Views from Wilberforce...

Third blood donation...

Yes, it has been 4 months since blood donation #2. On Saturday the 20th of August I went to the blood bank at Ola During Children's Hospital to give another 450 mls of blood. Since my regular partner in crime has left Sierra Leone (still miss you Shona!), another friend joined me this time. It was his first time to donate (well done Grant!). First things first, we started off with a cold bottle of coke. Then, we headed to the blood bank where we needed to check our own hemoglobins to make sure we were fit to donate. As usual, my Hb was on the low side: 11.2 g/dL. Slightly too low to donate, but I convinced the technician that I was happy to donate at my own risk. He allowed it. He then proceeded to check my friend's Hb. The machine read: error. He tried again. Same thing. He tried another machine. Both read: error. I asked when the machines were last cleaned. It had been a while. He said he would do it now. After a 5 minute search for a special hemocue cleaner, I suggested I get a cleaner from my office. The technician liked that idea so off we went to pick up a cleaning package. The tech then proceeded to clean the machine. However, he wasn't able to dismantle the machine to get to the optic lens, which is the part that needed to be cleaned. He graciously asked if I could help. To be honest, I have done it before, but never quite remember how I dismantle the machine. I did manage however, and cleaned both hemocue machines. Who would have thought I'd be put to work when going to donate blood? Only here. My friend's Hb was much better than mine and so we were ready to donate. We headed over to the donation room, got our weights and ages noted and got settled on the exam tables- one of which is propped up by a box. The process took longer than usual, due to slow running blood through my veins and a dislodged needle in my friend's arm meaning he needed to be stuck a second time. All ended well, and we both donated. It was, once again, a unique experience.

If you would like to donate at the Children's Hospital, let me know! I know the experience sounds a bit crazy, but really it's fine. World Health Organization Standards and all around good staff. No need to worry. And, the offer of an escort and free coke still stand. Come and donate - it's a great way to contribute to saving lives...

A story with a good ending...

Thursday did not start off well. I was showing a visiting doctor around the hospital and the first place we went to was ward 3. I think that’s my favorite ward. The patients are for the most part stable, but the cases are varied. There are general cases as well as children with tuberculosis, HIV, Burkitt’s lymphoma, etc. I thought it would be a good place to start the tour, but I was wrong. As soon as we walked in, I noticed a nurse removing a cannula from a child on the examination table. It only took seconds to realize that the child had died. What a terrible introduction to the hospital. Face to face with reality.

Later, on our way to ward 1, I noticed a mom walking into the building with a child on her back. The child was totally covered by her lappa and by the look of the bundle it looked like the child wasn’t breathing properly. I asked the mom to remove the child. The child was gasping. I found out it was a new patient and the mom had been looking for the registration area. To make a long story short and skip some of the frustrating parts – I carried the child up to the Emergency Room and we proceeded to treat the child.

Alongside me were a couple of nurses, one of who used to work in Aberdeen and is now doing her RN training. I was thankful to have her by my side. While putting the child on oxygen (with some delays), we checked the blood sugar, which was LO. We were struggling to get a cannula in and so in the meantime I grabbed the ambubag as a precaution. Finally one of my colleagues managed to secure a line. We gave 30 mls of Dextrose 10% and waited. And after just a few minutes the child’s breathing normalized, the child was alert and the child even started fighting the nurses. Thank God I ran into this child and got her to the Emergency Room. And thank God for Dextrose!

I have to say that it is one of the most amazing recoveries to witness. A child that comes in unconscious, often gasping, receives dextrose and then comes back to life as it were. I made it a point to use the moment as a teaching opportunity and talk to the (student) nurses about hypoglycemia and the importance of recognizing it and treating it and, once corrected, monitoring it. I think that the nurses were also amazed at the child’s response. Everyone was very aware that any more delay would have cost the child’s life.

This morning, two days later, I was on one of the general wards and saw the child and mom. The child is doing much better and the mom was very thankful. I am grateful for happy endings.

Denial, blame and lying...

While checking up on a few things today, I was reminded again how easy it is for people to deny issues, blame someone else, or blatantly lie about something. And unfortunately, it happens all the time using phrases like:

"I don't know anything about that."
"It wasn't me, it was..."
"Nobody told me."
"Ask so-and-so."

