Coordination and clinical work...

A lot of the work the Welbodi Partnership does is to coordinate and facilitate projects and training programs within the hospital. Our aim is capacity building – helping others to improve their skills rather than coming in to solely provide patient care. We believe that in the long run more patients will receive high-quality treatment and have better outcomes if we focus our current efforts on improving the services delivered in the hospital. That is why we have engaged in projects like electricity and water supply, the medical records/data collection and reporting system, the laboratory services, nursing care, the triage and emergency process, and training for the doctors.

This does mean that my job as a medical coordinator, although diverse, does not leave much room for clinical work. As I am trained as a doctor, that is not always easy. Fortunately, for my own professional development and to see how hospital systems are or aren’t functioning, I try to do some clinical work. However, usually my role as coordinator keeps me so busy, I don’t make it to the wards. If I do make it, it’s usually just to see a few patients. I decided that for now it is best not to do ward rounds on a ward because it is unlikely that I will be available to the nurses and patients for the rest of the day due to meetings and other responsibilities.

The last few weeks have been so busy, I have really only been able to see a few patients on the ward adjacent to our office, so it has been good to be able to be involved with patients a bit more on other wards.

It started one evening when I happened to be at the hospital and ran into a family with a very sick child looking for the Emergency Room. The child was admitted and stabilized but unfortunately remained in a very critical condition. Sadly, the infant died in the course of the following day. I was again hit by the reality of the mortality figures in this country. And I realized again that although it can be very rewarding to do clinical work, it is also pretty tough.

I was also involved in the case of an infant admitted a few days ago. With a hemoglobin of 3.5 g/dL, the child needed blood urgently. Fortunately there was a relative who was able to donate and the child received blood soon after admission. After that it was a waiting game. Thankfully, the next day the child looked much better. However, unfortunately the child had not received all of the prescribed medication within the first 24 hours of admission because something went wrong with the supply. So, I wrote a prescription for the missing medication and later checked up on the child again again. The child was stable and I expect will make a good recovery. Now, if I can only convince the mother to stop giving the child hot water and encourage her to exclusively breastfeed I will be really happy!

I love the clinical work and honestly do miss it, but I also have to admit that it can be quite frustrating. Yes, there have been many improvements over the last few years, but there is still a long way to go. I think all of the clinicians in the hospital would agree that clinical work in the hospital is challenging. The patient numbers can be high, working hours can be long, (once a week when on-call overnight the doctors work for about 30 hours straight) and the cases coming to the hospital are often quite severe, which means that on a daily basis one is faced with children dying. For doctors and nurses alike this can be very demoralising. Yet somehow, everyone must continue. Despite the frustrations, spending time on the wards gives me more insight into how the various systems (pharmacy, lab, blood bank, nursing, medical records, doctors) work (or not) and how they have improved (or not) over time. The barriers and delays to achieving good patient care become more apparent. This information can in turn re-start the thought process and refinement of how Welbodi continues to work alongside hospital management and other partners to improve systems within the hospital with the overall aim to improve pediatric care. And that is when I put my coordinating hat on again!

First posted @ http://blogs.bmj.com/bmj/2011/05/31/sandra-lako-coordination-and-clinical-work/

Random Freetown photos...

Astonishing Freetown traffic...

WOW! Traffic has been amazing the last two weeks. Today I managed to get from the hospital to my house (including parking the car on Spur Road and walking back home) in an hour. It's amazing. March and April were terrible months- and it would often take 2 1/2 hours to get home. Fortunately the average is usually about an hour and a half. But, for the last two weeks it's been round about an hour. I am NOT complaining. Hopefully I won't jinx it by writing this post. Tomorrow is Friday however, so you never know.

Post from two months ago...

This post was written 2 months ago and gives a glimpse of a more clinical day for me (which are far and few between).

*****

Today definitely had its good and bad moments. I loved the fact that I could do some clinical work but disliked the fact that I was doing it because someone else didn’t do it in the first place. I was annoyed to see nurses sitting around complaining they were to busy on one ward but happy to see nurses elsewhere eager to learn and help re-assess patients. It was a long day. Leaving the house at 6 am and arriving back at 9 pm. Here’s a glimpse…

Early morning ward check: At 6:30 am Becky and I arrived at the hospital to do a surprise early morning check. This is the check we do 4 times a month to monitor overall ward performance. It’s not very popular with the nurses, but needs to be done. Unfortunately this morning it was not particularly good as a number of patients either did not receive medication on time or it was not documented correctly. It can be discouraging but we need to keep trying to bring about change. It’s all about motivation and attitude!

