Only 1.6 kg...

On Monday I saw a beautiful girl who was only 6 days old. Her mother was only 7 months pregnant when she went into labor. This little one was tiny, weighing only 1.6 kg. Surprisingly she had no problems at delivery; and few problems now. But she had one major problem; she was not breastfeeding. The only way this child was being fed was by squeezing breast milk into her mouth. She was also being given water which is unfortunately given to most newborns here. This was not good enough for this premature baby. We would need to do better.

Observing her mother trying to breastfeed confirmed that she really was not sucking. We had the mother express milk; 30 ml. And then tried feeding the child with a syringe; she would not drink it. There was not much more we could do except refer the child to the Children's Hospital. And hope that with a nasogastric tube, she would be able to get the nutrients she needed so that in due time she would gain strength and be drinking on her own.

This is what we discussed with her mother and father. Both were obviously concerned. Their first child needed to go to a big hospital. We explained as best as we could and comforted as much as we were able. Soon they were on their way to the hospital in downtown Freetown. But unfortunately 3 days later I received news that this little one died; sad. The good part of this story was that both her mother and her father cared. They were sensible to come to the clinic with her and took our advice to go to the hospital. Despite their efforts though, they have lost their precious little baby. I am sad for them.

My malnourished kids...

On Friday I ventured out to the Feeding Center; seeing as I had 4 patients there, it was time for another visit. I mostly enjoy my visits to the feeding centre. Yes, it is sad and sometimes shocking to see how small these kids really are, but it is also great to see how the mothers interact with each other and to see the remarkable change in so many of the kids. Every time we show up there we are warmly welcomed by both the nurses and the patients. We were a bit later this Friday, showing up around 1pm which was good because chores were done and it was time for socializing. My patients made up at least ¼ of the patient population that day, so that made it even more fun. We all sat around and talked and watched the children. Some were playing. Some were just sitting. Some were crying. Some were sleeping.

Two of my patients are not doing very well yet. Moses is on his TB drugs but still unwell and very grumpy. Sidikie is 2 years old and only weighs 7 kg. He was also quite fussy and clung to me as I was holding him. Sadly enough his mother died not too long ago. To my surprise I noticed a very prominent spine on his back, which I didn’t remember seeing before. The nurses at the feeding center also had not noticed it so I told them they need let the TB doctor know, because if he has TB of the spine, he will need yet another strong medication (streptomycin) to be added to his daily drug regime. Let’s hope these two kids start improving!

The other two already look much better. Victoria, who is 1 year and weighs 5.6 kg, has only been admitted for 4 days. But seeing as she also had malaria when I referred her, and that has been treated, she has perked up a lot. I think she will do great. Then there is Abibatu, who had all sorts of this going on when I referred her on April 7th. She is now on TB treatment and thriving. Her mother is thrilled that she is doing well. And seeing as she has been there the longest, she is the one giving other mothers advice, encouraging them, etc. It was a lovely way to spend an hour on a Friday afternoon. Spending quality time with my patients and their mothers and wondering what it would be like to run a Feeding Center…

Not Connaucht...

I have to admit that one of the mistakes I have made over the past 4 years was to send a 12 year old child to the main government hospital. Maybe it was bad luck, maybe it was this particular case, maybe I do not have all the facts, but I feel like this child’s fate was decided for him the moment he stepped into that hospital. Okay, so that’s probably not entirely true. I think he was so sick, that maybe the outcome would have been the same had he gone to the Children’s Hospital. Either way, things did not go quite right at Connaucht Hospital. I do not want to be too critical since I am not very familiar with that hospital, but I will tell you what happened in this one instance, as relayed by the family…

It all started late March. Actually, it started mid-March, because by the time I saw the child he had been sick for at least 2 weeks with a fever, headache, abdominal pain and bloody stools. He was staying with his granny who did not take him anywhere. It was only three days prior to seeing me that he arrived at his mom’s house, who immediately took him to the local pharmacy for ‘drips’ (iv fluids). On Monday morning he showed up at the clinic, too weak to stand. He was thin, jaundiced, had a fever, palpable liver and spleen, blood and protein in his urine, blood in his stool; in short, a somber picture. At 10 am I heard there was no bed available at the NGO hospital. I checked again at noon, but no luck, I would have to send to a government facility. By this time he had been in the clinic for 4 hours, drank 2500 ml of ORS, had 9 watery stools and was still looking terrible. Because the child was quite tall, and my staff thought that he would be too big for the beds at the Children’s hospital (on the main wards they only have pediatric cots), we sent to Connaucht. Later we found out that they do have ‘adult-sized’ beds on a ‘special ward’ at the Children’s hospital.

At 1245 the child was referred. At 630pm I called the family to see how the child was doing. He was STILL waiting to see a doctor. He had been at the “Emergency Department” since 2pm. Meanwhile he was still passing watery stools. I was furious, the family was annoyed. I called again and talked to a nurse. Finally at 8pm a doctor arrived and the child was seen. He was started on iv fluids and was told that in the morning, he would see the doctor again and be given a prescription for drugs. Talk about delaying treatment!

Day 2: I called the father. The child was again waiting to be seen by a doctor. By mid-day he was transferred to a ward, but still not seen by a doctor and so still not on any medication. Finally that evening he was seen by a second doctor and given a prescription.

Day 3: The father came to visit me and had the prescription in hand but no money to pay for the medication. He had paid Le 30,000 for blood tests ($10), Le 50,000 ($17) for a bed and Le 20,000 ($6) for consultation. I sent him off with some money for the drugs. The father was discouraged; he said 4 people died on the ward that day.

