Exam Day: T-7...

Seven days to go.
As much as I do like studying, I have to say I can't wait for this exam to be over. I have no idea how I'll do, the only thing I know is that I'll give it my best shot. Let's just be honest, there's a lot of information to know, the exam consists of a lot of questions in very little time and the negative marking may just be a killer. I always think of the many people I met during the course in Nigeria who are attempting the exam for the second or third time. Ugh. In a few weeks we'll know. If I pass, well, then I am definitely celebrating big time and if I don't then I'll celebrate the fact that the exam is over, take a few weeks off and then start studying again for April. Either way, I'm celebrating!

I'm heading back to Freetown today. I'll spend the weekend studying, using my handmade flash cards (see photo): memorizing and hopefully retaining the information. These flash cards have become somewhat of a treasure - they never leave my bag - I'll be using them in the plane today and I better not leave them in the pocket of the seat in front of me. That would be a disaster. On Monday I'll go to the hospital for work and meet with my colleagues to discuss various things and help with some planning. Tuesday hasn't been planned yet but I'll stay West-side on Wednesday and Thursday to cram and hopefully not freak out. Friday morning by this time I will have arrived at the conference hall at Connaught Hospital, ready to take the exam!By God's grace I will get through the next 7 days in one piece. 

Unique ways to support...

I consider it a privilege to be able to volunteer with a charity. I am thankful that housing and transportation are covered by the organisation and that friends are willing to support me to meet some of the other needs. What I have realized more and more is that support goes far beyond the financial scope. One of the best ways I am supported is through people who pray for me. I greatly appreciate the number of people that do this. It was an encouragement a few weeks ago when a lady from my home church told me she still prays for me everyday. Amazing! 

And what I really like is the unique ways that some people support volunteers, without maybe even realizing it. The fact that I have been able to stay with family friends for the past 5 weeks has been incredible. And today I needed to get a vaccination and I was only charged for the cost of the vaccination, and not the services. I was told that it was the doctor's way of supporting the work I am doing. Others I know get all of their dental work for free. 

So there you go, supporting those 'on the mission field' is not just about money, it's about prayer, encouragement and finding your unique way of helping out. 

Thanks to everyone that makes the work I do/life I live in Sierra Leone possible!

X-ray Update & Appeal...

The Welbodi Partnership would like to extend a big THANK YOU to everyone who has donated to the x-ray project – and a plea to those of you who haven’t yet given, to please do so now. We are getting close to the target that will enable us to provide an X-ray Department for the national children’s hospital of Sierra Leone – please help us reach it!

When we circulated our appeal in July to raise funds for this project, a charitable foundation expressed interest in donating a large sum of money, under the condition that their donation would be matched by other sources. The good news is that the foundation recently agreed to release the money even though we had not yet raised all the matching funds. This is very exciting, but it means we need to continue our fundraising efforts to ensure that a functioning x-ray department can be put in place at the Ola During Children’s Hospital.

We have certainly come a long way. With the foundation’s donation and what we have raised from people like you, we are now 75% of the way to our total goal of £120,000. We would especially like to thank Graham and Mia Wrigley for hosting the Picnic and Pimms event, which raised over £8,000 for this project. We would also like to thank the Sierra Leone Institute of Child Health for its generous contribution of £10,000. And we would like to thank the Fox family and the Rosslare Parish Church for raising  £2000 pounds. And finally, our friends and supporters for donating £8,760 through the justgiving site in only 2 months.   

Would you (or someone you know) like to help us meet that goal and be a part of this exciting project?

An x-ray department will provide sick children with direct access to x-rays, enabling doctors to diagnose conditions more accurately and provide optimal treatment. It is also crucial for the accreditation of the country’s only children’s hospital as a training institution. The money you donate will go directly towards the x-ray project to:

- Purchase a robust, up-to-date digital x-ray machine 

- Fund an experienced radiographer to train national staff on the ground

- Ensure adherence to radiation protection requirements and training of a safety officer

- Provide essential infrastructure including a separate generator for the x-ray machine, air-conditioning units and a control booth

Join us. Help us improve healthcare for the children of Sierra Leone!

