatrics for doctors. And yes, children do get better everyday. While attempting to resuscitate the boy, the little girl lying next to him on the same bed was struggling to fight meningitis. Now, two days later she looks much better. Likely she will survive. And that is our aim; improving pediatric care so more children will survive. That is what I am going to hold on to for the rest of this week.

Ministry, treks through town, phone numbers and nonsense...

Last Friday our driver had the day off. So, one of my colleagues (bravely) said he would drive. However, plans changed a bit. An 8 am meeting on the west side of town lasted till about 1030 am. At the same time I was summoned to the Ministry to get a document signed for the release of a container. My colleague who was scheduled to fly back to the UK that evening decided not to go across town to the hospital but stay on the west side and meet up with the specialist-in-charge there. So, I said he could drop me off at the Ministry and I'd take transport from there.

I went up to the 4th floor and met a lady from the company in charge of getting the container released. Seeing as the container has been in port since September and they still had not managed to get clearance, I was not impressed by this company. Anyway, the lady was not very professional and the mere fact that I was requested to come to the Ministry by this company to get their documents signed seemed a bit crazy. However, if that is what it would take to get the container out of the port, well, then that is what I'll do.

Unfortunately the Deputy Minister of Health just stepped out of his office and his secretary was not sure if he went out for a meeting or not. I realized this could mean a long wait. Fortunately about 20 minutes later, the Deputy Minister reappeared, but then disappeared again into his office. At least I knew of his whereabouts. Minutes later a Ministry official walked by who knows me from my Mercy Ships days and greeted me. I mentioned my reason for being at the Ministry and he was quick to move into action. He went into the Deputy's office and came out 5 minutes later saying the documents had been signed. It really is who you know and not what you know. Thanks Y. We were now one step closer to getting the container out of port. Having said that, the container is still at the port!

I then had to find a taxi to take me part of the way to the hospital, knowing that I would be better off walking the last 25 minutes due to heavy traffic on the east side. After about 5 minutes I found a taxi heading to PZ and hopped in. The other customers were very friendly and pleasantly surprised that I had a grasp of the public transport system. And of course, one of the men asked for my phone number. I 'politely' declined.

After a 30 minute (slow) taxi ride I got out and ventured through the downtown streets on foot making my way down Goderich Street, past Eastern Police, along Kissy Road and down Patton Street until I reached the hospital. On my way I bought two 250 ml bags of water. I was walking in the heat of the day and feeling somewhat dehydrated which made me wonder what would happen if I fainted on the street. Would people stop to help? Would my backpack (with laptop) get stolen as I lay there passed out? Would they take me to some dodgy pharmacy or clinic? I quickly guzzled down the bags of water and kept walking, reaching the hospital in a very sweaty state. Phew, I made it.

By this time it was 1 pm on a Friday afternoon and I had a number of things I wanted to get done. I rushed around and did as much as I could knowing I would have to walk back to the center of town and take public transport home. It was 545 pm by the time I left the hospital after sorting out medical records issues and meeting with the lab technicians.

The crazy thing is that on Saturday afternoon I had to go back to the hospital. So I did the whole thing again. Took a taxi from my house to Congo Cross, then a poda poda to Goderich Street and then walked to the hospital. And did the same in reverse order 4 hours later. I must say that 4 such treks in a 28 hour period is a bit much. By the time I reached the poda poda stop Saturday afternoon I was ready to be home, away from the crowd. I almost got pick pocketed, had numerous men ask for my phone number, had to dodge a thousand cars/carts/dogs/people etc. and had to endure a great variety of 'white man' comments. In the end I couldn't be bothered to engage in a conversation so I was short, to the point and basically ignoring the person next to me in the poda poda. That is, until I found out he works at Roy's, a nice restaurant/bar along Lumley beach; a beautiful spot for a Friday evening or Sunday afternoon. Seeing as I would likely see him again at Roy's I thought I better be nice and talk.