Administration and trip to town: I spent the next hour doing some administrative work. I then went to town in order to try to meet an accountant because one of our accounts needs to be reviewed/audited. Unfortunately he was in meetings all morning and I was told I would be called. This never happened. Fortunately I managed to get the accountant’s direct line and talked to him later in the evening. I went to the bank to request a money transfer and withdraw cash. It’s funny how it doesn’t really faze me anymore to withdraw 5 million Leones. Then, since I was close by, I brought back lunch from Crown Bakery, as requested by my colleagues. Needless to say, I had a very tasty lunch.

Two ship patients: Earlier this week two patients showed up at my door – one needing plastic surgery, the other maxillofacial. Yesterday the little girl needing plastic surgery was at my door again and I found out that the mother, the 3-year-old girl and her 1-year-old brother were sleeping outside on the hospital compound. I decided that while waiting to contact the ship, I would ask if they could stay in ward 3 since there was a lot of space. The superintendent agreed and I took mom to the ward. Only to find out that the brother was sick- high fever and quite pale, which needed to be sorted out first. So I took the family down to triage to get him registered and that is how my afternoon of clinical work began.

Feeding Centre: While waiting for the 1 year old to get registered, a student nurse came by to say she was looking for a specific doctor, but couldn’t find him. She disappeared again, only to come back a few minutes later. She still hadn’t found a doctor and so asked if I could see a child. I said sure and followed her into the feeding center only to find a nurse attempting to resuscitate a child. Seeing as there was no ambubag or glucometer I decided to transfer to the emergency room where we resumed CPR. However, it was too late. There was nothing left to offer the child.

More clinical: I ended up in the Feeding Centre again later in the afternoon and saw another very sick child, in need of oxygen. I got that sorted and then went on my way again. I made sure the 1 year old got his blood transfusion. He did and thankfully he improved. Towards the end of the afternoon I went back to the Feeding Centre once more and ended up transferring the very sick patient to the Intensive Care Unit for better monitoring.

Namina: At 6:30 pm I walked to the ship, hoping to meet Namina and family on the ward, only to see that another patient now occupied her bed! I was informed that she had been transferred to the Hope Center, which is the off-ship hospitality center. So, I walked back out the port and up the road. I was happy to see Namina and her mom and brother there. It’s always great to spend time with them.

Re-assessments: After returning from the Hope Center I went back to the hospital and checked up on various patients. Some were still quite critical but at least in the intensive care unit. Seeing they were all being taken care of, I decided to head home. It had been a long day.

The run...

I’m sure you are familiar with the term ‘love-hate relationship’. Well, that is kind of what it is like with me and running. I love it and I hate it. So, as much as I wanted to start running again, it took some effort to convince myself that it was the right thing to do this evening. It had been months since I last ran, and it was high time for some exercise. And, since I was home by 5:30 pm for once, there was no excuse.

Seeing as I had to get down to the beach first, I thought I should wear running clothes that are more modest – as in, no shorts, but Capri’s. This meant, however, that I would have to forego the zip pockets and make do with one small pocket. I decided for safety purposes not to take anything with me – no phone, no iPod, basically nothing. I would only take some money and one key. So, I put 5,000 Leones (just over $1) in my pocket, and 5,000 Leones in each shoe, just in case I lost the money out of the pocket or someone decided to steal it! I then took another Le 1,300 with me for my transport money, so that I wouldn’t have to run with change jingling in my pocket! The 5,000 bills were for the way home: one to use for transport and two for contingency. I then took my apartment key and tied it onto my Capri cord tie. I was ready.

So, off I went. I headed down the stairs with a bag of water (yes, a 500 ml bag of water) in my hands, because I thought it would be wise to hydrate myself before the run. On my way from the house to the roundabout, which is about a 7-minute walk, I was slowed down a bit by multiple people asking if I was going to jog. Yes, I replied. As soon as I got to the roundabout there was a taxi waiting and we headed towards Lumley. Fortunately traffic was not bad and 15 minutes later I was at the Lumley roundabout. From there I walked to Atlantic and that is when my run began. A run from Atlantic to Roy’s.

I loved the initial part of the run, like maybe the first 5 minutes. I then quickly started hating it! I think there were times in between that I liked it again, but for the most part, I didn’t love it very much. Once I was done however, all of the hatred was gone and I was satisfied!

The things I loved were being on the beach, hearing the ocean, watching the sunset, knowing I was getting some exercise and greeting others on the beach. But I throughout the run I hated being out of breath, feeling like I couldn’t continue any longer and getting a stitch in my side. So, the verdict is out, do I love it or do I hate it? I think it really is a bit of both. Now, if only I can get to the beach more often (before it gets dark) to run, then maybe I will improve my condition and not feel Iike I am going to die while running!

Of course, it does take some effort to get to the beach and back as well. I think half of the time I was out was spent in transport. Once I reached Roy’s I walked for about 10 minutes and then ran again towards Family Kingdom. Once there I walked up to the Aberdeen roundabout. I managed to get a front seat on a poda poda but felt bad because I was getting the seat all sweaty! I suppose it happens all the time. When we reached Congo Cross I got out in order to take a taxi up to Wilberforce, got out at Cemetery road and then walked the last 5 minutes home.

