One month as Country Director...

 

16 October 2022. How time flies! It’s been one month since I started my role as Country Director - Sierra Leone with Mercy Ships. What an adventure it’s been already! 

It started with a flight to Senegal on day 1, then training and orientation over 12 days, a flight back to Freetown with a few days to prepare for an executive visit, meeting with high level government officials, the President of Sierra Leone announcing the Global Mercy’s visit in 2023, a few days to prepare for another visit, welcoming team members for the 3 week long assessment visit, and now engaging with (future) partners to listen and learn about the health system, to inform our program design.  

I’ll write more once the assessment visit has come to an end! For now, I’m grateful and excited. 

#globalhealth #globalsurgery #safesurgery #mercyships #partnership

Exciting transition into new role with Mercy Ships...

I’m super excited to announce my appointment as Country Director - Sierra Leone with Mercy Ships, commencing 16 September, based in Freetown!! 

What a great opportunity to represent Mercy Ships and work alongside the Sierra Leone government, health sector, partners and healthcare workers to see how the organisation can complement ongoing efforts to improve access and quality of healthcare services. 

I have a long history with both Mercy Ships and Sierra Leone. One of the ships was my childhood home for 14 years, and after studying medicine in The Netherlands, I moved to Sierra Leone, which has been my home for the past 17 years! I also worked for a Mercy Ships medical project here from 2005-2009 and have taken many patients to the ship for surgical care. It’s my worlds coming together. 

I’ll miss my AWC family and patients but I’m looking forward to this next adventure.

#sierraleone #mercyships #hopeandhealing #globalhealth #globalsurgery #partnership #equity #transformation #restoringhope #safesurgerysaveslives 
PC: Mercy Ships 

Happy 40th Mercy Ships...

Congratulations Mercy Ships!  40 years ago, on the 5th of October 1978, the first Mercy Ship was purchased.  As a 1 year old at the time, I was oblivious that this ship would one day become my childhood home. However, just a year later, my family joined the M/V Anastasis in Greece and I had the privilege of spending the next 14 and a half years onboard. To date, the Anastasis is still the place I have lived the longest, surpassing The Netherlands. However, Sierra Leone is catching up with 13 and a half years and counting.

I was the first child to go all the way from nursery through 12th grade onboard and although it wasn’t always easy, especially when I was the only child in my grade, I am so grateful that I grew up on the ship. What an amazing experience. From playing sticks, foursquare and sardines on the ship to swimming in the pool, playing basketball on the dock and roller-skating on the Aft deck. From sleeping outside during sails, watching dolphins swim alongside the ship, life boat drills and star gazing to having ‘fun nights’, ball room dancing, helping in the snack bar and watching movies in the lounge. I had the privilege of meeting so many people but also the heartache of constantly saying goodbye. The opportunity to visit over 40 countries was amazing, but also means some of my childhood memories are a bit of a blur in terms of where (in which country) a particular memory occurred. Being a part of community outreach including painting schools, building a playground, assisting in community clinics and spending time on the ward with patients coming for surgery, were defining moments.

Sierra Leone was one of the countries I visited as a child in 1992-1993. In our school yearbook that year I reflected on my time in Sierra Leone and ended with the following memory:

“I remember sitting down under the little palm-branch covered hut among the sick children and their hopeful moms. The sight of those children tugged at my heart. Holding a hopeless and suffering, measles inflicted child in my arms, after watching two other kids die from the same thing, made me realize how fortunate I really am. I also know that with God's strength I have something great that I can give to the dying children in the world today."

I know this was very idealistic, but that experience along with the life changing surgeries I witnessed on the ship, inspired me to pursue medicine. I was exposed to people who genuinely cared about others and one of my life heroes is still onboard, extending compassion and humility to the patients that come his way. In just a few days Dr. Gary will meet 7 patients that I am sending from the clinic I work at in Freetown to the Africa Mercy in Conakry for cleft lip/palate surgery. It is an honour to help these children on their journey and to partner with Mercy Ships. Although the M/V Anastasis was retired in 2007, the Africa Mercy and the Mercy Ships community still feel very much like home.

