Only 32...

Yay.
Clinic re-opened today.
And although I only saw 32 patients, it's better than none!
Not as many as usual of course, but it's still more than I saw all of last week.
It was good there weren't as many kids waiting outside because it gave us some time.
Time to make more entries into various record books.
Time for me to enter my prescriptions into the computer after each patient.
Time to cross-check the dispensary and reception entries at the end of the day.
Time to count the money in the cash box at the end of the day.
It will take more time however to mend the heart and build up trust again.
But for today I am satistfied.

Sunset & Shrimp...

The week was long.

The weekend was more than welcome.

Although lots of work needed to be done, there was also time for play.

We went and watched the kids at the SOS disabled village play football.

And then headed to Alex's for a meal.

Deep fried shrimp and chips.

Yum.

And a beautiful sunset to top it off.

Yay for some time to relax.

May day...

For the past week now I feel like I am calling out 'may day may day may day'.
Yes, this is a time of distress.
Exactly a week ago I was in my office checking up on some of the record keeping.
To my surprise, actually I was shocked, I noticed false entries in the medication book.
Much more medication was being written down than I was prescribing.
May day may day may day.
This was cause for alarm.
Sure enough, records were being falsified.
Not once, not twice but many times over and over.
Sometimes numerous times on one day.
It was a good cover up.
Taking drugs and making sure the books reflected the deduction as if I prescribed them.
Adding medications in the book for a patient who I only gave a few meds to.
Changing the amount I prescribed for a patient.
Writing medications under the ID of patients I sent elsewhere without meds.
Or under the ID of patients I hadn't seen in the last 1-2 years.
Clever.
And it has been going on for a long time.
After confrontation, dismissal and catching meds in someone's purse it was not yet over.
More people were accused of being involved.
Everyone denied.
Who to believe?
How can you trust, when someone you have trusted for 4 years has betrayed you?
Why do so many people here seem to think it is alright to steal?
Because we are white?
Because we have more than they do?
It's definitely a different set of ethics here.
Anyway, it's been a tough week.
Here I am supposed to be treating children and I am stuck writing warning letters and cross-checking records.
I have seen less patients this entire week than I usually do in one day.
Just think of all the children that have been sent away at the gate this week.
There must be a reason for all of this.
In the big picture it must make sense.
But I just don't see it right now.
However, I know that God will work through this and I will grow because of this.
But it is not easy.
Not easy for me.
But then, it's not about me; it is about Him.
And even through this, He can be glorified.

“Not to us, O Lord, not to us but to your name be the glory, because of your love and faithfulness.” Psalm 115:1

Dutch drama on Queens Day...

I just got news from my parents that a terrible tragedy occurred in Holland while people were celebrating the Queen's birthday! A day usually filled with fun and laughter ended abruptly when a man attempted to attack the Royal Family. All further festivities were immediately cancelled. Unbelievable. I just don't understand what makes people do things like this...

Five cheering spectators killed after speeding driver makes assassination attempt

Attempted attack on Dutch royal family leaves 5 dead

Another theft...

Is it terrible to say that I am not surprised anymore when I find out we have been thieved by people we know? By people who are supposed to be guarding our compound, people here to ensure our safety and watch out for our stuff. People we are supposed to be able to trust. People we have become friends with; laughed with, talked with, hung out with.

????

Terrible or not, I will say it again. I was not surprised to hear this morning that 2 of our guards were caught stealing diesel in the generator room. I guess after living here for 4 years and being thieved on numerous occassions (whether it be money, a safe, diesel, bags, chairs, etc. it was always by people we know), it just doesn't baffle me anymore.

So, I am not surprised but I am annoyed. Annoyed that once again it was some of the guys that I got along with and befriended. Annoyed that people here seem to think stealing is alright as long as you do not get caught. Annoyed that people risk their jobs, their source of income for their families, etc. by stealing from us. Yes, I know people here have little and any chance at some extra money is very appealing. But still, these guys had it good at our compound, at least better than many other posts. Why take a chance?

Most annoying of all is that once again I am faced with the reality of life here. The question: "Can I trust anyone here?" keeps haunting me. I just don't know if I can trust everyone. Or is it anyone? It saddens me to say that I really am not sure who I can trust here. As soon as I think I can trust someone and they seem loyal, they are the ones who end up stealing. Uggghhhh. This has got to be the hardest part of living in Sierra Leone - not being able to fully trust.

Salone rollercoaster...

I don’t know about you but I love rollercoaster rides.
The faster the better, the more loops the more fun.
Up and down, up and down.
Today felt much like a rollercoaster ride.

The rollercoaster ride I experienced was “The Ride of Emotions”.
Maybe you know the ride.
The one that takes all day, taking you through an array of different emotions.
Joy, sadness, surprise, frustration, excitement, amazement, devastation, to name some.

Join me on a segment of the day’s ride…

JOY - Ramatu, one of my hydrocephalus patients, showed up again after days of delay.

SADNESS - My former neighbor, 3 year old Jeneba, who I had sent to the feeding center where she also received TB treatment in 2007, was not doing well, still only weighing 7kg and not walking or talking.

SURPRISE - 4 month old Lamin, who I saw last Thursday with a moderate to severe pneumonia, showed up for review, 5 days late so I was wondering if I had lost him.

FRUSTRATION - N’gardie, the 1 year old weighing 4.6kg, did not show up for review today with her granny and aunty, so I am now hoping that they went straight to the feeding center.

EXCITEMENT - Ibrahim has been coming to the clinic for review for months waiting to hear if the expat cardiologist was scheduled to arrive and today I could finally tell him that he would be arriving in country next week.