So, the run was worth it. And hopefully I’ll be able to go for a run again soon. I’ll have to be creative and think of a way to make it easier to get down there and back in less time. Or, I suppose I can start running in Wilberforce and run all the way down Spur Road to Lumley. After all, it’s downhill. I’ll keep you posted.

Busy but good...

The last two days have been busy and diverse. It’s been good but I constantly felt like I was being pulled in different ways. I guess I was. I finally put my phone on silent today because it was ringing so often – it’s seems less intrusive if it just vibrates! So, to give you an impression, I’ll give you an overview of the last 48 hours.

• Discussed the re-wiring of the laboratory with one of our maintenance guys in order for the lab to be connected to the back-up generator.
• Arranged a meeting between Mercy Ships, Children’s Hospital, Maternity Hospital and Welbodi.
• Sorted out the patient charts needed for the morbidity and mortality review on Thursday, which meant spurring the medical clerks into action.
• Conducted a (2-hour) ward check with one of the in-charge nurses on all of the wards, checking whether or not the wards are clean, if patients received medications, if observations have been done, etc.
• Checked up on the little girl that was admitted on Sunday evening, who was still in critical condition.
• Involved with the admission of a 4-week-old twin, who was very anemic.
• Escorted the father of the above child to the blood bank to make sure the child received blood urgently.
• Chased down one of the administrative staff to ask why there are no charts available on the wards for new patients.
• Took a lab request form to the lab to ask them (again) to come and do some blood tests on the little girl admitted on Sunday.
• Took a call to discuss the plan for a cleft palate patient on TB medication that left the hospital due to family/social issues.
• Met with one of the Welbodi directors and a colleague to plan for a meeting on Saturday.
• Checked up on the twin from yesterday and found out he had not yet received a dose of gentamycin so wrote him a prescription for that.
• Tried to arrange for a 1-year old boy with cerebral palsy to meet with the physiotherapists.
• Talked to a communications person from the ship concerning a potential visit form a team from the ship later this week.
• Met with a donor organization to discuss potential funding for the reconstruction of the neonatal unit.
• Discussed a few cases with the person in-charge of infant feeding on the ship.
• Delivered the hospital data (statistics) to the Hospital Manager and discussed the Quarter 1 report briefly.
• Helped one of the doctor’s crop pictures and insert them into a power point presentation for a lecture he was giving.
• Took a call from a doctor at the Aberdeen clinic concerning a patient they referred to us, who unfortunately died later this afternoon.
• Attended a lecture by a WHO consultant on the issue of influenza surveillance.
• Went back to find the twin to see if he had received the medication as prescribed (unfortunately not) and encourage the nurses to do so.
• Sent some emails.
• Helped admit a 5 year old child, putting him on oxygen, making sure his hypoglycemia was corrected, going to the blood bank for urgent blood and handing over to the doctor on call.
• And maybe I did a few other things in between.

So, that was it for Monday and Tuesday. Like I said: “busy but good”.

Sunday evening encounter in triage...

This afternoon I took a poda poda from Regent village, where my church is, to Siaka Stevens street. From there, I walked through town to get to the eastern side of the city where the Children's Hospital is located. After cooling down from the hot and sweaty journey, I spent a couple of hours working on statistics and then went to the Africa Mercy to meet up with some friends from the IOC for dinner. After a good meal (it’s so nice not to have to cook!), tea, homemade peanut butter cookies and a good chat I headed to the lounge for the evening service, which was really good. This was followed by a quick visit to Starbucks before it was time to head home.

Unfortunately the driver that was going to pick me up called to say his car broke down. Fortunately some friends from the Aberdeen Center were onboard and could give me a lift part of the way home. However, I had to stop at the hospital on the way to pick up my laptop, bag, etc. I told them it would take about three minutes to run up to the office, get my bag and come down, but of course I was delayed, as often is the case.

While entering the hospital I noticed a group of people standing in triage; there was a lady holding an infant, surrounded by 3 or 4 others. I asked if the child was sick and they said ‘yes’. At the same time the lady holding the child told the man next to her (her brother) that she knows me. She then asked if I remember her. As I look at her face, she says ‘It’s me, Zainab.’ And sure enough, I do remember her. She is a former VVF patient who I have seen and spoken to many times in Aberdeen. She used to live near the center and come by to visit. I haven’t seen her in years.