Donate at: http://www.justgiving.com/xrayappeal 

So thankful...

About 4 weeks ago I was very disappointed when I realized my trip to Freetown was going to be delayed. Even though I knew it was for the best, it took me a good week to get used to the idea. Now, looking back, I can say that this unexpected 'time out' was most welcome and very much needed. Not only have my health issues been sorted out (for the most part), but I have many other things to be thankful for.

Here are my Top Ten Thankful Thoughts from the past 4 weeks:
1. More time with my sister and her family
2. Seeing my parents after 416 days, otherwise we would have had to wait till 2013
3. The couple that is hosting/spoiling/encouraging me - taking oh so good care of me
4. Extra study time: at least I've increased my chances a bit by being able to study more
5. Excellent colleagues who have supported me and always look out for me from afar
6. Friends in Freetown and all over the world who have sent encouraging emails
7. Skype calls and good internet access - being able to communicate easily with friends
8. Access to excellent healthcare and being able to get appointments quickly
9. No side effects to the medication I am on (last April it was a nightmare!)
10. The amazing opportunity I have been given to live abroad, travel, study, etc. 

I am truly thankful. God's timing has been amazing. I never imagined I would be away from Freetown for 6 weeks but it has been good. God has an incredible way of turning things around for the good and teaching us along the way. 

I'm wrapping up my time in the Netherlands: enjoying the good food, 24x7 electricity, high pressure showers, still studying, catching up on Welbodi emails and of course packing. Tomorrow will be a family day (with no work or study!) and on Thursday I am off to Heathrow late night ready for the BMI flight Friday morning. It's getting colder here, so it's definitely time to head back to Sweet Salone...

Being the patient, thoughts & feelings...

When a doctor is sick, people often say it’s a good opportunity for the doctor to experience the ‘other side’ and to be able to identify with his/her patients. I would agree.

Honestly, I can’t say I can relate to many patients, because my condition is not so serious; I have not had to worry about a life/death situation. A few of my friends immediately come to mind who are facing such situations/or recently faced them, and I can’t imagine what that must be like. I also think about the parents of children at the Children’s Hospital, who watch their children fight for life and know that there is a big chance their child might not survive. I cannot imagine the feeling.

However, I think I have experienced some of the thoughts and feelings that patients generally go through. See if any of this rings a bell: Impatience. Waiting for two weeks before hearing about test results. Worry. Fear. The “what if” scenarios that undoubtedly cross ones mind. Exposure and vulnerability. Being examined. Lack of control. Some decisions lie with me while some definitely seem to be made by the doctor. Relief. Knowing that results are normal/improving. Disappointment. The tests never seem to end. Discomfort. Side effects of medication. Unpleasant tests. Forgetfulness. Compliance. Trying to remember to take medication everyday. Importance of support from friends & family. Thinking ahead. The future. What do I value in life? What do I still want to accomplish? Realizing once again how precious life is.

I think that more than anything, I have become more thankful. Thankful for access to good healthcare. Thankful for insurance companies. Thankful for friends and family around me. Simply thankful. 

Welbodi research shows reduction of inpatient mortality rate after the introduction of emergency care...

Dr Matthew Clark, did an elective at the Children's hospital in 2007 (I believe). His experiences during that time led him to found the charity: Welbodi Partnership. While Matthew was in Freetown in 2008, Welbodi supported the hospital in setting up a triage and emergency system and Matthew did some research. Here are his results...

New research shows that relative simple interventions can dramatically decrease hospital mortality rates. The effect of these improvements in emergency care was analysed by a team of researchers in Freetown and London. This research showed a 47% reduction in mortality rate after the improvements in emergency care. It is estimated over a 100 children’s lives were saved in the first two months alone. In addition to examining the number of lives saved, the researchers also estimated the cost of saving a child was $148.

Dr Matthew Clark, lead author on the paper and director of The Welbodi Partnership says, “These results are very exciting. When a team of international volunteers works in close collaboration with local partners, amazing results can be achieved. Ultimately these results are a tribute to the dedication and hard work of the staff at The Ola During Children’s Hospital.”

