First 24 hours...

I arrived in Freetown last night after being away for a month. I had a great time on my three country trip but it was really good to come home! 

Besides the fact that the electricity cut out at around 3am meaning my fan switched off and it got pretty warm, I slept quite well. Thankfully the power came back and my fan cooled the room down again. Breakfast today consisted of tea with a Basha donut, courtesy of my housemate who was very considerate to buy some 'welcome back donuts' yesterday. 

Within 10 hours of arriving home I walked out of the front door and out of the gate to find a taxi to take me to work. On arrival I was warmly welcomed by staff at AWC, which is always encouraging and fun, except for the comments about how I’ve gained weight because I was fed so well while on leave. This is one of those cultural things I will never quite appreciate. Is it really okay to tell someone they are fat?! I'm sure the donut this morning didn't help. ;)

There were about 45 patients waiting in the clinic when I arrived and they had probably been waiting since 5 or 6 am already. That’s the way it works here - no appointments and people come early to make sure they are seen that day. Thankfully clinic didn’t get too busy and we were able to take our time during the consultations. I even had time for lunch, which was rice with potato leaves - my favorite AWC meal.

My first patient was an infant who needed to be referred due to severe pneumonia. I also saw a child with epilepsy, a 5 year old weighing 11 kilograms and a child who had been mismanaged at a pharmacy who I diagnosed with malaria and started on treatment. I saw others with acute respiratory tract infections, skin conditions like scabies and diarrhoeal disease. It’s definitely never dull! I even had a little time left over at the end of the afternoon to update one of our protocols. 

After work I found a taxi to take me to Aberdeen road junction, walked to a supermarket to pick up a few essential items and then walked home from there, ignoring quite a few “white girl” comments on the way. Another one of those things I have never gotten used to!

I had a relaxing evening at home, which is a nice change since I usually come home and have to start studying right away. Thankfully module 3 of my MPH doesn’t start for another week. 

Alright, that’s it for a little glimpse of my first 24 hours back in Sierra Leone. More another day. It’s bed time now.

#lifeinsierraleone #sierraleone #alwaysanadventure #outpatientclinic #AWC 

Arrival, Assembly, Testing and Distribution...

"Oxygen for Christmas" = a success...

The ferry ride...

"Oxygen for Christmas" = a success...

Join our team...

The Welbodi Partnership is currently looking for 2 people to join their team at the Ola During Children's Hospital in Freetown, Sierra Leone as early as July 2011. If you are a doctor, nurse or healthcare manager and interested in volunteering with Welbodi for a year to help improve paediatric care in Sierra Leone, please apply! Not only will you be able to experience healthcare in a developing world, you will also be amazed by the beauty of Sierra Leone - both its people and its beaches are amazing.

Come for a year and make a difference at the Children's Hospital.

For more information go to the following pages:

Information for Healthcare managers

Information for Healthcare professionals (doctors and nurses)

Life-saving blood...

While driving past an NGO hospital last week a friend read out a sign painted on the hospital wall stating that patients need to come with their own blood donors. He thought that was very odd but having been here for years it didn’t seem strange to me. I suppose in the developed world, one would not see such a sign.

Every day children come to the hospital with severe anemia, mostly due to malaria. So, not only do they need to receive anti-malarial medication, they often need blood transfusions as well. Unfortunately it can take up to hours if not days for some of the children to receive blood.
The reason for this is that the blood bank runs on a donor replacement system.

Basically, a family member needs to donate a unit of blood to the blood bank in exchange for a unit of screened blood that is stored in the fridge, which will go directly to the patient. Meanwhile the blood donated by the family member will be screened and if uninfected, it is stored in the fridge and used for a patient needing blood at a later time. It sounds simple but unfortunately in practice, the system does not always work. The main problem is that there is often no family member willing to donate; either no one but the mother is around or relatives do not want to donate. And for some reason the blood bank often refuses to take blood from the mothers.

I do not know why, but in general Sierra Leoneans do not like to donate blood. They either assume that by donating they will get infected with something, or are worried about the HIV screen or various other things. This is a problem because it means a child will not receive blood from the bank because the unit taken out is not going to be replaced. And, in all fairness to the blood bank, if this happens too often the blood bank will be depleted.

I have seen in the Emergency Room and ICU countless children in urgent need of blood. Children literally come in with a hemoglobin as low as 1 or 2 g/dL. Some of these children will die if they don’t receive blood within the first hour. It is for these cases that I will take the child’s blood sample and blood request form to the blood bank and ask for a unit from the screened stock, explaining how critically ill the child is. I do end up getting the blood but not without hesitation. And in all fairness, I totally understand the concern because the more we make exceptions, the more relatives will refrain from donating, assuming we will arrange for them to get blood without having to replace it. This is obviously not sustainable.

