Sweet & Sour Alarm Clocks...

I am writing this in memory of my pet chickens
Today was the day they met their fate.
It was inevitable, they ended up in the pot.
Tonight's menu read: sweet and sour alarm clocks aka chicken.
And not just any chickens, but MY chickens.
The chickens were just making too much noise in the mornings.
Too early, too often, too loud.
It was time to put a stop to it.
No more early morning alarm clocks.
No more messy garden.
No more pet chickens.
Strangest thing about my chickens was that they would eat left over chicken.
Who knows what else they ate?!
But tonight, they were for chop.
Chickens don don.
A belly full of rice and sauce, that's what I am left with now.
I was the 'fortunate' one to have a heart on my plate, I passed it off.
Fortunately I did not put a piece of liver in my mouth, like my friend did.
Besides the internal bits, all in all they made a pretty tasty sauce.
Bye bye chickens, may you rest in peace.

River no. 2...

Another amazing day at River no. 2 beach.
Very few people around. Little noise. View of the mountains.
Amazing sky with occassional dark clouds but no rain.
Very blue and green ocean. Great view of Banana Island.
Decent waves for some body boarding. Accidental encounter with a sea urchin.
Fish kebabs and chips. Floating in the lagoon.
Walking along the white sand. Getting some color in the sun.
A very near perfect day. Oh how I'll miss River 2!

Make haste...

There are few times in Salone that people hurry. Unfortunately, one of those times is when a person is very ill needing urgent medical care. Often it is parents frantically rushing to the hospital with a sick child they have kept at home for too long. When the child is near death they run, expecting the doctor to be able to do a miracle. Of course, there are cases in which the child has not been sick for very long but gets very sick quickly and needs urgent care.

The times that I am making parents rush like mad, and calling out 'make haste' is when a very sick child comes to the clinic and needs to be referred from the outpatient clinic to a referral hospital. "Make haste" I say when I hand them their referral letter and send them outside with a nurse to charter a taxi to the hospital. To be honest, it's not like they can speed up the trip, traffic is traffic. However, what I really mean is: go straight to the hospital. Unfortunately in the past some mothers have gone home first. This leads to various outcomes: they delay admission, they reach the NGO hospital too late and the bed is taken, they wait too long till the child dies at home, the relatives discourage the mother to take the child to the hospital. When I say 'make haste' I mean get to the referral center as fast as possible.

I used this phrase a couple of times today. I referred 6 patients of which 4 were very sick and 2 were sent for non-urgent matters (physio and to start TB treatment). I hope they all arrived at their destinations in time. I worry about some of them. But, what can I do now. I have seen them. Assessed them and sent them on for further care. These are the children that were rushed off today...

- A 3 year old weighing 9.7kg. Kwashiorkor malnutrition needing urgent admission at the therapeutic feeding center downtown.
- A 10 month old with a bacterial skin rash, moderate anemia and respiratory distress. Possibly septic. Needing urgent admission and sent to the NGO referral hospital
- A 1 day old brought to the clinic at 230pm looking as blue as a smurf. Multiple congenital defects including cleft lip and palate. Very floppy. Mother ran away after seeing the child. Here with father and granny. Sent to Childrens Hospital in desperate need of Oxygen. Unfortunately I think the chance of this child's survival is nil.
- A 2 year old with severe malaria. Deteriorating during the day so in the end sent to the Childrens Hospital for iv quinine.

I hope they all took my advise and went as quickly as they could to the referral centers. What can I say. It has been a long day. And I suppose an even longer one for these families...

Last ALONE day...

What a bizarre thought.

While seeing patients today I realized it was my last day to be seeing patients on my own.

As of tomorrow, there is a clinical officer coming to work with me in the OPC.

Don’t get me wrong; it is great to have help in the clinic and that she can carry on for a few weeks after I've left.

But it does feel a little strange.

I worked on my own for the first 2 years.

Seeing around 60 patients on my own (how did I do that???)

I was desperate for help to come.

I then had a good 1 1/2 years with various doctors helping out.

Yeah for two clinicians in the clinic!

It made the work more bearable and made it possible to be more social!

But for the past few months (since end January) I was on my own again.

The change from two clinicians back to one was big.

I was not used to the pace I was working back in 2006.

I couldn’t go back to seeing 60 a day.

It seemed crazy to run myself to the ground like that again.

Instead I decided I would see around 40 per day, often ending up being around 45.

Still long days but I was satisfied that a good number of children were being seen.

Today again was crazy and chaotic but I again saw 42 children so it was worth the craziness.

Tomorrow I will introduce a new colleague to the work here.

And once the new clinical officer is up to speed we’ll increase our numbers again…

Calling from Africa...

The plan was to talk to my parents on the phone using skype tonight.

Me in Sierra Leone and my parents in the USA.

Unfortunately it was not an easy task.

First of all we have had national power all day but it has been cutting out every 10 minutes.

I tried to watch a movie in the afternoon but had to restart dvd every 10 minutes.

I decided to request 2 hours of generator time so that I could use internet.

And planned to call my parents during that time.

However, that’s when my computer started acting up.

First of all my headset gives me trouble- skype does not recognize the microphone.

So when I call someone, they cannot hear me.

After about 30 seconds into the call I get a signal to change a setting and then it works.