“Poverty, overcrowding, poor sanitation and malnutrition, in low income countries, results in a huge number of children becoming acutely sick. Many of these sick children need to be treated in hospital”

“Surprisingly, there is hardly any research about how to improve the care children receive when they get to hospital. International agencies tend to focus their resources on preventive measures, as these are perceived to be the most cost effective ways of saving children’s lives. This research shows that improving the quality of hospital care is another highly cost-effective way of saving lives.”

With over half a million hospital beds in Sub-Saharan Africa, many of them providing sub-standard care, the expansion of such programmes could save large numbers of lives and help accelerate progress towards Millennium Development Goal 4”

The findings were reported in the scientific journal PLoS ONE and represented a commitment by The Welbodi Partnership to undertake rigorous research of their programmes and share these findings in peer-reviewed journals.

Click here for the research article: Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone

Reunion after 416 days...

Today is exactly 416 days since I last saw my parents. I think this is the longest I've gone without seeing them. 416 days ago we said goodbye in Denver, Colorado after spending two weeks with my brother and family. I had no idea when I would see them again, with me living in Sierra Leone and my parents living in Haiti. Up until three weeks ago, we were hoping we would see each other in January. However, things worked out differently. My trip back to Sierra Leone was delayed meaning I had to stay in Holland till the 28th and my parents were due to arrive today. So here we are, reunited at last! It was great to join my sister in the car to Brussels airport and have some time to talk and it was fun to surprise my parents by meeting them at the airport. I think secretly they expected I'd be there and probably would have been disappointed had I not been there! We've had some laughs already, play time with my nieces (their grandkids) and we'll have more great moments to come. I'm thankful for this unexpected time with family!!! God has turned a disappointing situation (the delay back to Freetown) into a happy occasion.

My parents in Haiti...

My parents currently work for Hope Force in Haiti. They arrived shortly after the earthquake in 2010 and have been helping the people of Sous Savanne rebuild their community ever since. The work they are doing is making an impact in the lives of many families in that area. Hopefully they can expand their work to a village called Babay which was affected by the earthquake as well as more recently by hurricane Isaac. My dad and the Sous Savanne community leader set off to visit Babay and ended up having to walk to the village because the road was impassable.

Here's my dad's quote taken from a Hope Force update: “Rubber boots are great for muddy paths and crossing fast-flowing river beds, but they are bad for hiking the steep hillsides of Babay,” René said. “But in less than an hour and a half, the Babay community leader and some of the other committee members were leading Joseph and I around the village’s many make-shift shacks and tents. At the end my feet hurt, but the terrible conditions I saw hurt me more.”

It's great to read about my parents' adventures in Haiti and to get a glimpse of the work they are doing and the passion they have for the people they are interacting with on a daily basis. I hope to hear more in person very soon, since they fly in on Monday for a few weeks break. It will be great to see them again. While in Holland, their compassion for the people in Sous Savanne remains evident as they plan to run a marathon to raise money for a latrine for Liliane and her family. Read her story here: Liliane's story. If you would like to support their work, this is a great cause.

Mom and dad, I'm proud of you!

Exam Day: T-20...

My sister asked me yesterday if I was starting to feel nervous about my exam. I said "no, not too nervous yet but I do want to get through all of my Nigeria material before leaving Holland if I can". I was on chapter 17 of 30. (I've been reading a lot of text books since Nigeria, but decided 6 days ago to start revising power points & notes as a final revision. Until yesterday, progress was good. I think I needed a bit of a study break, which I took in the afternoon.)

Today, I feel differently. Why? I decided to look through some past exam questions. Bad move. I thought I'd look through a couple of questions and encourage myself that I know a lot of the answers.

Well, the first question was about the composition of breast milk versus cow's milk. I thought I'd nail it because I know breast milk has: less protein but of better quality, slightly more fat (but more is unsaturated), lower osmolality, more carbohydrates (mainly lactose), less vitamin D (need to supplement), better iron availability and lots of other good stuff like immunoglobulins.