For instance, I notice a child that hasn't had vital signs taken since the previous morning. I ask one of the nurses why this has not been done. The response: "the early shift was supposed to do it". I react by saying that all shifts are to blame since it has been more than 24 hours since they were done. I end with: can you please do it now?

I ask someone if they have decided on where specific items should be moved to for storage while some reconstruction is taking place. They respond by saying "I know nothing about that". I remind them that I had discussed it with them two evenings ago when leaving the hospital. I end with: Can you please let me know by Monday morning?

I notice one of the pieces of lab equipment is not being used and find out someone has taken out the batteries (which are supposed to last for 5 years). I ask who did it. No one knows. And no one cares. "It wasn't me."

I stand at my gate, knocking for 10 minutes before a guard comes to open it and let me in. I tell him he shouldn't be sleeping. He says, "I wasn't." I give up as I walk past his mat and a second guard sleeping under the staircase and hurry up to my flat.

I can go on with examples, but it would only continue to frustrate me. I just don’t buy it that everyone comes to work for their salary without caring at all about what they do. I just can’t imagine that would be the case. Yet, sometimes it looks that way. Yes, there are some very dedicated and hard-working people here but there are many people who do not seem to be very active at all. Why do they even come? And this is not only a problem in the healthcare sector. It’s a problem in many sectors. Why is that? And, more importantly, how can it be changed?

How can you instill a sense of responsibility in people?
How can you convince people that it is there duty to do their job to the best of their ability?
How can you make people realize that even if someone else was supposed to do something but forgot or neglected to do so, they should do so in order to do their job the best they can?
How do you change something that is so engrained into the culture?

Unfortunately I know that there is no clear answer and that this way of thinking and behaving will take years to change. I suppose all I can do is to try to be a good influence. I can encourage people and mentor them. And hope that they see that doing your job to the best of your ability pays off. If anyone has any answers, let me know!

Wednesday Bible Study...

After a overwhelming first half of the week, it was great to be able to go to the Wednesday night house group and discuss 2 Corinthians 6 with friends. I was encouraged.

God reminds us, “I heard your call in the nick of time; The day you needed me, I was there to help.” Well, now is the right time to listen, the day to be helped.

“Our work as God's servants gets validated—or not—in the details.
People are watching us as we stay at our post, alertly, unswervingly...
in hard times, tough times, bad times;
when we're beaten up, jailed, and mobbed;
working hard, working late, working without eating;
with pure heart, clear head, steady hand;
in gentleness, holiness, and honest love;
when we're telling the truth, and when God's showing his power;
when we're doing our best setting things right;
when we're praised, and when we're blamed;
slandered, and honored;
true to our word, though distrusted;
ignored by the world, but recognized by God;
terrifically alive, though rumored to be dead;
beaten within an inch of our lives, but refusing to die;
immersed in tears, yet always filled with deep joy;
living on handouts, yet enriching many;
having nothing, having it all.”

Challenging Monday...

I don’t really know what it was about today that made it so challenging. I suppose it was a combination of things.

All day long I felt as though I was on the go. There was a lot of chasing up to do. A patient that had not received medication, a form that was not available on the wards to request for ceftriaxone, data that had not been collected for the monthly report, a lab result that had not yet been looked at. In other words, there were a lot of little things that ended up taking time to sort out or getting someone else to sort it out. Things I don’t mind doing, but that keep me away from my ever growing ‘to do’ list.

The reconstruction of the Special Care Baby Unit took up quite a lot of time today. From checking the mosquito screens (and having the contractor re-do some of them), to making sure the floor and cots were cleaned, to moving in incubators, to organizing the cots in the bays, to making sure the incubators work, to discussing the need for shelves for monitors etc. We are nearing the time when the babies can be moved into the new ward and need to make sure we are ready. Needless to say, it meant many trips back and forth to SCBU to cross the T’s and dot the I’s. Obviously, this needs to be done, and it is great to be a part of the process, but it takes up quite a bit of time. And, some of the aspects bring on their own frustrations.

