Queens Day 2011...

Today is Queens Day in the Netherlands. But I am in Freetown and I'm afraid there's not much going on here in the way of Dutch celebrations. It's still full on Independence here. So, I'm thinking of my friends and family having a great time back home - decked out in orange and enjoying the festivities outdoors.

It's quite funny this year with Sierra Leone's independence, the British Royal Wedding and Queens Day all being within a few days of each other. Makes me realize how patriotic people can be. And although I didn't care too much about the royal wedding, I did enjoy seeing a glimpse of the procession in one of the doctors offices yesterday. And I am reminded today of how excited I was last year to be within meters of Queen Beatrix in my hometown.

Anyway, I hope all of my Dutch friends have fun today. I am hoping I'll feel a bit better this evening to catch a glimpse of the lantern parade here in Freetown - the final Independence event I believe.

(see post from last year: Koninginnedag 2010...)

Independence Day at Charlotte Falls...

I decided to spend Independence Day with friends at Charlotte Falls. Actually, our first stop was halfway up the road to the Chimp Reserve for a quick hike up the ‘Butterfly trail’. It was a lovely walk but there were not a whole lot of butterflies! It was so peaceful though.

We then continued to Charlotte village. My friend decided we should take the second turnoff- supposedly less steep than the first turnoff. Well, it was still pretty steep and it was all loose rock. After getting stuck, we switched drivers. After a few minutes, when it seemed the land rover might just tip over, those of us in the back got out. The problem was that there was a deep crevice in the road, filled with some loose rocks. While trying to get the back tires out of the crevice, the vehicle kept sliding, lifting the back left tire about a foot off of the ground as the right tire went deeper into the crevice. It looked pretty scary but the driver continued to maneuver her way down hill- slipping and sliding over the rocks. Finally, the land rover made it to the bottom. When we reached the bottom on foot, we heard that part of the problem was that the handbrake was left on. No wonder they slid all the way down! It’s yet another story to tell.

We were quickly joined by Akim, our guide and headed to the falls. On our way we passed the chief’s house where they were having a big Independence celebration. Everyone was wearing green, white and blue, music was blaring, and people were enjoying food and drinks. Perfect.

The falls were great, even though there wasn’t a whole lot of water flowing. That’s what happens towards the end of dry season. There was still plenty of water in the pool though and we enjoyed a quick swim after our picnic. We were later joined by people from the local TV network who wanted to film us and talk about development. We were maybe too honest in saying we didn’t want the place to develop further – we liked the fact that we were in the middle of nature! Charlotte falls really is a beautiful place.

Friday...

It's Friday, 2 pm. This is exactly what I feel like doing.

A few hours to go and I'm heading back to the West side.

I'm looking forward to a weekend away!

Independence Eve in Sierra Leone...

The plan for the night (according to the schedule) was Carnival and Fireworks at Lumley beach, starting at 9 pm. I assumed that the festivities would start around 9 pm like they did on Sunday night and that the fireworks would kick off at midnight.

So, my colleague and I headed down to Lumley beach decked out in green, white and blue. We were ready for a party. The plan was to head to Montana’s on the beach and meet up with some more friends and then join in with the Saloneans to celebrate.

Well, the night did not quite go as planned. We ended up sitting at Montana’s with about 30 expatriates, waiting. Surprisingly, beach road was not crowded at all. The road was not blocked off like it was Sunday night which actually made it easier for everyone to get transport. However, I actually quite liked the street festival vibe on Sunday evening and was hoping tonight would be even more spectacular. There must have been a party elsewhere that someone forgot to tell us about!

My colleague’s friend was due to arrive tonight from the UK and so at 10:30 pm we headed to the water taxi to pick her up. We walked along Lumley beach road, which was still really quiet. No partying going on, but again, this meant we easily found a taxi. The friend arrived at 11:15 pm and decided that instead of heading back to the beach, we would head home. After all, it seemed more and more unlikely that there would actually be fireworks. And if there were, we would see them from our house.

It is midnight. HAPPY BIRTHDAY SIERRA LEONE!!