During the very next taxi ride, a similar thing happened, except this time one of the guys recognized me - he works at Bliss Bakery. We had a nice chat but him recognizing me still did not warrant a phone number exchange. Later that same evening as I headed to O'Casey's for dinner a guy on the backseat of the taxi (next to me) tried to convince me that we must be friends and he must have my number. I politely declined saying I didn't know him and wouldn't just hand out my number. But, like many men here, the response was 'if I have your number I can call you and get to know you'. No thanks. Funnily enough he then tried to convince me that because we were both on the backseat of the taxi, we were friends and supposed to exchange details. At this point the guy sitting in the passenger seat in the front joined in and also tried to persuade me that I needed to become friends with my backseat companion. Backseat passengers become friends. And front seat people become friends. Sounds logical, right? It was a load of nonsense of course but fairly entertaining. The best part being when the guy in front got out and asked for my number even though he wasn't sharing the backseat with me. My response this time was 'no, sorry, you're not on the backseat'. I was happy to be picked up by Farah, my very reliable taxi driver, later that evening. No nonsense, just normal talk.

Lessons learnt: Don't walk to the hospital and back two days in a row. Make sure you have Le 200 (USD 0.05) for a bag of water at all times. Get connected to people in the Ministry- it's who you know, not what you know. Never trust a company that says they can have a container out of the port in a few days. Always be cordial to fellow passengers (you might see them again). Don't give your phone number to anyone, not even your fellow backseat passenger friend.

Prospects and challenges of an x ray department...

The Ola During Children’s Hospital is close to having the x ray unit up and running. This is very exciting especially since it has been 6 years since the last x ray was taken at Ola During Children’s Hospital. Can you imagine a hospital without x ray services?

Presently children need to travel across town to Connaught Hospital for x rays. This is often a three-day process. The child receives an x ray request form on day 1, goes to Connaught very early in the morning on day 2, and goes back to Connaught on day 3to pick up the x ray and report. This is an obvious delay in the diagnostic process. Also, for very sick children, having to travel across town is simply not possible because there is no way to transport them safely, especially if they are in need of oxygen. Clearly, there is a need for a functioning x ray unit.

The new x ray unit will complement the ultrasound services in forming the radiology department shared between Ola During Children’s Hospital and Princess Christian Maternity Center.

In June the Ministry of Health and Sanitation promised to deliver an x ray unit to the hospitals. Honestly, I was a bit skeptical. However, they kept their word and mid-July an x ray machine was delivered to the radiology department. Step one was complete. The next step: assembling/installing the unit. This took longer than expected, but was a success. The next hurdle was to connect the new processor to the water supply. Unfortunately this proved too difficult, in part due to lack of high quality plumbing but also due to the poor water supply at the hospital. It was decided that for now the old processor would be used until the water situation has improved.

Now that the x ray unit is ready for use, the department is faced with the biggest challenge yet, namely, the lack of x ray films and developer and fixer solutions. The government supplied central medical store is in short supply and it is uncertain when or where the next stock will come from. To further compound the problem, Connaught hospital can now only give 10 children access to free x rays per day due to their limited supplies. Of course, one can still pay for an x ray but the majority of the families do not have the Le 30,000 – Le 40,000 ($8-10) needed for one x ray. Yesterday there were three children in the feeding center needing chest x rays who have already made the early 5 am trip to Connaught two days in a row and been turned back because the 10 slots for free x-rays for the day were already used up. This is a bit of a dilemma.

So, now I sit here wondering where the supplies will come from and how this department will be sustainable? Will the Ministry step in and be able to help with a constant supply? Will the hospital need to find funds to buy films and solutions from Guinea or possibly even the UK or USA? Will the hospital be able to provide free x ray services for inpatients or will it be on a cost-recovery basis in order to generate income to purchase more supplies? And what is the role of the non-governmental organizations (NGOs) in this? If the NGOs help with the initial supply, how long must they continue supplying and who will sustain this? It is a dilemma and I am afraid I do not have a solution.

So, if anyone does have a solution, feel free to comment. And if anyone out there has a never ending supply of x ray films and solutions that they could deliver to the door of the hospital free of charge, you would be more than welcome to do so.

Let’s hope that the x ray department starts functioning soon. It will improve clinical care for the children and it will also bring the hospital one step closer to accreditation as a teaching hospital. Ola During will move forward one step at a time…

First posted on BMJ

Water...