In December I was asking for blood so often that I decided it was time to replace some of the blood myself. It was time to donate. So, together with Shona (VSO doctor) we headed to the blood bank on a Friday afternoon after lunch thinking we would be in and out in no time. I should have known better. Although it took a while, I have to say we had an interesting experience.

We wanted the technician to go through the usual procedure to make sure we were fit to donate so he proceeded to check our hemoglobin with the Hemocue. Unfortunately it was not working. He pulled out a color card, which literally was a piece of paper with various shades of red painted on it. I questioned this method and suggested he use the centrifuge for a spun hematocrit. We were rather unfortunate once again as the blood spilled out of the capillary tubes while spinning in the centrifuge. What are the odds? Since I had recently had my blood checked at home, I knew my hemoglobin was okay and we decided to go ahead with the donation.

After the blood grouping, we reclined on the two makeshift beds and got as comfortable as we could knowing a large bore needle was about to be put into our veins. We were more at ease when the technician started playing Christmas tunes from his cell phone. He inserted the needle with ease and it was amazing to see my blood flowing into a blood bag, knowing that it could potentially save a child’s life. It felt incredible to be able to help in such a tangible way and be a part of a child’s healing process. It also made me feel good to know I was giving a unit to the blood bank rather than just taking.

I later learned that my blood had been given to two different children and although I don’t know who they are or what the outcomes were, I know that I helped those children. I will definitely donate as often as I can at Children’s and I definitely recommend that people come to the hospital to donate blood. It is a very worthy cause. Seriously, if you come and donate let me know and I’ll buy you a coke while you recover. And, if you’re not in Sierra Leone, donate at your local blood bank. A unit of blood can impact someone’s life. It can mean the difference between life and death.

First posted @ http://blogs.bmj.com/bmj/2011/02/11/sandra-lako-life-saving-blood/

A unique Christmas gift...

Do you want to give something unique this Christmas?

How about giving Oxygen?

Last Christmas I raised $5000 for a water well in Ethiopia. With your help that was possible. This year I am raising money for oxygen concentrators for the Children's Hospital in Sierra Leone. Can you help me again?

Watch the video and then go to: http://www.justgiving.com/sandralako

MERRY CHRISTMAS.

Tolo is walking...

Remember Francellot, my knight, a.k.a. Tolo? I recently received an email from his father telling me that Tolo talks about me and some of my other team mates all the time. He is now living in a tent with his family and is back in school. The best news of all is that he is walking again, although not very well yet according to his father. It's a great beginning though. I would love to see this boy again someday! For now, pictures will have to do. On the left Tolo with fixators in both upper legs and a big smile on his face. On the right, a big smile after returning from Medishare where his fixators were removed in late March!

Growing, growing, growing...

I'm sure that anyone who was following my blog while I was in Haiti will remember the two babies that were in the post-op ward (see here and here). Jean and Kevin. The latest update is that they have moved into the orphanage, are healthy and have grown a lot. Yeah! I'm still hoping for families for them and have no idea where that process is at right now. In the meantime I am sure they are getting their share of cuddles from the children and staff at the orphanage as well as from volunteers passing through. Keep growing little guys. Check out Jean's belly now! Jean on the left, Kevin on the right.

Louise...

Remember Louise? She is the one with a tibia/fibula fracture with long leg cast on her right leg, a femur fracture with an external fixator on her left leg, a large ulcer like lesion on her lower back and many scrapes and scratches all over her body. She is also the one who had a massive infestation of worms. And the one who was abandoned by her family. She's the one with the very sad story but with a continuous smile on her face. She is one of my heroes.

I recently heard from a friend who is still in Haiti that Louise is still at the orphanage. She ended up having to return to Medishare Hospital for a skin graft due to a swollen leg/foot, likely an infection. And her bones are healing VERY slowly. She no longer has the cast but still has the pins in her upper leg. However, despite everything, Louise continues to smile and enjoy life. I have no idea what the family situation is like at the moment, but hope that Louise feels loved and accepted at the orphanage. You can see her practicing to walk in the photo above and see how she is enjoying time with her new friends at the clinic/orphanage (pictures from left to right are Louise, Nancy and Founa). I am hoping for continued physical and emotional healing for all of them as all three of them are still there. Keep it up girls!