Unfortunately WACP thinks I should know this in more detail and expects me to answer true or false to whether or not breast milk contains 4.2 g/100 ml of fat, has an osmolality of 400, has 60.0 kcal of energy etc. Ugh. Of course, I can't remember the exact figures at that point and am unsure of whether things are true or false! A quick glance at my flash card reveals the answers true, false (300), false (66.6). Why can't they stick to testing whether or not I understand concepts. Why focus so much on numbers??? Surely that's not any more helpful in medical practice, besides you can look it up if you need to.

For now, I will ignore the exam questions and continue to revise my Nigeria notes. Once I'm done I'll tackle past questions again, and hopefully I'll see that not all of the questions are so bad and I can answer a good percentage of them correctly. Time will tell.

Being the patient, what to do...

Even though I don't feel sick, I do have a medical problem which I have to see a GP & specialist for, so I guess in theory that makes me a patient. Thankfully, I am rarely 'the patient'. I have been very blessed to stay healthy over the past 7 years in Sierra Leone, with only 3 sick days in that entire period and a few minor illnesses here and there.

So, I guess the question is, as a doctor what do I do when I become the patient? Do I:

a) self diagnose and treat

b) ask a colleague friend for advice

c) ask your sister (a GP) for advice

d) go and see your GP

e) leave it and risk waiting too long?

I suppose for me it depends on what's wrong and where I am at the time. If in Holland, I think I would go to my GP fairly quickly. In Sierra Leone, I'm more inclined to sort it out myself. Especially if it's something minor, like a skin infection or eye infection: I self diagnose and treat. Pharmacies are scattered throughout Freetown and medication is easy to come by, which is convenient but not always so reliable. I generally stick to the one pharmacy that I believe has good quality drugs. Having said this, when I had an abscess just above my knee I self-treated and even ended up doing some very minor 'surgery' on my leg. At that point I got a bit worried, wondering if my leg would be okay. I had reached the point of considering checking with a colleague but fortunately after 48 hours of antibiotics (doubling the dose to the maximum!), my leg looked better and I could walk normally again and there was no need for a consultation.

Likewise, if I had a fever I would probably head down to one of the few laboratories I trust (because I know the technician) and get tested for malaria. If positive, I would self-treat with the same thing I prescribe for my patients, if negative I'd wait it out. And, after two days, if I was not better (or if I got worse in the meantime) I would go and see a GP in town, possibly after checking with my colleagues or sister.

I think asking for advice from colleagues or family can be quite helpful. However, I also realize it puts them in a difficult situation. I know this because I have been in that situation a number of times. It's hard to be objective when you're treating/advising someone you know well. So, for the most part, I would ask for their opinion but generally not have them treat me.

So, how do I decide what to do? I guess part of the decision making has to do with my own experience in treating patients - if it's a condition I'm familiar with, I would self-treat. However, if it's something bizarre, I'd be more inclined to get it checked out. The same goes for treating colleagues, friends, expat children - I am happy to help/advise, but if it's more complicated and they need to be seen properly, i.e. more tests, full physical, etc, then I would refer them to a GP in town. (Remember: I don't have a clinic of my own and am not doing full-time clinical work.)

Part of the decision-making also has to do with the quality of care available in Freetown, or lack thereof. Sometimes it might be better to try to sort it out yourself or go to a colleague you trust, rather than some random clinic. There are a lot of random clinics in Freetown! You need to know where to go. With my anemia for example, I was happy to check my Hemoglobin myself. I wasn't as convinced to go to local labs, because I wasn't sure if I would even trust the results. Plus, knowing I was going to Holland, I decided to wait and get it done properly. So, on arrival here (after consulting my GP sister, I have to admit), I went to my GP and he got the ball rolling. It did come to the point where I could choose to go back to Freetown and go to a local lab/GP once a month or stay here and get things sorted out first. For reasons mentioned above, it seemed wise to sort things out in Holland. So here I am, 3 1/2 weeks later...

Elections in The Netherlands...