Knowing they came with a sick child I looked at the child’s condition. It was bad. There were obvious signs of respiratory distress. Apparently she has been sick for 4 days. I quickly walked them up to the Emergency Room and alerted the nurse and house officer. We went about checking the blood sugar (which was fine) and getting the child some oxygen. Unsurprisingly, there was no connecting piece for the oxygen concentrator and so I ran up to the office to get one. It still seemed to take a long time to sort it out so I looked around at the other concentrators to see if any of them already had two connections. Sure enough there was a machine with two connections but only one patient actually connected. I asked who the second set of tubing belonged to (as not to steal another child’s oxygen) and was informed that the child that had been connected to that point died earlier in the evening. This is the reality at the hospital. Children die. And I knew that if this new infant didn’t get oxygen soon, the same fate would be hers. We moved her closer to the concentrator and got her connected right away. Meanwhile the house officer was getting a history from the father. I am not sure what will happen to this little girl tonight. I suspect she has severe pneumonia, severe malaria or sepsis.

So that was my Sunday evening encounter in triage: an unexpected reunion with a former patient who was bringing in a new patient. I left the hospital happy to have met up with Zainab again, but sad to see one of her relative’s children in such a bad condition. It is now 1-½ hours since I brought the little girl to the Emergency Room and I find myself wondering if she is still alive. I can only hope and pray that I will see her in the morning. I hope this child survives. And hopefully I will meet up with her aunt Zainab again as well.

Back to Namina's village...

From top L to bottom R: Juliette, Saidu, Ibrahim, Wara, grandson, Isatu, me, Koleh, Musa, Namina

11 weeks ago I went to Namina's village for the first time. That is when I told her that she had been scheduled for surgery in March. Since that visit, she had surgery and spent a further 8 1/2 weeks admitted on the ship and at the Hope Center. During that time I saw her regularly. On Friday the 13th of May she came to the hospital to tell me she had been discharged. It was time to go home.

So, a week after her homecoming, I thought it would be nice to visit her. So, off I went with two of my friends - Osman, a driver, and Juliette, nurse I worked with in the Aberdeen clinic. It was a great day, full of smiles and fun and some adventure. We had a great time with Namina, her siblings, and her mother (Wara), and the rest of the village! It was great to see Namina settled again and playing with her friends. Her life has been changed. And so has her family’s. More details and photos to follow…

Mercy Ships Connections video: May 2011...

This is the latest Mercy Ships Connections video which includes some footage from the screening that took place earlier this year. I was asked to say a few words and the interview appeared on this video (towards the end). Just thought I'd share.

I have been able to refer a number (around 50 by now I believe) of patients to the ship including patients with cleft lip, cleft palate, lipoma, noma, clubbed feet, micrognathia (no lower jaw), contractures, hernias, bowed legs, and more. I have also been able to contact surgeons onboard for advice on various cases, which has been helpful.

Sometimes the never-ending knocks by strangers on my office door get a bit annoying, especially when it's yet another person with a goiter or hernia or something else that cannot be treated onboard. Also, the walks to and from the port are not always as convenient and it's definitely made my work busier, but in the end, it is a pleasure to be able to help both the children and adults in Freetown. For many of them this is a once in a lifetime opportunity. And of course, for patients I've have known for years, like Namina, this is what we have been waiting for. Mercy Ships has been a huge part of my life (14 years living onboard, 4 years working for them in Aberdeen), that I have to say it is only natural for me to stay involved. And it's a privilege. Of course, the perks are great too. I have to say that although I have never lived or worked on the Africa Mercy, the simple fact that it is a Mercy Ship still makes it feel like home to me. I think it's the familiarity of community life, and the familiar faces too of course.

#4 Photo of the week...

“Ward 3 - Ola During Children’s Hospital”

© 2010 Sandra Lako

Namina's admission on the Africa Mercy...

My connection with Namina began over two years ago, on the 21^st of January 2009, when she came to the Aberdeen clinic for the first time. To be honest, when I first saw her I doubted that there was anything I could do. (see post: Tears for Namina) I was wrong. It was true I would not be able to fix the large hole in the left side of her face but together with my nurses we were able to stop the infection, clean out the wound and get the healing process started. The process had its ups and downs. Namina often cried during the wound care, and her mom often did as well. It was hard for Wara to see her daughter suffer so much. (see post: Monday's thoughts) However, after intensive wound care, multiple days a week, for a number of months, as well as providing nutritional support, the tissue settled down and the hole began to close. Seeing as the hole would never fully close on it’s own and she could no longer open her mouth due to damage to her jaw, surgery was still needed. So, Namina and her mom waited, patiently, until they heard in 2010 that the Africa Mercy would be arriving in Freetown in 2011.