You can read the other posts about Louise here and here.

Prosthetic limbs...

Crystell is a 14 year old whose parents died in the Haiti earthquake. While rescuing her nephew, a wall collapsed on her leg, and her leg was amputated shortly afterwards. I have previously written about her here and here. Crystell had to move to the orphanage because her siblings did not want to take care of an amputee. As you can imagine, this made Crystell very sad and very self-conscious. However, with a lot of encouragement and perseverance Crystell is headed in the right direction. Quite literally she is heading towards a brighter future, as she was fortunate to receive a prosthetic limb about a month ago. How exciting! Three of the other children who had lower limb amputations also received prosthetic limbs, including Mistil I’ve been told! How I would love to see a picture of him with his new leg! For his story click here.

Namina's story...

Three and a half year old Namina and her mother arrived at the Mercy Ships outpatient clinic for children on January 21, 2009 after being referred from the Lungi Government Hospital following a one month admission there. She had been referred to the Mercy Ships clinic for surgical reconstruction of her face.

Namina had been inflicted with a devastating disease known as “cancrum oris” or “noma”. This disease is rightly referred to as the “face of poverty”, affecting the poorest of the poor. At the age of 3 ½ years, Namina weighed only 10 kilograms; her malnutrition making her more susceptible to infection. It started as a small lesion in her mouth but soon spread and turned into a gangrenous flesh eating disease causing massive destruction of her facial tissues. With a high mortality rate, few people survive. Yet Namina was a survivor, but it left her face disfigured.

The initial thought was to send her back to Lungi because this was not a condition that could be treated in the clinic; reconstructive surgery was not available. However, within minutes this little girl captured the hearts of those working in the clinic. The doctor went ahead and examined Namina to see the extent of the damage. It was bad. Sure enough there was a gaping hole in the left side of her face. It was a hideous sight. It was heartbreaking. However, Namina had already proved she was a fighter. She had survived the intial infection and it was now our job to make sure she continued to improve. Not only did she have a disfigured face, she also suffered from malnutrition and malaria. Immediately, the staff provided the necessary medications and nutritional support needed, as well as the wound care that was required. It was obvious that it would take months for the wound to heal enough so that reconstructive surgery could be considered. The follow-up was intense.

For weeks Namina and her mother came to the clinic for wound care; in the beginning as often as three to four times a week. The wound care was often a painful process in which the wound was thoroughly flushed and cleaned with saline solution and then dressed with sterile gauze. This often brought tears to Namina’s eyes, but once the dressing change was over, she was ready to play again and always looked forward to choosing a toy from the toy box. Nutritional support was given to Namina in the form of a high protein drink and as time went by, progress could be seen. Not only was the wound starting to heal, but Namina was becoming stronger and healthier.

After five months, Namina has turned into a vibrant little girl. She still has a small hole in the left side of her face, but it has healed considerably. Namina is happy. And both her mother and the staff of the outpatient clinic are very pleased with the results. It is now time to move on to the next step and look into possibilities for reconstructive surgery. The process is not over yet, but Namina has come a long way.

Other posts related to Namina can be found here and here.

Permission from Namina's mother was given for the publishing of her story.

Link to news on Deve...

I have previously written about my two-year-old Haitian friend Deve here and here. Amanda, a friend I met in Haiti recently flew and drove down to Tampa, Florida to spend some time with Deve and her father in the hospital there. You can read her account and get the most recent update on Deve here. I am so thankful she is doing well.

Update on Dev...

I have some exciting news regarding Dev, a very sweet two-year-old girl with a heart defect, who I met at New Life orphanage in Haiti about three months ago. I previously blogged about her and you can read the post by clicking here. The exciting news is this: in just over an hour Dev will be undergoing open-heart surgery to fix her PDA (persistent ductus arteriosus) defect as well as remove a subaortic membrane. For months now people have been working and praying to get her to the USA for surgery. Not only have medical people been trying to find a way to make this possible, but her dad has also sacrificed so much to try to make this work. He spent weeks at the New Life clinic, waiting for an answer, meanwhile taking such good care of his little girl. Now, finally the day has come. On Friday, May 7, 2010 Dev and her father Michellet arrived safely in Tampa, Florida and today (at 8 am Florida time) she will undergo surgery. Thank you God for answering prayers. Thank you to all the people who made this possible. Please pray for wisdom for the doctors, a successful surgery and recovery for Dev as well as a speedy return back to Haiti.

"With man this is impossible, but with God all things are possible." Matthew 19

Glimpse of Haiti...