I remember the excitement back in 1998 when I was eligible to vote for the first time in the Dutch general elections. I guess it made me feel grown up and like I was a part of something bigger in my country. Today, approximately 75% of the Dutch went to the polling stations to cast their votes. Unfortunately, I was not among them. Firstly, being out of touch with the world outside of Sierra Leone, I didn't know about the general elections until about 2 weeks ago. Secondly, because I am not a resident and had to 'sign out' of Middelburg, I didn't receive a voters card. By the time I knew about the elections it was too late to sort out the paper work through the Hague (it takes 6 weeks). Next time!

It will be interesting to see what happens. I am by no means a politician and know very little about my government. What I do know is that there are 150 seats in parliament, which will likely be filled by about 10 different parties. This means that the main parties will need to form a coalition. The previous coalition collapsed. Let's see what happens this time. Let's hope that the principles voters based their votes on aren't totally skewed due to coalition-forming and that the parties keep the best interest of the voters in mind.

Just thinking ahead a bit: it's just over 2 months till the elections in Sierra Leone. Let's pray they are as peaceful...

Exam Day: T-26...

After reading various books (paediatrics, physiology, embryology - not in full, but big chunks of them at least) I decided I should probably work through my Nigerian revision book, which is a collection of all of the presentations given during the revision week I went to in July with my notes included and nicely bound together. There are thirty chapters in all and I need to go through every one of those chapters thoroughly. It also includes some questions that were thrown out as example exam questions (very important!), notes to self about topics to read up on, questions asked by the professors that prompt further research, etc. Lots of good study material in other words. I worked my way through chapter one today: "Pharmacology". Tomorrow I hope to tackle "Transplantation Immunology", "Immune Mechanisms, Immune Deficiency and Hypersensitivity" and "Haematogenesis". Fingers crossed I'll succeed. More importantly, I hope that I will retain the information. I'm not sure if it's age or something else, but I am finding it more and more difficult to retain information. Sometimes I feel like my head is empty and won't allow anything else to enter and other times I think my brain is like a sieve. A lot goes in and a lot comes out again. It's time to keep things in my head! I'd really like to belong to the 1 in 5 that pass this exam...

A Sunday in Middelburg...

I had an early start today. I left the house at 6:30 am to meet a group from church: the early birds. The church I am a part of in Middelburg chose today as their special church day - a day with all sorts of activities and a chance to get to know each other.The plan was to begin outdoors and watch the sunrise and thank God for His amazing creation and for the church family He has given us. It was a chance for me to get to know some people (seeing as I am hardly here I don't know a lot of the members). The colors in the sky were absolutely stunning and it was great to spend some time in the cool breeze looking over the water and talking to God. After our outdoor adventure we drove to the church and enjoyed a delicious breakfast with about 100 people.

Breakfast was followed by a service. I missed some of it because my sister and brother-in-law were on stage leading worship and my youngest niece (here that is) was not too happy about that and really really wanted to go to her mom and not sit with me. My niece and I ended up taking a long walk outside. Let's just say we had some quality time together. We saw a windmill, trains, boats, ducks and a lot of people on bikes. My niece was pretty happy.

I spent some time this afternoon studying as well as skyping my parents and a few friends. It's always nice to catch up with people. I then ended the evening with an impromptu BBQ with friends. It's been a good day. And I am again so thankful for the amazing life God has given me. I'm especially thankful today for the the beauty around me and the people in my life.

A reminder...

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

-Leo F. Buscaglia

Exam Day: T-28...

In a previous post I explained that I am studying for a paediatric residency entrance exam. Well, the studying continues for another 27 days. 28 days from now I will be sitting at a desk at Connaught Hospital, writing an exam.

I never thought the Krebs cycle would come back to haunt me but sure enough, I found myself in the depths of biochemistry yesterday reading about metabolism of carbohydrates, lipids and proteins. I have to say, it is somewhat more interesting to look at it with much more clinical experience but the fact remains, biochemistry is not really my thing.