Finally, on the 27^th of February the ship arrived in Freetown and I was able to make arrangements for Namina’s admission and surgery. Then on the 5^th of March I traveled to Namina’s village, to let her know the surgery had been scheduled, and she was to be admitted the following week! The entire family was delighted. This is the news we had all been waiting for, for over two years. Finally, on Monday the 14^th of March Namina, her mother and her younger brother, Ibrahim, made their way from Bailor town to Freetown and came to the Children’s Hospital. The time had come. We were excited and a little nervous as we headed off to the ship for Namina’s admission. I felt privileged to be a part of the admissions process and I think Wara appreciated it as well, and she was happy to send me off to the lab with Namina for her blood tests! Having built up a relationship with Namina and Wara over the years, it was amazing to be a part of this important moment in their lives. With a thankful heart I left them onboard, and walked back to the Children’s Hospital. In two days, I would be back to watch her surgery…

Waiting in the lab

Pre-operative blood testing.

A balloon to make up for the finger stick.

Wara's fingerprint for consent for Namina's surgery.

Wrapping up the admissions process.

Namina's mom, Wara, and her little brother, Ibrahim.

Another weekend, come and gone...

It’s Sunday night and I’m not sure I’m ready for Monday morning just yet. I had a lovely weekend and wish it wasn’t over!

Friday night, movie night...When I lived in Aberdeen, we used to have movie nights on Fridays. They were always good fun and very relaxing after a busy workweek. This past Friday, Sarah and I decided to get together for a movie night. So, I headed down to Aberdeen and we ended up watching ‘The Bucket List’. Afterwards, while waiting for a friend to pick me up, we made up our own verbal lists of things we still want to do in life! I realized there is still a lot I want to do.

Meeting by chance...Months ago I tried to meet up with someone from a certain organization but unfortunately I called him the day before he was leaving so we never met. About a week ago my driver friend, Osman, told me that a doctor he knows was coming to Freetown for a week and he was to pick him up from the water taxi. It wasn’t until Friday morning that I realized this was the other doctor working for the organization I wanted to connect with So, I told Osman that at some point I’d like to meet this doctor. Little did I know that we would end up meeting late Friday night at the Aberdeen Women’s Centre since Osman had just picked him up and had planned to give me a lift home. We talked about the work he is doing at Connaught and the work I am doing at Children’s and it was interesting to hear about the similarities of what we’re doing. Anyway, Osman and I dropped him off at a hotel, and then Osman dropped me off at home.

Saturday breakfast...Sarah and I decided we would meet at Montana’s for breakfast at 9 am. Little did we know that Montana’s is not open until 10:30. Oops. Needless to say, we enjoyed an early morning walk along Lumley beach and then took a taxi to Bliss and had a lovely brunch there. It was a fun way to spend the morning.

Meeting a newborn...In the afternoon I went to Tengbeh town to meet a friend's newborn baby. He is only 4 days old and I’ve decided he’s adorable. I held him for a long time and at one point he started sucking on his hand. It was a first, so of course out came mom’s camera. The fact that my friend had him in Freetown is pretty incredible. As her colleague noted: Sierra Leone used to be called ‘White Man’s Grave”, so this baby being born in Freetown is pretty significant and a sign of hope for many.

Alusine and family...In the evening Osman drove me up to Alusine’s house. Alusine is the Welbodi driver and drives us to and from work everyday. His wife was very sick last week and his son was sick on Saturday. So, I wanted to make sure they were okay and that his son was on the right medication. He wasn’t. We stayed for about an hour and then headed back to Wilberforce, stopping at a pharmacy along the way to pick up the right malaria medication.

Church...Before heading to church I called Alusine to ask him to meet me at the Regent junction so that I could give him the medicine he needs for his son. Fortunately by the time I reached the Regent area, Alusine was at the correct junction and I could handover the medication while staying in the taxi. I then continued on to church. I was excited about listening to Pastor Michael teach today as I didn’t have Sunday school but ended up having to watch an 11 month old whose mom was teaching Sunday school. He wouldn’t keep still for the first part of the sermon, so I ended up outside anyway. Fortunately he got tired and fell asleep on my lap and I was able to listen to the second half of the sermon!

Ship...From church I went to my flat to drop off a bag of mangoes I received as a gift and from there I took a taxi to Congo cross, a poda poda to Regent road and then walked down to the port. I had arranged to meet up with a new friend, Allison on the ship. After a few minutes onboard, we headed off the ship again and walked around in town for a bit. After a coke and fanta at Mem’s cookery we walked back to the ship. I enjoyed a lovely dinner of roast beef, mashed potatoes, veggies (beans and mushrooms!), salad and a tangerine followed by a nice chat on deck 8, We then went to the evening service (which was great) and ended the evening with a caramel macchiato at the Starbucks café. It was a great visit! Thanks Allison.

Bed...And now it’s time for bed. I have a buys week ahead. Lots of work to do and I have the next four evenings planned – dinner tomorrow with the doctor I met on Friday night, meeting up with my friend Ans on the ship on Tuesday evening, International Bible study on Wednesday evening and women’s group on Thursday evening. It’s no wonder the time flies here…

Second blood donation...