Haiti. from Sandra Lako on Vimeo.

A glimpse of my 3 weeks in Haiti. And a glimpse of the country and the people. An incredible experience. A humbling experience. What I saw was: HOPE in the midst of devastation, JOY in the midst of suffering, PEACE in the midst of chaos and LOVE in the midst of brokenness. The children in this video are some of the bravest children I have ever met. It was a privilege to work with them. Please continue to pray for Haiti. It is not over yet. But He is the "God of this city". (Music by Chris Tomlin)

Favorite pictures & moving on...

Above are my favorite pictures from my time in Haiti. And my favorite memories are also with the children I met in the post-op ward. I have tried to reflect and process my trip through the stories I have posted on my blog. Sharing events that took place, special moments, daily activities, frustrations, prayer requests. Of course there are many more stories to tell and I hope to be able to share those in the future (as well as share stories with family and friends in person). But right now it is time for me to move on, at least for now, as I prepare to go to Switzerland for a week of relief orientation with Medair. The time has come to focus on something new and pour my heart and energy into something else. This does not mean I will forget about Haiti. Never. The memories will remain with me. And each of these children has a place in my heart. I will continue to pray for them and for their country. And hopefully I can do more for them in the future. I will continue to seek God for direction for my future, wherever that may be. It is in His hands, just like each of these children (and those not pictured) are. These children are entrusted to His care. His shelter. His love. His comfort. His healing touch.

Children praying...

Sunday February 27 -

Best moment of the day was Bible study for the children, led by Amanda, one of the nurses on our team. She taught on the friends lowering their friend down to Jesus through the roof of a house for healing. Afterwards she encouraged the children to pray for each other. A few of the children did not understand what she was saying, a number of them did. It was precious to see Founa and Carlandia with their hands stretched out to the other one's broken leg, praying. And I could not hold back the tears when I saw 12 year old Mistil with his leg amputated, reach over to 3 year old Shakira, put his hand on her shoulder and pray for her with her leg amputation. Precious moments. God is moving.

Literacy class...

Two of the 9 year old girls in the post-op ward had never been to school before. They did not know how to write their names. So, I took it upon myself to teach them. I love teaching children/adults how to write their names. I feel like if there is one thing people should learn to write, it is their name. One of the things I noticed when working at the Fistula Hospital in Sierra Leone was that the women were much happier when they could sign papers using their name, rather than their fingerprint.

Both Founa and Marie were very excited. On a Sunday and Monday afternoon I sat down on Founa's cot and started showing her the letters to her name. She was hesitant at first, unsure of how to even hold the pen but soon enough she was very eager to continue. It is always interesting teaching someone to write for the first time. It seems so easy, but in their minds, it's not. The logic of making each letter the same size, just does not come naturally in the beginning. And even tracing letters seemed like a very difficult task. But with lots of patience and repetition, she got it down. She was so proud of herself. Unfortunately Founa's mom died years ago and her father died in the recent earth quake. Her cousin is looking after her for now, but is uncertain if he will be able to continue. Let's pray for a home for her and the opportunity to go to school!

Marie loved the idea of learning to write. Having broken her left arm, she was fortunate to be right-handed. So, on a Wednesday afternoon we sat down and started writing. She was also hesitant to start. When I first asked her if she wanted to learn how to write her name, she said no. When I asked her why not, she said because she has never gone to school and thought she couldn't learn. I explained to her that I could teach her right then and there how to write her name. She wanted that. She caught on very quickly it was amazing. Tracing letters, copying them down, and finally putting them together to write her name. She was so proud of herself. Later she was coloring a picture and then came to find me because she had written her name on it! A few days later she pulled me over to the blackboard where she had been writing her name. I found out from one of my team mates that they had loaned her a coloring book, but seeing later that she wrote her name all over it, decided to give the book to her. Smart girl!

What a privilege to be able to help these children in so many different ways!

Sweet girl suffering...

One of the patients that tugged at my heart the most was a 10 year old that came to us from the Medishare hospital on Friday, February 19th. She has a broken lower leg on the right side which is in a long leg cast and a broken upper leg on the left side which is being fixed with an external fixator (pins). She also has a nasty ulcer like lesion on her lower back as a result of burns she suffered during the earthquake. She came to us with her aunt. However, we soon realized that her aunt was not the most committed. Apparently aunt had a job and so was gone a lot during the first few days. I started worrying however, during my last week there, when I did not see the aunt at all over a 4 day period. By the time I left Haiti, it has been a week since the aunt showed up. I am worried about what this means. Has this 10 year old been left at the clinic for good? Or is the aunt trying to do her best for her by making money to provide for her once she is discharged? Apparently the child's mother and siblings are living in the countryside, her father died in the earth quake. Long before the quake, her parents had sent her to Port-au-Prince to live with an aunt. I think they just could not take care of her as well as her other siblings and maybe hoped for a better life for her in Port-au-Prince. Unfortunately she has not yet begun school...

