Psalm 23...

Lord, you are my shepherd. I have everything I need.
You let me rest in green meadows, you lead me beside quiet streams.
You give me new strength everyday.
You guide me in the right direction, bringing honor to Your name.
Even when I walk through the darkest valley I will not be afraid because You are with me.
Your rod and your staff make me feel safe and secure.
You prepare a meal for me right in front of my enemies.
You welcome me as a guest, anointing my head with oil.
I am overflowing with blessing.
I know that your goodness and love will pursue me every day of my life.
And I will live in Your house forever.

The doctor is out...

This morning I went to the doctor’s office.
As I entered, the assistant informed me that the doctor was not in.
He was called out to an emergency.
He would be back soon, but would be running behind schedule.
I was told there were 3 people waiting before me.
My response: “no problem”.

As I sat there it was interesting to hear other responses.
One lady looked at it from the view point of being the one in urgent need.
And said she would be thankful too if the doctor would attend to her right away.
Another lady was in a hurry and could not wait.
She would make a new appointment.
Someone else grumbled a bit before sitting down.

My thoughts drifted to Sierra Leone.
There, people are thrilled if they can get to a doctor’s office.
In Holland we take easy access to medical care for granted.
Everyone has a family practitioner they can go to.
It’s only a matter of calling up and making an appointment.
And even today, with the ‘extra long wait’ I was only there for an hour total.

If only people knew what it was like in Sierra Leone.
A country with 168 physicians for a population of 6 million.
Compared to Holland with 60,519 physicians for a population of 16 million.
Fathers and mothers lined up in front of clinic gates by 5 in the morning.
Waiting rooms full by 8 am with 50+ children sitting around till late in the day.
Families who get sent away without help due to lack of resources/staff.

As I sat there thinking, I realized how privileged I am.
And hoped that others too, would realize how fortunate they are.
Fortunate to have access to health care, education, water, and so much more.
It’s true, we cannot choose where we are born; in wealth or poverty.
But we can choose how we live in this world.
Let us choose to be satisfied and reach out to those less fortunate than ourselves.

The Fistula Centre...

Watch to see the life-changing surgery that women like Yeabu experience at the Aberdeen West African Fistula Centre in Freetown, Sierra Leone. Thousands of women in the world suffer from obstetric fistula. Sadly prolonged labor usually ends in the birth of a stillborn baby but too often the woman is also left with a fistula, usually a hole between vagina and bladder causing them to leak urine continuously. The centre in Freetown provides free surgeries for these women. The outpatient clinic for children where I worked is co-located in the same center. When the women were fortunate to have live babies, I would be the one to make sure their babies are healthy, during the mother's admission on the ward. Needless to say the little babies brought much joy with them. And although the women were sad and depressed when arriving at the center, most left with tears of joy as they headed back towards their villages to start a new life. I would like to credit Jenny Chu as filmmaker.

Video of Mercy Ship's Outpatient Clinic for Children...

Video by Linda May Kallestein 2008

Recently posted on http://thelegacyofhope.blog.com

Dire state of healthcare services...

Another interesting read about healthcare in Sierra Leone. And the pregnant lady who lost her baby due to lack of transportation to get to a hospital lives just outside of Freetown, the capital city of Sierra Leone. Imagine what life is like for people upcountry.

"The recently-built health centre in the Sierra Leonean village of Charlotte was shuttered. Inside were lamps without bulbs, infant scales that had not weighed any babies, an unused baby cot, boxes of surgical plaster, unopened bottles of formaldehyde, and rows of beds without mattresses...

Aminata Conteh was pregnant in January 2008. When she went into labour her pains persisted and the local traditional birth attendant was unable to treat her problem. With no other transportation, neighbours placed her in a wheelbarrow and pushed her 9km to the closest health centre in the neighbouring village of Regent. She lost the baby. "This is what happens to most of our sick people. Especially those who fall severely sick in the night - look at the road", said village leader Conteh, pointing at a dusty rocky dirt path, "How can you carry someone in the middle of the night along this road?"

Click here to read more

Clinics shut down in SL...

Sierra Leone was in the news recently; The Ministry of Health has shut down bogus clinics.

"Nearly 50 illegal health clinics in Sierra Leone are to be shut by officials amid claims that botched operations killed patients. The clinics in Freetown were staffed by people with little or no training, who offered inappropriate treatment, deputy minister of health told the BBC."

Sound shocking? Well, it's not. To be honest, I am not exactly sure what group of clinics this article is referring to, but to me this is no surprise. Over the 4+ years I have worked in Salone I often saw children who had been to other so-called clinics prior to coming to me. Mind you, a lot of these clinics did have actual signs outside the doors and unfortunately were probably legal. In my opinion, many of these clinics SHOULD be closed.

So often I would have patients coming in who had been to a so-called clinic only a day or two before. I would often be told that the 'doctor' had not even taken a history or examined a child. Sometimes the child was briefly examined but only very seldom was the blood checked. Once I had a child come in with hemoglobin of around 4 g/dL; a child clinically very anemic. And in the end due to malaria. What had the 'doctor' done for the child? Prescribed antibiotics and 'blood tonic' (a syrup with iron in it). Not very helpful obviously. Meanwhile the mother thinks she is helping the child with the medication and the child dies of untreated malaria. To say it nicely, I was often furious with these clinics. And sad that parents did not realize the bad treatment their children were receiving.