After a four-month wait, I was finally allowed to donate blood again at the Children's Hospital. I still think it's crazy that women have to wait 4 months, while men can donate after 3 months but rules are rules. Anyway, after lunch on Good Friday (great day to donate and reflect on the blood Jesus shed for us!), Shona and I headed to the blood bank to donate. Last time we enjoyed Christmas music, this time we enjoyed an Independence song serenade by yours truly: Omar.

I have to say, the whole process is quite amusing every time we donate. My Hb was 12.3 g/dl this time I believe, which is not bad considering I hardly eat meat these days. And I lost 3 kilograms since the last time I donated. I won’t complain about that either. So, Hemoglobin fine, weight fine, ready to donate. And that’s when my least favorite part comes in- the big big needle needs to be inserted into my arm. Ouch. And unfortunately this time, shortly after the needle was in place, the blood stopped flowing. After some slightly painful maneuvering, the blood still didn’t want to come out and so we decided to give it another go. This meant a second needle stick. Fortunately this time, the blood flowed quickly into the collection bag. And there was a fresh bag of blood, waiting to help one or more women or children.

I love the thought of helping others in such a tangible way. And what does it cost me? A little time and a little blood. Oh, and two needle sticks this time. I would again encourage everyone in Freetown to come and donate blood at the Children’s Hospital; every 3-4 months please. And really, if you come, I’ll buy you a coke!

Sunset over Lumley beach...

13 May 2011: By far the best sunset view yet from my balcony! Stunning!

Trip to Namina's village...

On Saturday the 5^th of March I woke up at 6 am. I had a big trip planned- a visit to Namina and her mom in their village. Farrah, a taxi driver friend of mine came to my house at half past 6 and after loading up a huge bag of rice and some other gifts for the family, we headed towards town. On the way we picked up one of my former colleagues, Ramatu, who used to work with me as a nurse in the Aberdeen outpatient clinic.

By 8 am we were on the ferry, heading towards Lungi. From Lungi we were told it would be a 15-minute drive to Bailor town, Namina’s village. Wrong. We picked up her older brother Saidu, to show us the way and after 25 minutes we found ourselves in a remote area, driving in and out of very small villages. Saidu kept saying we were almost there. We came to a bridge and wondered if we could cross it. Saidu said taxis do it all the time. So Farrah braved it. The crossing was very noisy as the loose planks were moving about under the tires of the car. I loved watching Farrah’s face as he was driving across the rickety bridge. He was happy to make it to the other side and already dreaded having to cross the bridge again on the way back!

After 75 minutes we reached Bailor town; a peaceful village on the beach surrounded by palm trees. The people were friendly and of course Namina and her family, including her granny, were thrilled to see us. Many children crowded around fairly quickly to get a glimpse of us. I was happy to see Namina and Wara again, and loved the fact that I was able to get a glimpse of their lives.

With all of the children in tow, we walked to the beach and enjoyed picture taking and refreshing sips of coconut water. There was laughter all around. It was great to see Namina in her own environment. We walked further down the beach and then turned back up to the village and back to Namina’s house.

A few hours later we were served food. Culturally, the guests are given food and everyone else waits to eat at a later time. So the three of us were served a wonderful meal while everyone else remained busy in the kitchen or in the house. I would have loved to sit down and eat with everyone, but I know this was a way for them to show their appreciation and respect. Their hospitality meant a lot.

When we realized we would miss the two pm ferry, we sat around and talked some more and then left in time for the 4 pm ferry. Of course, we had to cross the bridge again. And this time, we actually got into trouble- the tire slipped through the planks and was stuck in between the metal bars of the bridge. After trying various tactics, we managed to get the car tire out. We went on our way again, thinking we would miss the 4 pm ferry but in the end, there was no 4 pm ferry and had to wait for the 5:30 pm ferry. I think we were home by 7:30 pm.

The visit was eye opening and I will treasure the memories. I was happy to see where Namina and Wara live and grateful for their hospitality. I think what I was reminded of most from the trip is Wara’s commitment to her daughter. Wara’s husband died a few years ago and she is now the sole caretaker of 7 children (of which two are above age 16). I thought about our journey to Bailor town and back – the cost, the time, the distance, the effort, the challenges. And I thought of Wara making that same trip every single week to get Namina to the clinic in Aberdeen for her wound care. They would take the ferry on a Monday, stay with relatives in Freetown, come for Namina’s appointments and then head back to Bailor town on a Friday evening. And Wara did this for months on end and never complained. Wara was determined and dedicated and I can certainly learn from her. It is her perseverance that pulled Namina through. And after months of follow-up and more months of waiting for the ship, it was a delight to be able to take Wara and Namina to the ship for Namina’s admission. I feel privileged to have played a part in Namina’s story and am glad that I will continue to be involved in their lives.