10 years since opening the outpatient clinic in Aberdeen...

On May 10, 2005 a pediatric clinic opened in Aberdeen, Freetown, Sierra Leone. A doctor from the Netherlands came to set up the clinic and after two months of preparations the doors were opened to patients. Soon this became known as one of the best pediatric clinics in Freetown and parents and children lined up to receive good quality care.

It is hard to believe that it has been 10 years since I opened the outpatient pediatric clinic in Aberdeen. At the time it was called the ACFC - Aberdeen Clinic and Fistula Centre - operated by Mercy Ships. It is now known as the Aberdeen Women's Centre and no longer run by MS. Although the pediatric clinic is currently closed due to Ebola, I am confident they will reopen in the next few months.

I remember the two months leading up to the opening of the clinic - it was a bit of a bumpy ride trying to get the community to agree to the scope of services that would be provided. I was keen to open a pediatric clinic since the child mortality rate in Sierra Leone was the highest in the world and there was no pediatric care nearby. Fortunately the stakeholders agreed that this was a good idea. 

Day 1 of the clinic went well and I soon went from seeing 3 patients, to 18 patients, to 27 patients, to 50 patients, to anywhere between 60 and 80 patients per day. There were many mornings that I had to turn patients away at the gate which was very difficult. There were some occasions in which children died in the clinic because they came in such a bad state and there was so little we could do for them. Those were difficult moments in which we were faced with the reality of the high child mortality rate in the country. Fortunately there were many children, thousands, that my team and I could help and for that I am grateful. It's fun reading through some of my blog posts from 2005-2009 to see some of the adventures I had working in Aberdeen. There were good times and bad times but overall it was such a great experience. It was a really busy time, running the clinic, seeing patients everyday, overseeing the lab and dispensary, ensuring supplies were available, etc. It was worth it though. It was a very rewarding time. A few of my nurses still work there and it is great to be in touch with them. Sometimes I run into some of 'my former patients' or their parents in town or at the Children's Hospital and it is always a blessing to know that I was able to make a difference in their lives. 

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.

Screening: the highs and the lows...

On Monday I had an early start, reaching the national stadium at 6:45 am for the Africa Mercy Screening day. When I arrived, I could already see hundreds of people waiting outside and I could only see a portion of the crowd. I was excited to be a part of this day, a day of expectations, and a day that was sure to end with much rejoicing. At least, that is what I thought.

After the organizers cleared up a few small issues with ‘extra’ lines, the screening soon began. One by one people entered the stadium grounds; the first stop was the pre-screeners. The pre-screeners asked people their reason for coming and then proceeded to tell them whether or not they could see a doctor. Due to the specific nature of the conditions treated onboard, there are always people that show up at a screening that cannot be helped. The pre-screeners had a tough job, but it was definitely needed in order to effectively screen those patients who were suitable candidates for surgery. I was impressed to see the pre-screeners persevere, patient after patient.

For those with conditions that could most likely be dealt with, the process continued as they made their way past a few more stations to the specialist screening areas: orthopedics, maxillo-facial, plastics and general surgery. It is there that they find out if they will receive surgery. To me it seemed as though this was a critical moment for patients, since the news they were about to hear could change their lives drastically. And it was these moments that were the most meaningful to me.

I was at the maxillo-facial station with Dr Gary, primarily to learn from him. The station consisted of three tables, each with a dentist and a translator to start the screening process. Dr Gary, the maxillo-facial surgeon, rotated between the three, seeing each patient and making a (differential) diagnosis and plan. It was remarkable to work with Gary and discuss/see conditions such as thyroid glossal duct cysts, cleft lips, neurofibromatosis, fibrous dysplasia, lymphomas, TB adenitis, and encephaloceles. He not only has a wealth of knowledge and experience but also worked with such confidence, humility and care for the patients.

Besides the sheer excitement of being a part of such a big undertaking and knowing that many people would be scheduled for surgery, it was awesome to watch the faces of individual patients light up when they heard they would receive an operation. Imagine a dad and his boy smiling when they heard the boy would receive surgery for a growth he’s had since birth. A woman thrilled to hear she could be operated on. A young guy, happy by the mere fact that he was being assessed properly and scheduled for a CT scan for further investigation. A shy 13- year old girl, hearing she can receive cleft lip surgery. It is these moments I try to remember when thinking about the screening, because the joy was quickly overshadowed by the tragic event that took place.