I never did see fireworks tonight, and it didn’t sound like much partying was going on, but it was still an enjoyable evening. People must either be partying elsewhere or getting geared up for the 7 am parade tomorrow! Of course, on our street, the music has piped up and the party has started. I think the music may just go on all night. For me, it’s time to sleep. I’ll continue the Independence Day celebrations tomorrow! And I am sure that tomorrow there will be a lot going on…

World Malaria Day 2011...

Today is World Malaria Day and unfortunately, although a preventable disease, malaria still kills many people in the developing world. At the children's hospital I work at, we see malaria cases everyday. Some cases are very severe; the children are literally on death's doorstep and other cases are mild and improve with oral medication. As you can imagine, the disease has a major impact on child health in Sierra Leone.

In November of last year, we had 999 inpatients in the hospital and in that month (as often is the case) malaria was the most common reason for admission, followed by chest infections, diarrheal disease and anemia (unrelated to malaria). Sadly, children die at the hospital on a daily basis. In November, 54% of the hospital deaths were attributed to malaria. In November 67 children died at the Children’s Hospital as a result of complicated malaria. We obviously have our work cut out for us. Having said that, I do believe that the staff at Ola During is working hard to do their part in combating malaria. The staff, management and partners of ODCH and the Ministry of Health and Sanitation must be commended for their ongoing efforts to improve healthcare. The laboratory has definitely improved and more blood smears are being examined for malaria. Thanks to one of the partners in the hospital, malaria treatment is readily available. Improvements in the triage and emergency system mean that children receive their treatment more promptly. There is still a lot to be done, but progress is being made.

The theme for the fourth World Malaria Day is Achieving Progress and Impact. The theme recognizes the international community's renewed efforts to make progress towards near zero malaria deaths by 2015. We’re not there yet, but I like to believe that things are improving. Hopefully the country of Sierra Leone can tackle issues like: distribution and use of insecticide treated nets, prompt diagnosis, appropriate treatment, etc. Various barriers play a role, such as: cultural/traditional ideas impacting use of nets and quick presentation of child to a health facility, lack of experienced laboratory technicians, lack of rapid diagnostic tests, inconsistent supply of ACT medication or quinine, etc.

Hopefully, health education in the communities, training in health facilities (lab and medical staff), and improved supply chain will decrease the number of deaths related to malaria in Sierra Leone. The day that there are near-zero malaria deaths in the country will be a day to celebrate for sure. Count me in…

(see: http://www.worldmalariaday.org)

Beach road festivities...

Lumley beach is apparently the happening place this week. Last night they had a massive party there. When I went to the beach this morning at 6 am for an Easter sunrise service there were hundreds of people walking from the beach towards Aberdeen. I guess a lot of people didn’t sleep last night!

This evening, after dropping off my colleague’s parents at the water taxi, we headed to Lumley beach. I was curious as to what the atmosphere would be like. We went to Roy’s for a drink. Initially the beach wasn’t too busy. However, the road was blocked off just past the helicopter road turn off and no vehicles were allowed onto the main part of beach road. That is, no vehicles except for the occasional VIP, or ‘someone who knows someone’ type of vehicle and of course the Ambulance. The ambulance drove up and down the road with siren on for no apparent reason. Patrolling? Driving around VIPs? Picking up people who have fainted? Who knows? It seemed like ‘a lot of noise, but little action’. And I almost hate to say it, but that sometimes seems like a common theme. Anyway, it was great to have a whole road to walk on, except for dodging the occasional okada (motorcycle).

After Roy’s we decided we would venture a little further to see what was happening at Montana’s- where we had seen a pretty big stage the day before. Sure enough there was a bigger crowd there. And actually, the road was much busier with people too. I have to admit that there was a great atmosphere there. Everyone seemed happy and friendly. There were many stalls on the side of the road selling drinks, biscuits, street meat etc. It really resembles a street festival at home. I ran into a former patient and his mom, as well as a former lab technician of mine. It’s fun to run into familiar faces. When we reached the stage there was again a lot of noise from the stage and little action – Airtel; one of the mobile networks was doing some kind of promotion talk. People seemed fine with it though. We stayed for a bit and then headed back. We took a fabulous taxi from beach road to Congo Cross with a built in DVD player/screen and watched Michael Jackson video clips during our journey home. We changed taxis at Congo Cross and then walked the last bit up Cemetery Road to our house. It was an enjoyable evening.