It's unbelievable how much material I have to cover. Physiology (renal, cardio, pulmonary, digestive), biochemistry, embryology, pharmacology, statistics, etc. There's just not enough time, but I'll do what I can. I'm a bit alarmed at times but once I sit down and study, I find I quite enjoy it. I can only do my best and hope for the best. Unfortunately the exam contains of loads of questions in little time, plus there is negative marking. It's going to be a bit of a gamble to know how many questions to fill in!

This all makes me wonder if this idea is just too crazy. Is this what I should be doing right now? It's funny how throughout life we/I tend to question what the future will hold and how we can shape that according to God's plans. Spending a bit of time out of Sierra Leone gives me the chance to reflect. I find myself wondering if the hospital will ever change? If we (me, Welbodi, aid in general) are making a difference? How we can motivate people? If there's any point in carrying on if people's attitudes don't change? If I should continue to invest time and energy? Will spending hands-on time on the wards day in and day out change things? As you can see there are many questions and right now, few answers. It's a good thing I have a few more weeks in Holland to reflect in between the studying!

Cholera situation reminds me to be thankful...

I’m currently staying in a house with friends in The Netherlands while waiting for my return to Sierra Leone. I have a roof over my head that does not leak, continuous access to clean drinking water and good sanitary facilities. Meanwhile, the Cholera epidemic continues to spread in West Africa.

As of September 3^rd, 15,834 cases, including 251 deaths, have been reported in Sierra Leone. All but one of the 13 districts nationwide are now affected. In Guinea, its neighboring country, 5,699 cases, including 109 deaths, have been confirmed. This is yet another example of people suffering and dying from a preventable disease. With rainy season continuing, chances are cases will continue to rise.

It is so easy to take things for granted. So often I worry about things that don’t seem to be going the way I think they should in life and I forget about the amazing blessings that God has given me. I forget how fortunate I am compared to those around me. Even in Sierra Leone, where I can’t drink water out of the tap, I can still afford to buy packets of clean drinking water from a shop nearby. At the same time, my neighbors stand in line to collect a bucket of unclean water from a standpipe, 10 minutes from my house.

According to Unicef, only 12.8% of Sierra Leone's 5.5 million people have access to proper sanitation, while 42.9% do not have access to clean drinking water; 28.9% defecate in the open. Who am I to complain?

Although I’m far away and can’t do anything about the cholera situation at the moment I can remember to be thankful. Today I am thankful for clean drinking water, a roof over my head and good plumbing (and good friends who have kindly let me stay with them for longer than expected!). Take a few minutes to name three things you are thankful for.

For more about the cholera situation, read: http://gu.com/p/3a6j8/tw

Unexpected stay in Holland...

To follow up from my last post. After discussing results with my GP, talking to friends and family and running through various scenarios in my mind, I decided to delay my return to Freetown, to sort out this anemia and weight loss. Why head back to a country with very limited healthcare, when I can get things sorted out here now? So, the decision was made and I went back to the GP today. We did some more tests and hopefully I can see a specialist within a weeks time. Fingers crossed. I am not expecting anything serious but would be happy to know for sure that's the case. I'm hoping I'll return to Freetown within 3 weeks.

I'm sad that I wasn't able to return to Freetown on Sunday; I'm missing friends and my own place but honestly, I can't complain. I am thankful for the medical care here and to be honest there are many plus sides to staying a bit longer: time with family & friends (seeing friends I didn't have a chance to see during my 10-day stay), great food, chocolate, dairy, rest, study time, etc. And, thanks to internet, I can do some of my Welbodi work from here.

There were a number of things that I needed to sort out in Freetown and I was able to do most of that by phone, skype and through friends in Freetown. For example, I didn't want our driver to show up on Monday morning and wonder where I was. Same goes for our cleaner who comes to our flat on Tuesdays and Fridays. Namina's mom is supposed to pick up money for Namina's school fees. Arranging someone to teach my Sunday school class. Getting some forms printed for people in the hospital etc. I'm thankful for friends in Salone who can help me out! It was fun trying to guide someone by telephone through my house to find some keys hidden in a cupboard!

Alright, time to get some more work done.