Down time...

Some of you have asked what we do for down time. Sierra Leone is a beautiful country with beautiful beaches. A group of us often try to go to a beach in the weekend...to spend some time relaxing and enjoying our surroundings!


River no. 2 - a gorgeous beach! ..... Lakka beach - with a great pool too!

The first 'marklate' day...

Up until Wednesday the out patient clinic was primarily focused on cure (besides the health teachings given in the clinic and on the wards). Well, that has changed. On Wednesday we held our first "MARKLATE" (Krio for 'vaccination') day- children could come for their childhood vaccinations- for Free!

A few weeks ago we met with some of the community leaders to let them know of our plan and to make sure they would communicate it with the rest of the community. Letters were read in the churches and mosques, announcing the vaccination day. Later we heard that the 'town crier' had walked the streets of Aberdeen village, ringing his bell, telling people to take their children to the clinic for their 'marklates'!

The turn-up on Wednesday morning was a bit disappointing. There were about 7 mothers with children. It was a start...but not good enough. The frustrating thing was knowing that some vaccines (measles, yellow fever, BCG) could only be given if a certain number of children would be vaccinated. The 9 month measles vaccine for example is a 10 dose vial and can only be kept for a maximum of 4 hours, or the vaccine will spoil. The government (who supplies the vaccines) told us that 40% wastage for the measles vaccine would be acceptable...no more. That meant we needed to have 6 children present in order to open the vial! Well, there were 3 present that needed the measles vaccine. I was hoping for the best and decided to have the patients wait awhile, and to open the vial at noon and start vaccinating. I figured that would give us until 4pm to find more children so that we would vaccinate at least 6 kids and not get in trouble for vaccine wastage! So, the nurses started vaccinating. Of course, there was a lot of noise coming out of the clinic that day- a few crying kids sure makes it sound really busy! Fortunately with time more children came in, but still not enough for the measles vaccine. (DTP and oral polio are multi dose vials and don't spoil easily). At 3pm I had one of my nurses go across the street to a compound called 'The National Dancetroop' (apparently a lot of the occupants are national dancers!). I wasn't sure what to expect...but sure enough at 330 she showed up with about 4 more children for the measles vaccines and a bunch more for some of the others. So in the end it worked out well. We were able to vaccinate 27 children in total- a good turnout for a first day!

We will definitely keep the vaccinations as part of our out patient clinic program; hoping to hold vaccination days twice a month. Maybe before the next time we'll walk the streets ourselves with a megaphone...to make sure enough people know about it!

Mother comes back to say thank you...

A few weeks ago a lady came into the clinic with her 3 year old daughter who had a high fever and was very weak (lethargic) – not even able to sit up. Right away I knew that she was very sick and would need referral. At a time like that it is very difficult to decide whether or not to go ahead and get some lab work done or to refer her right away. I decided to check her blood sugar and do a rapid test for malaria…within a few minutes I had the results- malaria! The next decision was whether or not to start treatment or get her to the referral center as quickly as possible. A call to the doctor at the referral center confirmed my idea- to send her their way immediately. So while I gave medicine to reduce the fever, someone else was waving down a taxi and negotiating the price. Soon the mother was in the taxi with the child and I continued the clinic. During clinic I was of course wondering if she made it to the referral center...on time. After clinic that day I called the referral center and heard that the little girl had made it, and iv treatment had been started. Two days later I went to visit the little girl- she had been improving initially but had now slipped into a coma. That was very discouraging. The mother was sitting next to the bed, happy to see us, but without hope in her eyes. We could only tell her that we were hoping for the best. Looking at the little girl lying there in a coma made me wonder if I could have done anything more for her at the clinic. Leaving there, I knew we had to pray for the best. Five days after visiting the girl, I called again, not knowing what to expect. And amazingly enough the doctor told me that the little girl was doing well. She had pulled through! She ended up staying at the referral center for another 5 days until she had fully recovered. A couple of days after the child was discharged her mom brought her back to our clinic…to say thanks. I told her I was very sorry that we weren’t able to do more for her; since all I really did was refer the child. The mother said that she was grateful that we were able to help the way we did; even if she didn’t get the treatment at our clinic, we helped to get her to the right place. It was great to see her daughter walk into the clinic with a big smile on her face. Sometimes I still get frustrated because I want to be able to do more for patients, and I guess I need to realize that even though at times it may seem like I am not doing much, I am doing something…and something can make a lot of difference.


follow up visit...child doing well!