Rumor has it that Tuesday’s events will include live bands and fireworks. That’s Independence Eve folks and I think we’ll try to be there. Of course, there will be hundreds of people there, and so to the concerned ones out there, don’t worry; we’ll do our best to stay safe. If the crowd gets out of control, we’ll head home. It’s just hard to pass up the 50^th Anniversary celebrations.

Quick update on Namina...

Almost 6 weeks ago Namina was admitted onboard the Africa Mercy.

I was able to go with her for her admission and see a good portion of the 4-hour surgery two days later.

I've been to visit Namina multiple times a week, first on the ship, then at the Hope Center.

She is recovering well and at the same time picking up words of Krio and English and becoming quite active and a bit troublesome : ) .

More on Namina very soon.

(Photo by Debra Bell)

More on Namina here and here

Independence Day in Sierra Leone...

After more than 150 years of British colonial rule, Sierra Leone won its independence on the 27th April 1961. At the stroke of midnight, Sierra Leone’s green, white and blue flag was displayed for all to see and the new government, led by Prime Minister Sir Milton Margai, was welcomed.

Now almost 50 years later the celebrations have begun once again. A month ago the first signs of a pending 50^th Anniversary Celebration appeared in downtown Freetown. Now the city is filled with decorations: from green, white and blue bunting to flags waving in the breeze, from bracelets and other jewelry in the national colors to banners wishing Sierra Leone a happy anniversary. And since a few days the actual celebrations have begun.

On Wednesday the entire republic of Sierra Leone will celebrate 50 years of independence and because of this, I believe most, if not all, of next week has been declared a public holiday. Everyone is celebrating. There are celebrations on Lumley beach every night this week, masquerade parade through town, a lantern parade, football matches, fireworks, etc. I’m sure there will be enough to do, he trick will be avoiding crazy crowds and dodging traffic.

One thing I have been wondering is what Sierra Leone was like 50 years ago. Was it in a better state at that time? I’d love to travel back in time and see what the streets of Freetown looked like in 1961. To sit in a school and experience the education at the time, to go to the Children’s Hospital and see what the health care was like. As you know, an 11-year long war destroyed much of the country and the country is still struggling to recover. Yes, there has been progress and hopefully that will continue. However, it seems as if there is still a very dependent culture; a dependence on non-governmental agencies and other foreign aid. My hope is that the 50-year celebrations will inspire Saloneans to stand up and change their nation. I want them to feel empowered and realize that they can make the difference. Hopefully the national pride displayed this week will transform into a strong will for individuals to make this country a better place.

Amazing grace...

At Easter we take the time to reflect on the sacrifice Jesus made. We think about how He died on the cross, for our sins. Watching 'The Passion of the Christ' on Friday was a vivid reminder of the suffering that Jesus went through. He went through some serious torture before His death on the cross. And he did that for us. In the movie they show Mary the mother of Jesus and Mary Magdalene looking on as Jesus is beaten. Can you imagine how Mary must have felt? Her son, the one who reached out to others, healed others, raised people from the dead, now seeming so powerless. Yet He did have the power. It was a matter of timing and completing His mission.

As passerby's yelled out "You who would destroy the temple and build it in three days, save yourself! If you are the Son of God, come down from the cross", Jesus remained silent. It was not yet time. Because of His great love for us He had to give in to death. On the third day though, His power enabled Him to overcome death through resurrection. Imagine how utterly amazed the Mary's must have been when they saw Him again. They must have been shocked. I can't even imagine. I wonder how long it took the disciples to grasp what His death adn resurrection meant for their lives and their futures. I still find it incomprehensible at times.

I'm very thankful for the amazing grace we have been shown. His power over death has brought us life. We are now truely free and this is something we must remember everyday.

Amazing Grace: Life. Freedom. Hope for the Future.

Easter eggs in Sierra Leone...