So, I got that sorted but then next thing I know though, my computer freezes and I have to restart it.

It stayed frozen for an awfully long time and I wasn't able to restart it initially.

Twenty minutes and a bit of worrying later I try to call my parents again.

We managed to get it about 7 minutes of conversation of which I could only hear every other sentence.

Highly frustrating.

I hung up and tried again.

4 minutes into that call, in which the connection was still very bad, our power goes off.

The guards switched off the generator and we were back on National Power.

I tried calling again.

At least this time I could hear my parents but then the power fluctuations started.

From that moment onwards the power went off and then on again about every 2-3 minutes.

So, in the end I actually called my parents 9 times.

Basically in a time span of 22 minutes I made 7 calls with an average of 98 seconds per call.

The shortest call was 8 seconds, the longest was 2 minutes and 23 seconds.

Not much time to get a whole paragraph or words in there.

So, despite many efforts, in the end, we still haven’t really talked.

We will try again tomorrow!

Hopefully we will be on generator or national power will be better behaved.

(PS: I will be impressed if I can get this entry posted on my blog tonight!)

Why oh why...

I ask myself this question over and over.
I also ask my patients’ parents this question over and over.
Why oh why do they not take their children to a decent hospital sooner?
The most common answer: no money.
Other answers: aunty said to try syrups first, father said to go to the pharmacy, the father was upcountry and so the mother was waiting for his return to get money, decided to go to a nurse’s house first, and the list goes on.
Basically there’s never really a good reason.
Granted, many clinics are not great here.
And the city is overloaded with pharmacies who love to do business.
But it’s still not a great excuse.
There’s our clinic, a few other decent clinics, a Children’s hospital and NGO hospital.
No need to sit around and wait till the child is ‘sick past mark’!

Today a mom came with her almost 2 year old.
She’s brought her to the clinic at least 2 times previously.
They had gone upcountry for a month and returned to Freetown exactly 3 weeks ago.
On arrival in Freetown the child became ill.
How long did it take her to come to the clinic?
Three weeks.
Why?
Because she had no money to come to the clinic.
What did she do instead?
She went to a pharmacy where the child got half the dose of malaria treatment needed!
Now, after being sick for three weeks the child has an Hb of 4.0 g/dL.
She is ‘white past mark’ and needs a blood transfusion.
How much did the mom spend at the pharmacy?
At least Le 5,000, if not more like Le 15,000.
How much would she have spent at our clinic for consultation, lab, medication?
About Le 2,500-3,500 - total!

Another mother came with her 5 month old.
He has had boils and a fever for some time now.
Why did she not come to the clinic sooner?
The aunty said to go to a pharmacy first and try syrups, so she bought ampiclox.
The child’s fever continued so she finally came to the clinic.
And yes, the child had a few boils left, but surprise, the blood also showed 3+ malaria!
Again, why didn’t she just come to the clinic to begin with.
Do these people not realize that the pharmacies here are run like business.
The more medications they sell, the better.
No prescriptions are needed here, basically the employees decide what meds to sell!
So, yes, the syrup from the pharmacy can sort out the boils.
But in the meantime the malaria parasites are increasing by the day!

Why oh why do they wait so long?
They end up wasting so much money on medications bought from nurses and pharmacists.
When what they actually need is a decent consultation, lab tests and specific medication.
It’s no wonder so many children die here.
Parents keep them at home so long trying all sorts of things at home until their child is ‘sick past mark’ and then rush to the hospital, often too late!
They wait so long that either they end up spending a lot of money once the child is admitted or they wait so long and the child is dead.
When will they learn?

Makes you wonder...

Sometimes the cases I see make me wonder what is really going on.
They're definitely not all straight forward.
These are just 2 examples.
The picture on the left is a little girl who had swollen hands and feet 2 months ago.
After a month or so the swelling on her left foot 'burst'.
A week later the mother noticed a bone protruding from her foot.
I wondered if it was her bone, or a foreign bone.
Her own bone that has protruded due to osteomyelitis?
Possible a piece of bone stuck in her foot to heal it traditionally???
The picture on the right is the xray of a 7 year old boy.
He has had 'piss problems' for over 2 years now.
This boy is in severe pain every time he urinates.
To the point of having to lay on the ground in agony as he pees.
He had a very bad urinary tract infection which I treated.
But his symptoms remained.
I could only think there was some sort of obstruction.
I referred him to the urologist, or 'piss doctor'.
His next step was an xray.
Is this very round object the cause of obstruction?
The father was told this was a coin.
I'm thinking maybe bladder stone, but it's awfully round???
Again, is it something put there by a traditional healer?
We'll see next week what the urologist had to say about it.
Everyday definitely has it's unique cases!

My pets...

A gift from one of my patients- Namina with cancrum oris.

I've known Namina since January and seen her a couple of times a week.

I was very surprised when I heard that she and her mom had come with a gift.

2 chickens.
The chickens now live at the team house.

Sometimes tied up, sometimes free to roam.

I must say they really are 'chickens' seeing as they scatter anytime I come near.

I'm not quite sure what they are so afraid of.

But then again, maybe they are worried about ending up in a pot.

And to be honest, if they keep making such a racket in the morning waking me up,

That is just where they might end up...in the pot.