Sierra Leonean lanterns...

The Sierra Leonean lanterns are still around in town. The first one is from Aberdeen, the second one is from Tengbeh town. And, the picture may not show it, but the Independence ship was pretty impressive on the night of the parade. As stated in my blog post about the lantern parade: Sierra Leonean lanterns are not actual lanterns, but floats!

Petrol crisis in Sierra Leone...

A week ago I was caught in a heavy downpour just after finishing up a meeting in town. I called a friend to see if he could pick me up. He could, so I found a bit of shelter under a tarpaulin and waited.

He arrived about 30 minutes later and we headed towards the West side of town. We did however need to get some petrol. This sounds easy, but it being only 4 days after the increase of the petrol price, we knew this would not be the case. For a few days many of the petrol stations had been closed, selling petrol for only a few hours everyday. Long lines of cars appear outside of petrol stations, waiting for station to open. Numerous jerry cans were lined up outside of stations, waiting to be filled. No one was happy.

The price of petrol used to be Le 17,500 for a gallon of petrol. Seeing as one UK gallon is 4.55 Liters, this means the liter price used to be Le 3,846. The new price is Le 5,000 per liter. For some reason, they have now started selling petrol per liter instead of per gallon. Maybe they’re hoping people won’t realize how big the increase in price was. If you look at the gallon price now it is Le 22,750 per gallon. This is quite a significant increase in price especially in relation to the average income in Sierra Leone!

My friend and I found a petrol station that looked like it might open soon. There were about 20 cars lined up outside so we joined the line. About 30 minutes later, the petrol station opened. We continued to wait, moving forward every few minutes as cars in the front of the line moved on. Of course the unthinkable happened. There were only two more cars in front of us and at that moment the station manager decide to stop selling. By this time we had been there for over an hour. And that is what happened to many people over the course of a week. It was not pleasant. Fortunately we made it home with the small amount of petrol left in the tank. I still don’t know why petrol stations were not selling for most of the day. Did they really have a short supply? Or was this all a power play? Were they trying to make a statement because in reality they were hoping for more of an increase in price? I hear it is even worse upcountry where they are charging up to Le 8,000 per liter!

So now taxi and poda poda drivers need to spend more on petrol. This means that transport prices have gone up from Le 1,000 to Le 1,300. In the meantime, salaries don’t change and so people spend a higher percentage of their salary on transport costs, leaving less money for living expenses. Prices of commodities are guaranteed to go up, to compensate for people’s loss of money (money now going to transport). As you can imagine, people are not so happy. But there is nothing that can be done about it. So, people will manage. They will need to manage with what they have. And I can again be thankful that I don’t need to worry about where my next meal comes from. I am privileged.

Help AdvocAid in Sierra Leone...

"In 2005, a young woman in Sierra Leone was sentenced to death for a murder she did not commit. Her purported crime was the killing of a 6-month-old baby, the daughter of her husband's second wife. The infant died after its father sat on it, but the young woman, whom we know only by her initials M.K., took the blame – and even told police that she had killed it. "I said that I was guilty because my husband told me to," M.K. says. Her husband told the police that she had poisoned the baby, and they believed him. M.K. ended up on death row in Sierra Leone's notoriously grim Pademba Road Prison in the capital city of Freetown, far from her home village. Forgotten by her family and unable to read, write, or pay for a decent lawyer, M.K. was confined to a small, dirty cell for nearly six years. But then she met Sabrina Mahtani, the founder of AdvocAid, a nonprofit group based in Freetown that provides free services for women who find themselves inside Sierra Leone's prisons. Ms. Mahtani got to know M.K. and was moved by her story. Mahtani offered to help..." For more on this story: click on this story about Sabrina and AdvocAid.

AdvocAid is a great organization set up by Sabrina who has dedicated her time to helping women in prison. It is far from easy to do the work that she does day in and day out but she does it. One of the quotes that strikes me the most in the above article is that "it's not about numbers, it's about impacting individual lives." That is exactly what Sabrina and her team are doing. Helping one woman at a time. They are changing lives. And to do this, they need our support. Finding funding for this type of work is not easy. Will you join with AdvocAid today and help the women and children imprisoned in Sierra Leone? Donate through paypal or through AdvocAid's justgiving page today!

Sick small...

So, since June 2005 I have actually only been sick once – sick as in, needing to stay home type of sick. That was within my first two months here when I came down with some serious shigella, became dehydrated and fainted. After 48 hours I was on the go again. Fortunately that was just before clinic opened.