My good friend Sarah invited me over to the Aberdeen Women’s Centre Monday evening to decorate Easter eggs. It’s a tradition and it’s fun. And boy, did we have fun!

I actually ended up spending all day at the office in Wilberforce because people we arranged to meet with between 8 and 10 am did not show up till 2 pm. It’s a long story and it was most definitely African time. It was frustrating not to be able to get to the hospital, but at least it meant I would be home by 5pm. This also meant I could go to the Aberdeen Centre on time and join them for dinner! Usually I’m not home until 630 or 7 pm.

After dinner we went upstairs and boiled the eggs. Then the decorating began. This was definitely not the traditional decorating – no paints, no pastel colors, no designs. We actually ended up making egg characters. And in the end we somehow ended up with a wedding party, including a bride, a groom, a ninja jellyfish, a bunny, a royalty, a smiling face and a happy Easter face. It was quite the collection of egg characters.

We did not have time to re-enact an entire wedding but did do some wedding party shots in various places around the compound. We laughed a lot and that was so good! I think everyone else thought we were crazy. We decided we should get together and be creative more often! It’s quite therapeutic, good fun and wonderful to spend time with friends.

I know Easter is not about the eggs but we did have fun. And while we were out taking pictures, laughing and being crazy I couldn’t help but feel a great sense of freedom. And thinking about it more, and reflecting on Good Friday today I realize again what an amazing gift we have been given- the gift of life, the gift of freedom.

Happy Easter!

Tokeh beach...

After spending two weekends working/at the hospital I decided it was time to head out and so last weekend was spent at Tokeh beach. It was nice to have a real break from work and from Freetown.

We did have an interesting time getting to Tokeh. First of all 'cleaning Saturday' caused a bit of a delay. For the past month or so the government has enforced a cleaning morning every Saturday to make sure the city is clean for Independence. This means that from 6 am to noon no one is supposed to be out and about- you either need to be cleaning your compound or cleaning the streets. Well, we headed out at 11 am (because previous Saturdays cleaning always finished by about 10) but there were no taxis. We decided to walk down to Freetown supermarket on Wilkinson road - about a 25 minute walk. We would meet up with the rest of the group there and do some shopping for the weekend. We reached there by half 11 and met one security guard and a locked shop. So we waited. By 12 the shop opened and friends arrived. We then slowly headed towards Lumley to pick up more people and off to Tokeh we went. We were able to use a taxi from Tokeh which was great except for the fact that the door kept falling off. Oh Salone. At least no one fell out.

The beach was lovely. Surprisingly, although there was an evening/night outing (with loudish music), it seemed very peaceful. To be honest, it was still less noisy than my neighborhood. We had loads of fun. The guys took their drinks into the ocean and tried to tackle the waves without any spillage. They later had a sword fight with burning sticks from the fire. Boys will be boys and for once we were outnumbered - 5 guys and 3 girls!

I slept terribly- on the hard sand but it was amazing to wake up to the sound of the ocean and the cool breeze. After a fabulous breakfast we walked to River 2 and swam in the river. After catching up with some friends at River 2 we headed back to our campsite and by early afternoon we packed up and drove to Franco's for a seafood lunch before heading back to Freetown. It was a successful weekend and I must remember to go camping more often!

Abubakar...

While walking to the ship yesterday evening a mother stopped me on the road.

"Can you help my child?"

I asked to see the child.

She pulled a wasted 2-year old off of her back and said "here".

The child was obviously malnourished and quite pale.

He was not an emergency case, but I definitely wanted him seen sooner rather than later.

I asked why she had not yet taken him to the hospital.

Apparently she only arrived from upcountry the previous day.

I urged her to go to the hospital right away, but she was hesitant.

She was afraid she would be turned away.

I tried to convince her to go, but she still didn't budge.

Meanwhile little Abubakar stretched out his arms for me to pick him up.

My heart melted.

I called the 0n-call doctor and asked if he could make sure to see a child I was sending over.

He agreed right away.

So, mom went one way with her child, I went another way.

At 9 pm I was back at the hospital and ventured over to the feeding centre.

Sure enough, Abubakar was admitted.

He weighs 6.5 kilograms.