But having said that, there were also pediatricians that really got my blood flowing. Once there was a pediatrician that saw a newborn baby a few hours after birth and because the child was not doing so well decided to give the child diazepam (a sleeping drug). The next day the mom brought the child to me. The child was very floppy and dehydrated. I just couldn't believe a pediatrician would have sent this child home. And really could not believe that the child had been giving sleeping medication. But, it was right there on the prescription paper. Sad but true. Fortunately the mother came to the clinic and I sent the child on to the NGO hospital.

And then there are the prescribing habits of many doctors, nurses and dispensary workers. Almost anyone can prescribe drugs. And to be honest, you can buy practically anything in a pharmacy over the counter. Most times children will already have been prescribed 6-10 various medications, of which 3-5 are usually antibiotics. Another popular drug in the mix is phenargan (promethazine) in adult dose and blood tonic is always a very sought after item as well. The drugs are often only prescribed as a single dose or for a few days, and often in adult rather than pediatric dosages. It's a wonder there isn't more drug resistance in Sierra Leone. And it's not a surprise that many of the children are not getting better. Many pharmacies also have cots in a dark room in the back where intravenous fluids are administered for any number of ailments. If you have a bit of a cold or some loose stools and think that only an i.v. can help then just ask and you shall receive. I actually do not want to know what happens in a lot of the pharmacies.

So, Honorable Minister of Health, I beg for you to continue investigating this matter as I think there are more clinics that are not providing optimal care and need to be shut down. And at the same time, maybe you could investigate what happens in so many of the pharmacies all over the country. Maybe you can put a stop to the terrible things that occur there. And finally, health education for the public would be advised. People need to learn that they do not need a 'drip' or antibiotics everytime they are ill. What they need to do is see a well-trained doctor and follow his/her advice. Of course, this means that health care needs to be both accessible and affordable to the entire population. Thank you.

Two years ago...

I have time to think now. Think about the past, present and maybe most importantly the future. Some people tell me to move on, " don't think about the past too much". As much as I have to let the clinic go, I do think it's good to look back and reflect on the past 4+ years. The good times, the bad times, the things I would have done differently, etc. I decided to scroll through my blog a bit and I came across a blog post from September 14, 2007, written on a Friday afternoon discussing highlights and lowlights from that week. Reading it is a good reminder of common issues during my time in Sierra Leone, both things I miss and things I don't miss. Most of all, the little boy's smile still gives me a warm fuzzy feeling. I miss the kids.

Reflection: Tamba

Tamba: a Land-to-Ship Partnership Story

by Lu Mizen with Morgen Kleinknecht, originally posted December 2006

Kono, Sierra Leone: “Throw the child away, it’s not worth keeping! How will you ever afford medical care or even begin to look after it?”

Huddled together in the small hut, the mood grows darker and more foreboding as harsh words pass back and forth. Family members peer down at the newborn baby; all are intent on expressing a view. Finela tries to cover her ears as each word pierces her heart. Gazing at her husband, Ishaka, their eyes begin to fill with tears. Their hearts overflow with compassion. This is their newborn baby boy, Tamba.

The 8cm tumor protruding from the forehead is gruesome. Little Tamba is a sight to behold, yet he is still a gift from God.

After a month of living under the constant words of condemnation from family and friends, Ishaka and Finela decide to go. Leaving their four older children with relatives, they travel with Tamba from their village to Sierra Leone’s capital, Freetown.

“My heart was so heavy,” Ishaka remembers. “I had some savings, yet I had no idea if Tamba could be helped. All I knew was that we couldn’t give up on him.”

But arriving in the city, hope was difficult to find. Various hospitals offered a range of advice, while charging exorbitant fees for counsel and medicine that did nothing. Ishaka was growing desperate. His only desire was to help Tamba, but he was frustrated at every turn and now he was running out of money.

“Looking back, I just feel sick,” Ishaka explains, “Over a month I spent more than $300 on hopes that were never fulfilled. These are all my savings. I was even charged for a surgery that Tamba never received.”

Then Ishaka heard of a Mercy Ships clinic in Freetown. He went there and met Sandra Lako, a doctor at the children’s outpatient clinic of the Aberdeen West African Fistula Centre.

“The timing was perfect,” Ishaka smiles, “I could afford nothing more. I was desperate and exhausted. Sandra believed in us and was a gift from God. Praise Him!”

After diagnosing the mass as a congenital tumor, Sandra explained that the surgery could not be done at the outpatient clinic. But it could be possible onboard the Mercy Ship in Liberia. She told Ishaka that the hospital ship has the skilled surgeons and the CT scanner necessary to help Tamba.

“And the most incredible news of all…” laughs Ishaka, “Sandra explained that Mercy Ships is free. Never in our life had we heard of free medical care. This was a miracle. Then another miracle happened. I had no funds left, but Sandra blessed us so greatly. Through her provisions we were able to financially afford to reach the ship.”

Sandra admits, “It did feel a little strange handing over a large amount of money to someone I had only seen three times. I made it very clear that they need to use this money for transport, and if they choose to use if for something else, I will not be able to give them any more money. My prayer for them was ‘Lord, keep Tamba and his parents safe in their travels. Give the surgeons on the ship wisdom! Lead, protect, guide.’”

Tamba and his parents reached the ship safely at the end of September. A CT scan confirmed that the tumor was operable, and a successful surgery took place later in October. Ishaka phoned Sandra periodically to keep her updated on Tamba's progress.

From his son’s bedside on the ship, Ishaka tries to put his gratitude into words, “I just cannot say thank you enough. Financially I have lost everything, but my son has life. I am just amazed that people have believed in me and wanted to help me. From Sierra Leone to Liberia, I have met people who really love and really care. Now I truly know that there is a God who cares for me and my family.”