As mid-morning approached, the crowd became impatient and people started pushing forward. Those in the small, gated entrance to the stadium grounds were trapped. To relieve the pressure, a small gate was opened and people ran out, forming a new line. The situation quickly escalated. The pushing and shoving worsened and within minutes a larger gate opened and those pressed up against the gate, flooded out of the small space, onto the pavement. A stampede followed and the consequences were grave.

Within minutes, casualties were brought to the pre-screening area and there was a rush to attend to the victims. Some were in a serious condition while others had fainted or were still in shock after having been confined in a small, overcrowded space. Despite good efforts, one man died that day and 13 more were injured. This was not how it was supposed to end. A day of anticipation, excitement and joy, ended in a tragedy. It was very difficult to carry on but it seemed wise to continue screening those in the stadium. After an hour however, the situation outside grew tense once again and the decision was made to stop screening and leave the premises.

With heavy hearts the 200 crewmembers that put a lot of effort into the day, returned to the ship. Meanwhile, I walked back to the hospital still in shock at what had happened. How did the situation get out of control? Is this the Sierra Leone I know? I was saddened that the screening had to end like this. Saddened for the crew, the family of the man who died that day and saddened for the people of Sierra Leone. I couldn’t help but think that somewhere in Freetown there might be a family waiting for their father to come home, but he won’t. I kept thinking about the patients needing surgery, still waiting outside of the stadium to be seen by a doctor. I think about those who were caught in the stampede and traumatized by what happened. I think of the crewmembers that have come to Africa for the first time and experienced such a tragic introduction to what is actually an amazing country.

Looking back, part of me wishes I did not go to the screening that Monday yet a bigger part of me would not have wanted to miss the priceless smiles of those who heard they would receive surgery. There were highs and there were lows that Monday. However, I know that this is just the beginning; the beginning of something good. Although it was a very unfortunate beginning to the outreach I am convinced that despite all that has happened the Africa Mercy is going to have a huge impact in Sierra Leone and many lives will be changed. I am sure that those in urgent need of surgery will be scheduled somehow, at some point. The ship’s visit has been anticipated for years and now the time has come. Great things are going to happen. For those of you who pray, do pray for the crew onboard the Africa Mercy. This is not an easy time. Pray also for wisdom for those in leadership who are planning the next screening.

Welcoming the Africa Mercy...

At 6:30 am I left my house and taxied down to the Seafarers Lodge on Lower Savage Street, just minutes from the port. I met Hannah and the rest of the advance team getting ready for the big occasion. The Africa Mercy was on its way. I felt honored to be a part of the event and be at the pre-fest activities. It was still dark when I arrived but the ship’s lights could be seen in the distance. Exciting!

As is often the case, there was a bit of a stressful moment. The line handlers at the port were on strike. Yes, that’s right. And, what’s worse, there was another ship docked in berth 6, where the Africa Mercy was due to dock. Fortunately this did not get Tracy and Jeremy down. As deck hands they knew exactly what to do and with a team of volunteers, they managed to get the one ship moved to a different berth! The port was now ready for the Africa Mercy.

In the meantime, the team, myself and a few others were waiting for the arrival of the delegation from the Ministry of Health and Sanitation. The honorable minister, Ms Zainab Bangura, the Chief Medical Officer (Dr Daoh), The Director of Hospital and Laboratories (Dr Conteh), the Principal NGO Liaison (Yayah Conteh) and a few others. The head of the advance team graciously introduced me to the delegation as well, which was an added bonus for the Welbodi Partnership. Of course, Dr Daoh, Dr Conteh and Yayah know me, from many meetings that have taken place in the Ministry over the past 9 months. It was nice to know that in a different context, they still knew who I was!