He had been clerked in by the doctor and put on treatment.

Lab work was done revealing a very low hemoglobin and need for blood.

As I sat next to his bed, he again stretched out his arms.

So, this time I sat him up and held him close to me.

I think he just wanted to be comforted.

As he was pressed up against me I could feel he was breathing really fast.

He likely has tuberculosis.

I could only hope this child will survive.

I'm hoping to see him again this morning.

And hope for the opportunity to talk to his mother a bit more.

She too will need some comforting and encouragement.

More about Abubakar later in the week...

#3 Photo of the week...

"Emergency Triage Assessment and Treatment workshop with the nurses at Ola During Children's Hospital - a partnership with ABM in Wales"

© 2011 Sandra Lako

Training & Tokeh...

I realize that I have not posted again since my 'crisis' day 10 days ago. No, it wasn't a crisis. I just hit a low point. I got out of it quite quickly, so no need to worry. Since then it's been really busy and I just haven't had a chance to blog.

Last week we had an excellent week of training for the national nurses. Together with the Welsh team from ABM, we delivered a 4-day course on Emergency Triage Assessment and Treatment (ETAT). More soon. It was exciting to be able to teach others and amazing to see the nurses so eager to learn. We had a lot of good laughs. Now, it's time for implementation.

Fortunately I was able to get away this weekend and for the first time in weeks, did not do any work over the weekend! Hurray for me. A group of us went to Tokeh beach and camped their overnight on Saturday. It was lovely. I love waking up to the sound of the ocean and watch the sunrise over the mountains. Unfortunately though, I slept terribly. I need to buy a self-inflatable sleeping mat! On Sunday we walked over to river 2 beach and caught up with some friends there and in the afternoon we drove to Franco's for a pasta and lobster lunch. No complaints from me!

It's back to work now and actually we're stuck at the Spur Road office, waiting for a government official to come and sort out our expat registrations. We've been waiting for two hours and we're still hoping they'll come soon. Then it's off to the hospital to assess the nurses on their ETAT skills.

Breaking point...

You know how you can move at a really fast pace for some time and then all of a sudden you reach your limit? Well, that’s what happened to me. As I was walking in town today I almost burst into tears when a police officer denied me access to a street and made me go another way. I didn’t cry but I was close.

I think this week has not been the best of weeks. It started out a bit strange with an audit starting up, unexpected meetings etc. Yesterday the generator at the hospital as well as the medical records computer broke. And today was just all around crazy.

This morning I had to report at the Ministry unexpectedly to discuss the release of a container that was sent by a link in the UK months ago that still has not been delivered to the hospital. I was just trying to facilitate but I have to say it turned out to be quite a heated discussion. And the conclusion is that the case is not yet solved. We will probably have the Ministry start with the process since the company the UK link used is not managing well. Of course, since I’m on the ground, I am the lucky one to try to keep things moving. So, now I have to figure out the next steps, and figure them out quickly whilst trying to remain at peace with certain people.

After that meeting I went back to the house to meet the landlady. As often is the case, the flat bills were not prepared properly and she has to go back to the accountant with them. Then the cleaner we are thinking about hiring for a few hours two afternoons a week decided that the ‘in my eyes generous’ salary I proposed was not nearly enough. Seriously? Sometimes I hate money.

I then went to town to try and get some color printing done and was charged a ridiculous amount and so left it and continued to the hospital where I was met by another patient asking about screening for the ship. It was an adult with an ‘old’ orthopedic problem and so I sad sorry, but they won’t be able to help. I do feel bad at times that it is so easy to say no to some of these cases. I definitely have a more difficult time saying no to the children.

We then had an informal meeting with a VSO volunteer, which was actually great. Followed by a Welbodi team meeting, which was fine too. I then rushed back into town, this time on foot, to go and meet the only truly trained radiologist in the country, Dr Gordon Harris. I was lucky to be able to set up this meeting with him at such short notice, because he leaves tomorrow for a few weeks. It was great to discuss x-ray issues with him and get him excited about helping with postgraduate training.