All of the above meant that I didn’t do much of what I had hoped to do. I think part of today’s problem was realizing how swamped I am. I had hoped to finish the finance documentation, plan a team meeting, get approved projects underway, arrange meetings with SLICH Board members, read Comic Relief documentation, sort out contracts, call people about various registrations, chase up an audit, etc. It just wasn’t possible. And that got to me. I know I can only do so much, but being hit in the face with my limitations throughout the day was tough. Every time I looked at a clock, it was a few hours later than I expected. The day was flying by and I still had so much to do. I realized again that I need to acknowledge the fact that I will not be able to accomplish everything. I am one person, trying to do a job that is bigger than I can do at the moment. Hopefully, that will improve a bit over the next few weeks. For now, I’ll just have to manage. In Sierra Leonean style: ‘A go manage.’

To top it off, we now seem to be collecting rainwater inside our house! Our roof has a hole in it and the water is dripping into the corridor by the kitchen. There’s never a dull moment here. It’s go, go, go.

Another Sunday Summary...

My weekend was quite busy. Saturday was spent at the hospital overseeing some of the work in the special care baby unit. The place needed to be fumigated, which was scheduled for 9 am and finally took place at 3 pm. I then donated blood, which was an adventure as usual. For the rest, I did a mixture of work and surfing the Internet. It was nice to be in a place with electricity for the day! The evening ended out with a steak dinner, to replenish my iron stores.

On Sunday I went to church. Although I was not on the schedule to teach, I did end up with the Sunday school kids because there were so many of them. I can’t say I minded. I also ended up seeing a sick child and referring him to a clinic.

After church I spent a few hours at home before hopping in a taxi to Aberdeen to meet up with Sarah for a run. We headed down to Lumley beach, and after catching up with friends who have just returned from their holiday we were off. Seeing as we’re just starting up, we didn’t run very far, but it was long enough for us. We continued walking until we reached the amputee football team playing a football match. Within seconds, an expatriate came up to us and before we knew it we were discussing laboratory services and medical care in Sierra Leone. Networking. Not what I would have expected to be doing on a Sunday afternoon, but it’s potentially a good contact to have. We then walked further down the beach before turning around to go back to the center. After a shower (with great water pressure) I left the center and went to meet another friend. On my way out, I ran into a mom who was waiting to register her child for the clinic the next morning. To make a long story short: the child needed to be admitted and so I sent the child to the Children’s Hospital for a blood transfusion. My friend ended up meeting me in Aberdeen and we walked the whole stretch of the beach to Lumley. I can definitely say I got my exercise for the day!

It was another good weekend come and gone. I can’t say I had the chance to rest much this weekend, but maybe I can make up for it during the week. Probably not!

Okon...

Five-year old Okon was admitted in July and discharged on the 11th, the day Comic Relief was at the hospital to do our grant approval 'reveal'. On that day Okon and his mom were full of smiles, because after being treated for malaria for four days, he was well enough to go home.

Today, when I came to the hospital, I saw a man and child sitting on the bench outside my office door. The child looked very familiar. It was Okon. Everything about him was the same, except for the smile. He was no longer smiling. For some reason, he is sick with malaria again and it has made him very weak. He has had two blood transfusions in the past two days. I hope he gets better quickly. And starts smiling again.

It makes me wonder how many children get sick again shortly after being discharged from the hospital. And why? And how many of them do not come back? And how many of those die? It would be sad to know that we aren’t fully curing patients. I have thought about this a lot in the past because I know that despite free health care, not all of the drugs are free to outpatients. While a patient is admitted everything might be free, but when they are discharged they may need to pay for some of the medication. Does that happen? Or do they go home partially treated, only to get sick again within a few days or weeks. Or do we treat one condition and overlook another. I suppose it is all possible but I sincerely hope we are treating all patients well the first time around.

In Okon’s case there are a lot of questions that can be asked. Did the doctor prescribe the right medication on discharge? Did the nurses dispense it to the mom? Did anyone explain to the mom how to give the medication? If mom had the medication, did she give it to him properly? Does he sleep under a bed net? I don't know the answers. Let’s just hope that he gets better quickly, and that when he is discharged it will be clear to all what needs to happen.