Day 5: I visited the child at the hospital. He was still very weak, sick and pale. He had been seen by a doctor and on the previous day two of his uncles had each donated a unit of blood. He was to be transfused today, but the nurse on the ward that day was not qualified to assist with transfusions. He would be transfused in the evening when the doctor was in. That evening the father called, the transfusion was put of until the next day. Another delay.

The child was eventually transfused, and did receive various medications. But it sounded like there was little improvement. For a little while I did not hear anything. Then, on Easter Sunday, the father called me. His son had died. It was the end of a drama; a bad ending. Who knows, maybe this child would have died no matter where he was treated. I do not even know the diagnosis. All I know is that there were numerous delays and a lot of money changing hands. And, that in the end, another life was lost. My lesson learnt was that I will stick to Children’s hospital if the NGO hospital is full.

Hard Rock...

Although the weekend was already packed with outings and activities, I managed to be persuaded to join the Timpers family for their final beach trip on Sunday afternoon. It didn’t take all that much to persuade me I suppose, except the arrangement to leave later in the afternoon rather than right after church. The timing was perfect. We left our compound at 4pm and headed out to Lakka beach; a 40 minute bumpy road, out of town and towards the ocean. On arrival we decided to arrange our dinner at the Hard Rock Restaurant first, so as not to order later and still have to wait hours for our food! Seeing as there was only fish on the night’s menu, the decision was easy. Fish it was. On our way back to the sand, we walked past the outdoor kitchen and were shown the big Bonita fish that would later wind up on our plates. We were more than pleased. After a lovely swim in the ocean we sat down to our evening meal with the backdrop of a blue ocean and orange tinted sky and the sound of waves crashing against the rocks. It was amazing. What a fantastic ending to a great weekend; tasty fish and chips, a gorgeous sun set and excellent company.

Night at Bure...

An overnight trip to the beach. What an amazing experience. The beach itself is beautiful. But to have the beach to yourself is fantastic! On Friday there were no other beach visitors until later in the afternoon, and they only stayed briefly. It was very nice to have the beach to ourselves.

On Saturday, it was a different story. By mid morning there were 2 beach outings taking place with van loads of local people attending. Despite the large amount of people it was actually quite entertaining, and not nearly as loud as anticipated. Yes, there were loud speakers and they had music booming, but it could have been much worse! And the people themselves were quite fun to watch too- it was like a fashion show. Men with funky hats on trying to make a statement, women wearing their coolest outfits, many items of clothing that we would not be caught wearing! What variety. From men in dress pants, to African shirts, to underwear only...

We stayed overnight in a tent. Just two white girls and some Sierra Leonean guys as our guards. They actually ended up sleeping next to the fire a couple of feet away from our tent. But hopefully they would have woken up to the noise of any intruders! Maybe looking back it wasn't exactly the wisest to be on a deserted beach alone. But hey, we have to take some risks in life, right?! The guys also cooked dinner for us- baked fish and rice. It was delicious! The cook was embarassed that he showed up with the food an hour late. But hey- this is Africa. As if we were surprised. And who really watches time when they're at the beach overnight anyway?!

The most fun was on Saturday when we took the body boards out for some adventurous wave riding. The waves turned out to be fairly decent and we managed to catch some waves all the way in. At this time more and more locals were showing up, so I think us two white girls gave them quite a show on our body boards. Fun times. Late afternoon we decided it was time to head back to Freetown...taking the peninsula road...driving along the coast, enjoying some peace and quiet before the craziness of a new week.

Alive...

He lived in order to die.

He died so I may live.

He gave. I received. He loves. I believe.

HE IS MY LIFE!

Time to reflect...

Does a day ever seem like one big blur to you? Today was definitely one of those days.
45 patients and 11 hours later I have time to sit and think. What actually happened today? So many faces, so many problems. Thankfully it was a diverse day.

Tonsillitis. Boils. Sickle Cell disease. Torsion of a testicle. Severe pneumonia. Malaria. Hydrocephalus. Anemia. Post-cicumcision urethral fistula. Virusses. Septic arthritis. And more.

Many children could be helped. At least two are admitted for urgent medical care. Two will need to spend lots of money at the government hospital for surgical treatment. And one child likely cannot be helped.

It is this one child that is now on my mind; 4 month old Ramatu.
Her large head makes her problem obvious; she has hydrocephalus.
Her fontanelle is bulging and her suture lines are separating.
She is showing signs of raised intracranial pressure.
What are the realistic options?
None.

Shunting can be done in places like Ghana and Kenya.
But they are too far away, too expensive and require too much follow-up.
Recently I learned about a new procedure: the ventriculocysternostomy.
Complex, I know.
It's a new technique to cure hydrocephalus without the need of a shunt.
Definitely a good solution for these children.
But this new procedure is only being performed in a handful of places.
As far as I know, it is not available in West Africa.

So while I sit here thinking of new techniques and ways to cure hydrocephalus.
I am brought back reality.
Ramatu's world.
Sierra Leone, where this procedure is not available.
News of this technique is of no help to Ramatu and her mother.
And I am left with little to do.
Except think, and hope, and pray.

My new name...

I have been here for over 4 years now and still have not been given a Salone name. I suppose since my name is fairly easy, there has not been much need for a Sierra Leonean name. However, I did think it would be fun to have one.

After our outpatient clinic staff meeting on Wednesday- which was a bit of serious talk and lots of fun (I love my staff) – I mentioned to my three nurses to think of a Salone name for me. They start coming with very bizarre names that I had never heard of and would likely forget very quickly! To make things easier, I suggested they choose on that begins with an ‘S’. They rattled off some more names I have never heard of. And I must say, after having seen over 13,000 kids in the clinic over the past years, I have heard a lot of names. I suggested they think of one a little more common. And then one of my nurses said: “How about Saffiatu?” And I replied saying: “I will take that one”. Saffiatu it is.