It was during this walk to town that I finally had a few moments to think; probably something I should not have done at the time. I was frustrated by how much people blame others for things not getting done, annoyed that some people get amazing salaries for doing such little work, irritated about unnecessary delays and unmotivated staff and disappointed that some things are not really moving forward. And all of the “white girl”, “hey baby” or “I want you for my girlfriend” comments certainly didn’t help matters today. I reached the point where I wondered what I was doing here.

At least I had a good meeting with the radiologist. That made up for some of today’s bad. I later walked down to Savage Street to meet Namina in the hope center. And I have to say that 20 minutes of football with her and all her giggles made up for all the rest. I have never seem Namina and her mother smile so much. They made m me smile. They are both amazing. Namina is doing really well. I didn’t have much time, as I wanted to see two patients onboard and only had 30 minutes before it got dark but I hope to spend some more time with her on Saturday. One of my other patients had surgery onboard on Thursday and is recovering well, the other is still in theater after going in 6 hours ago so I am hoping he does well and recovers quickly.

I’m now back at the hospital seeing as I am supposed to have a Skype business call. However, wireless Internet is not working and neither is the dongle. I am not surprised after a day like today. So, since I am waiting for a driver, I will make good use of my time and go and do a surprise ward check, in the hopes that I will be pleasantly surprised by the work done on the wards. Please please please.

And really, I do know why I am here (for the most part) and I do think that although at times I would rather be on the wards all of the time, there really is a lot to say for strengthening systems, doing training etc. In the end, in the long-run, more patients will benefit from the improved services at the hospital. And of course, I know, everything takes time. Small, small. I think I just need to slow down and take time to enjoy more.

(Note: the ward check was good. Well done nurses.)

A not-so-quiet Saturday...

It’s Saturday afternoon, 3 pm.

It’s been a busy week and so I thought I would not plan anything for today. I didn’t set my alarm. I didn’t make any arrangements. I spent the morning at home: sleeping, cleaning, washing my clothes and drinking tea. I decided that since the management meeting took forever yesterday and I didn’t have a chance to go and visit Namina, I would do so this afternoon.

I called Alusine, the Welbodi driver, to see if he was available to drive and he was. We met an hour later at the office we park the car at. As we started to climb the steep driveway, the car stalled. It wouldn’t make it up the hill. Apparently the same thing happened the previous afternoon. This was a problem. I called Osman, the previous Welbodi driver and the guy I usually end up calling in evenings/nights/weekends to take me home, and asked for his advice. We somehow got the car up the hill and drove to Lumley to meet with Osman. The conclusion after a quick drive was that there was a problem with the clutch and pressure pads. I don’t even know what pressure pads are, but it was clear to me that there was a problem and the car had to go to the garage.

Since I still wanted to get to the hospital, Osman decided he would take the Welbodi car to the garage and Alusine and I would take his car to the hospital. Seeing as he doesn’t generally lend his car out, I double-checked if he was okay with that. He was and so off we went. Well, it’s been an hour now and we’re still stuck in traffic. Oh well, such is life in Freetown.

We’re almost at the hospital. I’ll pop in and see a child I treated in the feeding center and another one I saw at 10pm last night in the Emergency room (I happened to be passing by after visiting the ship and met a child fitting). I’ll print off some stuff I need for Monday, do some emailing and then head to the Hope Center to visit with Namina and family for 30 minutes. After that, I’ll head back across time, hopefully with better traffic. We’ll meet Osman again to see what the progress is on the car. I’m just hoping it’s not going to cost a whole lot of money! I’ll then head to Aberdeen and meet up with friends at Alex’s for dinner which will be nice.

For not planning a Saturday, it ended up being rather busy. And I have to say, it’s this part of being in charge of the logistics that I’m never too excited about. I don’t like car trouble. I have no knowledge of cars whatsoever, but I have to say I am fortunate to know some people who do seem to know to manage cars and try to advocate for better prices in the garage because they know we’re a small charity with small small money. I’m happy to have some Sierra Leonean friends I can call at any time to help me out of a tricky situation. And it’s nice I don’t have to sit in the garage all afternoon! And, at least I found out there was car trouble today and not first thing Monday morning. I am glad there’s always a way to see things in a positive light!