I like to think I’ve become immune to a lot of the pathogens floating about the hospital, Freetown etc. People here get sick all the time and I’ve managed to avoid illness altogether, except for the occasional bout of diarrhea which is never severe enough to keep me at home. Unfortunately Friday evening, my stomach started acting up and I realized I would need to stay close to facilities. There went my planned weekend beach trip! It was bad enough to keep me in bed most of the next day and I decided that the remedy would be lots of fluid and no food. I figured if I don’t eat anything, nothing can come out. I did venture out after 24 hours, hoping that water, coke and ORS would keep me upright. I enjoyed a bit of the lantern parade and went to church in the morning. I think a 30 minute walk in the hot sun due to a transport crisis did me in yesterday but some ORS revived me again. After 24 hours without food I got pretty hungry and thought I better eat something – soup and crackers it was. It seemed to go well, except for a bit of nausea afterwards. In the evening I decided to try oats and so far so good.

I’m at work today and besides a splitting headache and a teensy bit of nausea, I’m fine. I’d hate to say I’m actually sick…maybe ‘sick small’. As long as my stomach doesn’t explode, I’ll be fine. We’ll see what the day brings! I guess I’m not as immune as I thought, but I have to say that getting sick only twice in 6 years is pretty impressive, especially considering there are a huge variety of pathogens in my work place! To the rest of my friends out there who are unwell (there’s a lot of illness in Freetown right now) – get well soon!

Independence Lantern Parade in Sierra Leone...

I was not expecting to see the lantern parade on Saturday night because my plan was to stay overnight at Tokeh beach, however, a 24-hour bug kept me at home on Saturday. Since I hadn’t eaten all day my stomach settled a bit by the evening and so around 10 pm when a friend said she really wanted to go and see the lanterns, I joined, seeing as it was the last of the Independence celebrations! (Plus I was going a little stir crazy having been in the flat for over 24 hours!)

Off we went at 10 pm trying to find transport, forgetting that there would be hundreds of people trying to get transport at that time and of course the petrol crisis made it all the more difficult. We finally found a taxi and it took us right into town for Le 2,000 each (USD 0.50). Surprisingly, the taxi was able to drive us right to the end of Pademba road, very close to the Cotton Tree, where the event was happening. Bearing in mind that the event was scheduled to start at 7pm we were surprised to see at 11 pm that, although busy, not that much was happening as far as a parade. We met up with some other expats and stood chatting and waiting for the lanterns to come by. So far, my friends who had already been there for 2 hours had not spotted a lantern. This was true Salone time.

Finally, at midnight the first lantern approached the Cotton Tree. This was both exciting and fun but honestly, I am not sure why they are called ‘lanterns’. I think a cultural float is a better description. Most of them were basically massive puppet shows on flat bed trucks; some with puppet soldiers, one with a puppet lion who’s head was bobbing up and down, one with puppet street cleaners, some with live music to add to the effect, some designed as ships. They were definitely entertaining, to say the least. Unfortunately I don’t have any pictures to show you; I didn’t want to take a chance with my camera!

In the next thirty minutes we didn’t see another float so we thought we would move around and try to find them! Seeing as none of us felt like staying out till 4 or 5 am, which is when the lanterns were likely to reach the Cotton Tree for judging, we thought we would make a move.

We attempted to walk down Siaka Stevens street but the masses quickly made us change course. We went back down Pademba and then took a right down the second side street ending up by the Electricity House. We walked along Siaka Stevens street and after some minutes a large group of young men ran past us. This surprised us and we quickly jumped to the side of the road. Within seconds a lantern appeared behind the group of men. A second lantern spotted. After walking a bit further we felt like the crowd was too rowdy and turned up to Pademba road again only to later return further down on Siaka Stevens where we saw the third float. Seeing as it was really busy, and time was ticking along, we thought we would call it a night. We decided to head home, but of course, with the busyness, transport would be hard to get.

We started walking down Pademba road and sure enough, just as we were wondering where the lanterns were hiding, a lantern turned onto Pademba road. The crowd behind it was massive and so we waited on the side of the road. It was definitely intriguing and entertaining to watch the crowd pass by. I assume most of them had been following the lantern from Tengbeh Town, which is the community that built this particular float. It was by far the best float: a ship with helicopter and all. The crowd seemed very proud of it and we were all impressed. After a good twenty minutes we could finally move towards Campbell Street. There we saw a couple more lanterns. So, all in all, we couldn’t complain.

We ended up walking to the stadium due to lack of transport and in the end got into someone’s personal vehicle to Congo Cross. Three of us then got out and took a taxi the rest of the way home. It was a late night but it was worth it and fortunately my stomach coped! I would definitely watch the lanterns again but maybe I would go to bed early and then wake up at 5 am and go to the Cotton Tree to see the final parade of all the lanterns at once! Actually, I hear they park the lanterns at the Youyi building, so another option is to go and see them there. However, I’m not sure the experience would be quite the same without the masses of people, the search for the lanterns and the sounds on the street.