On Saturday morning I decided to do some hand washing. Unfortunately, half way through the process, the water ran out. Water don don. I thought it was a simple matter of someone forgetting to turn on the pump to pump water up to the tank on top of the house. However, I found out it was much more complicated. Not only are we being supplied with less water, but someone managed to damage the pump. So, there I was, without water. You would think I would have had water stored in preparation, but no. Seeing as we have had water non-stop for the past 5 months I didn't think it would be necessary.

It is amazing how much water I use without even thinking about it. Water for washing clothes, taking a shower, flushing the toilet, drinking, hand washing. I literally use water all the time. While preparing food in the kitchen I realized how often I actually wash my hands (which is a good thing I guess) because I kept turning on the tap to start washing my hands and faced with the 'no water' issue rather quickly.

Not being able to wash the dishes was annoying. Not being able to rinse my soapy clothes was a bit frustrating. And not being able to flush the toilet is just not pleasant. Fortunately on day 2 we were able to get 3 buckets of water to aid our situation. Not much, but better than nothing. I was also fortunate to able to shower at other people's houses on Saturday and Sunday.

In the end, I really can't complain. All I need to do is look at the world around me. I have neighbors who have to walk and collect water everyday, and have probably done so for years. There are children on the street that have to carry buckets of water on their heads multiple times a day. There are people who have to live without running water every single day. And they manage. They have to. So, although I hope we have water again soon, this has been a good reminder of how many people here (and in many places in the world) live. Let's remember that water is a precious commodity. It should not be taken for granted.

If you want to be a part of bringing clean and safe drinking water to people in developing countries visit:www.charitywater.org

Return to Freetown...

Return to Freetown - Wednesday 20 October 2010

Gone for 20 days, back for 3 and I feel like I have never been away. It’s good to be back.

I must say, at the check-in in Heathrow I already felt like I was well on my way to Sierra Leone life. Literally while checking-in, a Sierra Leonean joined me at the desk and started discussing his own check-in details with the lady. No space, no privacy. Honestly, the same has happened to me in the bank here in Freetown while trying to sort out Welbodi finances.

Later standing in the immigration line at the Lungi airport watching a few people being whisked to the front of the line, I remembered quickly that it is who you know that is important not what you know or maybe it is how much money you are willing to pay someone. I suppose this happens everywhere.

The baggage claim was hectic as usual with huge crowds waiting for their luggage. Surprisingly no one came to me to help with my bags. I didn’t mind because it can be a little annoying to be pounced on right away so I simply waited. Once I spotted my suitcases I did ask someone to help me, to make things easier. Why not ask someone to help out and pay them a couple thousand Leones for their services?

The wait for the shuttle to the Pelican Water Taxi was chaotic, which has not been the case in the past. I soon found out that there was no helicopter service that day and everyone was trying to take the water taxi across. Rather than pushing my way into a van I decided I might as well wait for the next shuttle. It was interesting seeing a bunch of expats force their way into a van, much like the Sierra Leoneans push their way into poda podas. It’s shocking how quickly people lose their friendliness in these situations.

While waiting for the next shuttle I chatted with a couple of expats and Sierra Leoneans about life in Freetown. It’s always interesting whom you meet. A Sierra Leonean veterinarian, an expat vet coming to visit for a few weeks, a doctor from Central America, an airport porter, a business man. We finally got in a shuttle and off we went.

Unfortunately when I arrived by boat at the Freetown side, I found out that my luggage was still on a boat at the Lungi side. Time to get used to being very patient again; something I have never been very good at. By this time it was 11 pm and I was ready to go home. After a good 45 minute wait the boat arrived and I headed home in my reliable taxi driver’s taxi.

I awoke early the next day to leave by 650 am to head to the hospital where I was greeted by many familiar faces. It was good to be back. It was back to business very quickly as I had to sort out container issues and other fun stuff. Unfortunately the reality of children dying became evident very quickly as well. In the first two days of being back I witnessed two deaths and know of two others who died in the night. That is one of the difficult sides to being back. Children dying. Mothers wailing. Hospital staff disheartened. However, this does in part reflect the reason for me being here; to try to contribute in some little way to improving child health in this country.