Everyday we spent some time with this girl. Doing her woundcare; cleaning her pins and her open wound on her back. Praying for her. Sitting with her. Helping her on a bed pan. Trying to teach her to make a bracelet. Etc.

There were a couple of moments that my heart broke for her. One time was at around 7:30 am one morning when we found this girl in her tent, laying on soaked sheets. We have no idea how long she had been laying on wet sheets or why they were wet (sweat? pee? trying to wash herself?) but were heartbroken to find her like, wishing her caretaker would actually show up to care for her or that the night nurses would check in on her now and then. Poor girl was trying to clean herself up with wet wipes. We got her out of bed, onto a clean, dry cot and took her outside to join the other children already situated out under the mango tree. We changed her bed and hoped that this situation would not repeat itself. It didn't. However, we did often have to go to her tent in the mornings to get her onto a cot and out under the tree so she wouldn't remain lying on her bed in the very hot tent till late in the morning. You see, most of the other children had caretakers to move them out, or the children could go out themselves.

Another issue was worms. This girl was unfortunate to be without a caretaker, not be able to go to the bathroom on her own, and have worms. For us, this meant helping her get onto a bed pan multiple times a day. And on 4 occassions it meant disposing of worms. Let's just say that was definitely one of my least pleasant experiences while in Haiti. Bless her though, she's had it rough. Praise God that after 2 albendazole treatments it seems she has been cured.

Pray for this girl. She needs it. She has been in the hospital/post-op ward for weeks now; since the earth quake. And she still has weeks to go. Her follow-up appointment at Medishare is on the 20th. Let's pray for healed bones. And let's pray for her future- that her aunty would come back for her or that she would be able to move to the countryside where her mother lives. This girl needs to be shown the Father's love. She needs to know that when people abandon her, there is a loving Father who welcomes her with open arms, all the time. Lord, be with this girl and touch her heart and touch the heart of her aunty and mother too.

Praying for Deve...

Today Deve turned 2.

Happy Birthday sweet girl.

Deve spent her birthday at the post-op clinic at New Life Children's Home in Port-au-Prince, Haiti.

A place she has been at with her father since the earthquake.

Not because of an earthquake related injury but due to a congenital heart defect.

She was scheduled for surgery at St. Damien hospital around January 12th but seeing as this hospital collapsed, surgery in Haiti was no longer possible.

She is waiting.

While I was working at the Medishare hospital I met a cardiologist there and asked him to look at Deve.

The diagnosis written on her papers (all in French) was persistent arterial canal.

We weren't sure what this meant and with only auscultation the cardiologist could not be sure as to the type of defect.

So again we waited, trying to make some contacts to get her out.

Deve needs specialist care.

She needs to be accepted and flown to the Dominican or USA.

We need to pray for a miracle.

For some reason the logistics are taking forever.

Yes, she is growing well, happy and not distressed but it looks like she really does need this surgery sooner rather than later.

Please pray for Deve and for her dad.

It is her birthday today.

Let's pray that this year is one full of miracles for her.

A year of open doors and God's provision and healing.

So far, it has seemed pretty impossible to get this arranged.

But God is the master of the universe and He can do the impossible.

Join me.

Let's stand in the gap for Deve and her family.

Baby update...

An update on my 2 favorite babies in Haiti. Jean pictured on the left, Kevin on the right. We weighed Jean and Kevin before leaving the post-op facility. And both have grown! Praise God. They are now both 7 1/2 pounds (Jean - 4 1/2 months old - is a few ounces heavier than Kevin - 10 weeks old). They are doing SO well. Kevin is alert and happy, stretching his feeds to 3 hours. Jean is still a hungry little boy usually wanting to eat every 2 to 2 1/2 hours. The last few days he was full of smiles. And my last day there he started grasping objects. How cute to see them change so much. I pray that God will continue to protect them and provide for them. I am praying for a family for Jean! And praying that Kevin's situation will become clear- with his parents showing up to discuss what they want. I pray that all involved will be granted wisdom and insight as to what is best for Kevin. Lord, keep these two little ones in Your hands. We trust You with their lives.