AMAZEMENT - I went to our pharmacy to look for a specific drug for a patient (that we do not have on our inventory list) and found a box of that drug in our donated drugs pile; and it wasn’t expired yet!

DEVASTATION & SORROW - I visited a 4 year old patient with cancer at his house and saw how much this child was suffering and knew there was nothing I could do for him except for supportive care..

It was quite a ride.
And of course, most days here are like this.
I guess that is what makes this work special.
Being able to share so many moments with so many emotions with my patients and staff.

5 interesting cases...

Another long day with about 40 patients keeping me busy from 8am till 630pm of which 5 were quite interesting/memorable and I should be seeing again. Let me introduce you…

First of all there was 2 year old Hussanatu who had been sick with diarrhea and vomiting for 4 days. She went to a hospital 2 days ago but staff couldn’t get an iv line started so the mother took the child back home. When she showed up at the clinic it was a shock that she was so dehydrated. We got to work right away to start rehydrating. 4 hours and 800 ml of ORS later and she looked much better and even wanted to play with my toys. I hope to see her in the morning!

Second there was Sulaiman, 2 years old, who looked fairly okay except that he was very pale. Sure enough he had an Hb of 5.5 g/dL! Unfortunately I could not find the cause as multiple malaria tests were negative and he has not previously had this problem. Worms? Nutritional? Hemolytic disease? Seeing as he was stable I am treating him as outpatient with antibiotics and iron and folic acid and will see him again tomorrow when he returns with his results (blood film and sickle cell test). We’ll see how this unfolds!

The strangest case was a very playful 1 year old who made me wonder why he came. His mother proceeded to give a somewhat bizarre history of him having seizures everyday for the past year. Nothing quite added up. I wasn’t sure if I should believe it. Well, to my surprise, while in the lab later, he had a very short seizure-like-episode so I did refer him for further assessment. Interesting!

Most interesting was a 7 year old boy who lives upcountry and pain/difficulty urinating for 2 years! He has been to various hospitals upcountry, been admitted, been transfused, given country medicine. Of course, no diagnosis was ever made. When I asked him to pass urine to collect a sample he did so, but was in obvious pain; poor little guy. The long history was bizarre and I was hoping for some clarification through the lab. Fortunately his results pointed towards infection.First of all he had malaria which explained his large spleen. Second of all his urine showed many signs of infection: blood, leukocytes, nitrite. So, he is on antimalarials and antibiotics and I’ll see him again on Friday. I pray this problem clears up after 2 years. If not, maybe we are looking at a more complicated urinary tract problem!

My most adorable but also most worrying patient is a 1 year 2 month old girl weighing only 4.6kg; sweet but too small. Her father died just before she was born and her mother left her to the granny and aunty when she was only 5 months old! Now she is not thriving. Her weight for age is at the bottom of the chart. Her mid upper arm circumference is tiny, probably the smallest I have measured yet. So, I have referred her to the therapeutic feeding center and they’ll have to check for HIV, TB etc. However, the social situation is complex, so I will actually see the whole family in the morning to discuss admission with them. Hopefully I can convince them…

World Malaria Day...

April 25, 2009 marks World Malaria Day; a day to focus on how we can play a role in reducing the impact of malaria world wide.

The impact of malaria hit home once again this week when I met Mohamed.
Mohamed is 8 years old and came to the clinic on Thursday with a temperature of 39.7
He had been sick for only two days but looked ill enough to be prioritized.
Sure enough the lab results showed he had malaria: 3+ - a high parasite count.
After drinking ORS he was looking a little better so I decided to try oral treatment.
If he vomited either of the anti-malarial drugs, I would refer him.
Thankfully he kept the drugs down and even managed to eat rice in the afternoon.
That is when I had to decide: refer for in-patient treatment or treat as out-patient.
The never-ending dilemma of a shortage of beds and financial strains.
Since he took the oral meds, I decided on out-patient treatment, taking a slight risk.
And sure enough, once Mohamed left the clinic I started having second thoughts.
Maybe he really was too sick to send home, maybe he would only get worse in the night.
My decision had been made and he was gone; it could go either way.
I hoped I had made the right decision.
At least his mother was sensible and knew where to take him if he got worse in the night.
I was to see him again on Friday morning, Lord willing.
I thought about him multiple times through the night.
At 7:50 am on Friday I headed over to my office wondering if Mohamed would come.
As I passed the main gate, I was thrilled to see Mohamed sitting there with his mom.
He made it through the night, was looking a bit better and even gave me a smile!
I made him take his second dose of his anti-malarial drugs in the clinic.
And had him wait another hour to make sure he did not vomit them.
This time he did not just lay around and sleep the whole time like he did the previous day.
He was slowly improving.
I gave him some other medications cause his hemoglobin had dropped a bit.
And I told him to come again next week Wednesday.
If he'll also take my advice to use an insecticide treated net I will be even happier!

In the outpatient clinic I see malaria every day of the year.
Some children are only mildly ill, others moderately ill and some severely.
It's not uncommon for me to have to refer a seriously ill child due to malaria.
Or refer for a blood transfusion due to the severe anemia (Hb <5g/dL) it causes.
And unfortunately at times these children die.
They die a death that could have been prevented.
We can keep children from getting malaria.
We can cure children who get malaria.
But it requires resources; nets, spraying, diagnostic measures, treatment.
We need to work together to decrease the burden of malaria.

Visit: http://www.rbm.who.int/worldmalariaday/index.html