All the while, we kept a look out for the ship. By this time it was light, but also quite hazy. Soon though, the ship appeared through the fog and it was remarkable that it was the cross at the front of the ship that we saw emerging first. As the ship approached and the pilot boat went to meet the ship, we walked down to the port and met a number of people waiting on the dock. There was a Mercy Team, 30 Gateway students, friends from the Aberdeen Women’s Centre (formerly AWAFC/Mercy Ships) and others. There we all stood waiting. Meanwhile on the decks of the Africa Mercy, the crew was anxiously awaiting their arrival in Freetown. I think the ship’s arrival seemed extra special because all of a sudden it was a reality. In 2006 and 2007 the Anastasis was scheduled to come to Freetown, but unfortunately the trips were cancelled. Thankfully, the time has come for Mercy Ships to return to Salone.

As the ship approached, it became easier to spot the crew on the deck and there was a flurry of excitement as friends on the dock and friends on the ship spotted each other. There was a lot of waving and cheering as the ship came closer. Soon the ship docked and after a bit of a wait getting the gangway in place, the time came for a brief ceremony.

The ceremony began with a crewmember walking down the gangway with a Sierra Leonean flag and handing this over to a ten-year old Sierra Leonean boy. The boy was a former Mercy Ships patients having had cleft lip and palate surgery onboard in 2001 and 2002. A symbol of lives touched in the past and lives to be changed in the future. Afterwards, the Chief Executive Officer and his wife met with the Minister and brief speeches were held. The delegation then went onboard for further formalities. At this time, those of us on the dock headed home. We’re now waiting until we can actually go onboard and meet up with friends but happy for now that the Africa Mercy is here!

A big welcome to the crew onboard the Africa Mercy! Welcome to Salone. Kushe. And hope to see you soon. Actually, surprisingly I can see the ship in the distance from my balcony all the way in Wilberforce!! Especially at night when all her lights are on!

Arrival of the Africa Mercy...

A blog entry will follow tomorrow when I can use my own laptop and have internet at the office. But for now, enjoy these photos.

Namina...

There is nothing quite like a visit from a long lost friend. For weeks I had been looking forward to seeing Namina and her mother again but not having any way to contact them, I was not sure when this reunion would take place.

You see, Namina was a patient of mine when I worked at the pediatric outpatient clinic in Aberdeen and I saw her regularly between January and June of 2009. Namina was fortunate to have survived a very lethal disease called ‘cancrum oris’ but unfortunately she was left with a large gaping hole in her face. With the help of my dedicated nursing staff, we were able to help three-year-old Namina with frequent dressing changes, nutritional support and tender care. Months of care followed and slowly the infection cleared and the wound started to heal. Throughout this time, Namina’s mother was an inspiration to me, traveling from Lungi to Freetown by ferry every Monday, so that Namina could come to the clinic 2-3 times a week for care, and then returning back to Lungi with Namina on Fridays. When I left in July 2009 it was difficult to say bye to Namina and her mom, but at least Namina was better and all she had to do was wait for her surgery.

Initially I was hoping to fly Namina and her mother to the Africa Mercy, a hospital ship run by the organization Mercy Ships, currently docked in Togo. However, a better option presented itself. In April of this year I found out that the Africa Mercy is going to conduct it’s next field service in Sierra Leone starting in February 2011. This means that Namina does not have to go anywhere. She can stay in country and have her first surgery here and although this means Namina will have to wait longer for her surgery, it is definitely an easier option from a logistical point of view.

On Friday June 25^th I was sitting in the office working behind my laptop when I heard a knock on the door. I said come in and the door opened. As I looked up to see who entered I was delighted to see Namina and her mother step into the office. Namina’s mom was very happy to see me and we quickly started chatting about Namina and how both of them were doing. I do not think Namina really remembered who I was but that is okay. I am hoping I will see more of her and be able to win her over once again. It would be great to see where they live and be able to assist them where necessary.

I am very excited that I will be in Sierra Leone when Namina goes onboard the Africa Mercy for her surgery. I am hoping I will be able to be there in the operating room with her and observe a miracle unfolding before my eyes as an amazing maxillo-facial surgeon and role model, Dr. Gary Parker, begins to reconstruct her face. I can’t wait for that day.

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.