A clinic day during the COVID19 pandemic…

It’s 6:45 am on a Monday. As I head out the door, I put on a cloth mask and make my way to the paediatric outpatient clinic at the Aberdeen Women's Centre. Unlike many places in the developed world where outpatient services have switched to telemedicine, here in Sierra Leone due to limited connectivity we are still doing in-person consultations. It is the only way to keep essential health services going, which is vital in a country with some of the highest maternal, child and infant mortality rates in the world. 

It goes without saying, safety is our priority: personal safety, colleagues’ safety and that of the patients and caregivers. This is not an easy task and takes considerable planning and resources. Hand hygiene, screening, personal protective equipment (PPE) and social distancing occupy my mind throughout the day. Psychologically it is challenging. Everyone I come into contact with potentially has COVID19. 

On arrival I wash my hands and go through the screening process. Once screened, I enter the hospital compound and make my way to the children’s clinic. I wash my hands. After changing into my scrubs, I wash my hands again before I don personal protective equipment (PPE): head cover, mask, apron, face shield, gloves. Now I am safe, as long as I don’t touch my mask or my face and I wash my hands frequently.   

I walk out of the clinic’s side gate and meet the line of patients waiting to be seen. Our first priority is triage and screening. Triage to ensure that the sickest children are seen first, and screening to identify any potential COVID19 cases to isolate them for testing. During this process we have to ensure that patients are socially distanced and masked up. Although it is made somewhat easier due to painted markings on the sidewalk and chairs placed at least a meter apart, it can be chaotic, requiring a lot of patience. 

Screening takes time but eventually the patients enter the clinic; all wearing face masks. Next, one of the nurses does a health talk, using the time to educate the caregivers about corona virus and how to prevent it. Meanwhile I attend to very sick children in our observation room or, if there aren’t any emergency cases, I prepare my consultation room; disinfecting the table and chairs and making sure I have gloves and hand sanitizer. Finally, I start the general consultations. 

Consultations are carried out as usual except that I consider every person to be a suspect case. Although we screen at the gate, we will miss cases, in particular asymptomatic caregivers. So, I make sure the caregiver and child are sitting at least a meter away from me and I keep my mask and face shield on, using gloves for every patient contact followed by hand hygiene. This process repeats itself until every patient has been seen, either by my colleagues or myself. 

After all of the patients leave, I remove my face shield for disinfection and reuse, wash my hands and attend to administrative tasks, trainings and meetings. My mask is kept on, because even those I work with are suspects. Anyone could be an asymptomatic carrier. 

It’s time to clock out. I doff any remaining PPE, wash my hands, change my clothes, put on a cloth mask and make my way home. On entering my compound, I wash my hands before heading indoors. The workday is done and I can only hope that I kept myself safe today. 

All across Sierra Leone, healthcare workers continue to provide essential health services, as well as COVID19 care. Please pray for courage, safety and perseverance. 

#TogetherWeCan #EndCorona #ProvidingEssentialHealthcare #ChildrenMatter

Another year...

Today marks the first day of another year at Aberdeen Women's Centre! Yesterday, I completed my first year working as a doctor in the outpatient paediatric clinic. There was a lot of transition at the start, including a move to a new home, resuming clinical work and starting my online Masters in Public Health and at times I wondered if I would make it to the end of the contract. Thankfully, I did and I’ve decided to stay put for another year.  

Although there are parts of my work that are frustrating and challenging, like any job I suppose, the work I do in Aberdeen is also very rewarding. I have the unique opportunity to help children get better and advise and encourage the caregivers to provide healthier environments for their children, whether it’s through nutritional advice, encouraging them to bring their children for immunisations or teaching them how to prevent illness. It’s a privilege to work alongside a Sierra Leonean team and provide healthcare that makes a difference in the lives of children and families in Freetown.

Now that the rains have started, the clinic is even busier than usual and in the past three days alone we’ve treated over 400 patients. We are seeing more diarrheal disease, respiratory disease, as well as cases of severe malaria, in children of all ages. At times it’s scary to see just how sick these children can get but on the flip side, it is amazing to see how so many of them recover. I’m hoping for ongoing wisdom and energy for our team as we strive to help as many children as we can despite the craziness and long days. Here’s to another year at AWC.  

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 

It’s 2018 and I’m back in Sierra Leone after a cold but fun two week break in The Netherlands with family. I wonder what this year has in store for me. I have some hopes and dreams but I also have many questions and things to ponder. Don't we all. Some of these dreams I’ve had for a very long time...

So, 2018. What will this year hold? Am I the only one who never seems to know what I want in life? “When I grow up I want to be a...” Wait a minute I am grown up. Well, there are days that I really don’t know what I want in life and I don’t feel very grown up at all. The good thing is, we never have to have it all figured out. 

What I do know is that right now, I’m in the right place, doing the right thing. And I’m trusting that if I need to head in a different direction at some point, it will be made clear - I will know when to move on and where to move on to. For now, I am staying put. And trusting God. 

Life is busy. Work is busy. There’s an abundance of disease and never a shortage of patients. Today on my first day back I was in the clinic on my own. Seeing 54 patients. There were a surprising number with malaria and a lot with gastroenteritis. One child tested positive for HIV, while another had to be reminded of the importance of taking preventative medication due to his sickle cell disease. There’s never a dull moment. And, just to keep me on my toes, last month I started a distance learning Masters in Public Health. Yes, it’s busy. 

Let’s see where 2018 takes me...

#2018makeitcount #alwaysanadventure #actjustlylovemercywalkhumbly #sierraleone

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.