Walk with a purpose...

This past Sunday my mom, Melissa and I went to the beach for a walk. This was not just an ordinary walk. It was a walk with a purpose. Together with about 1000 other people we walked about 8 km (4.9 miles) along the beach, walking to fight hunger. On the same day, in 90 countries around the world, people were walking for the same reason. “Fight Hunger, Walk the World” is an annual event organized by the World Food Program, to raise awareness and funds and make it possible to eradicate child hunger by 2015.

At 8:30am we got to the starting point. We were surprised to see so many people present, Sierra Leoneans and expats alike. The first thing we noticed was that everyone was wearing the same t-shirts. So we made sure to get in line to buy the shirt! Before actually walking, there was a short program. A number of different people spoke, including the vice president of Sierra Leone. Unfortunately however, the microphone wasn’t working, so I’m not exactly sure what he said. After that we all started walking! The walk took about 1h45m. Fortunately it was dry and not too hot. It was great to take part in a global activity, and to walk with so many others for the children who suffer from hunger. For more info see www.wfp.org or www.fighthunger.org


me, Melissa, and my mom ... and the t-shirts :)

Yummy for my tummy...

Many of you are probably wondering what the food is like here. Well, to say the least, the food is great. And it’s usually prepared for me! That is definitely a blessing. In the weekends we don’t have a cook, so we eat leftovers, prepare our own meals, or eat elsewhere.

Breakfast is self-service. For me, this usually means eating cereal (with powdered milk) or bread (with spread cheese or peanut butter & jelly). In the weekends I have some more time to make breakfast, so I’ll occasionally enjoy other things like French toast, eggs...

During the week we eat lunch at the center…African food! The menu is the same every week…the sauces are different everyday, but the staple remains the same...RICE. I don’t care too much for the potato leaves, but the rest is good. Greens are my favorite. Some of the cooks use more hot pepper than others- you just have to make sure you always have your water bottle close by :)

Just to give you an idea, here is the center’s menu:
Groundnut sauce (peanut sauce), chicken and rice
Cassava leaves, fish and rice
Potato leaves, dry fish and rice
Greens (tastes like spinach!!) and rice
Groundnut, chicken and rice

At the team house our cook, Abdul, prepares our dinner. Here are some of the dishes that rotate through our menu; usually accompanied with fruit salad or normal salad and sometimes cake:
Grilled peanut chicken, rice, vegetables (a house favorite!)
Fish, couscous, vegetables
Shepherds pie, (one of my favorites, believe it or not)
Spaghetti, garlic bread
Chicken kebab, fried rice, avocado salad (favorite!!)
Grilled fish, sweet potatoes, plantain
Meat loaf, potatoes, green beans

So, as you can see...the food is YUMMY! A good mix of African, European and American food!

Finally...some photos...

First patient in clinic


First patient on ward (VVF patient's child)


My office/consultation room


Me and my nurses (Ramatu & Juliette)

Just so you know...

The out patient clinic opened on Tuesday, May 10th. On the first day I saw 3 patients- a slow start I know, but at least it gave us the chance to make sure that the clinic, lab, pharmacy etc. were functioning as they should. On Thursday the numbers increased, and I saw 16 children and 2 of our employees. Today, I saw 27 patients- actually it was a bit too busy. But at least we know there is a need for the clinic! The clinic days right now are Monday, Tuesday and Thursday. Once we start our immunization program we hope to have an immunization afternoon (Wednesdays) as well. And hopefully we will be able to do health teaching etc. in the community on Fridays. And who knows, maybe we’ll have more clinic days in the future.

It’s good to have started the clinic. However, I realize even more how challenging it is. And at times I feel very inadequate for the job. Especially being the only one to see the children and make the diagnosis etc makes it difficult. It would be a lot easier if there was someone else to bounce ideas off of! Most children come with complaints of fever and cough. And then half also have complaints like vomiting, diarrhea, or skin conditions. So as you can imagine, at times it is hard to figure out what is really going on. I at least try to discern which children are very sick and which are just feeling unwell. And I try to diagnose what I can, and treat with what I have! I guess I have to get used to things here too; used to working on my own, with limited medication, limited (and right now part time) lab etc. And it’s hard when a really sick child comes in and you know that you can’t really do a whole lot except refer the child to a center 20 minutes away- at times like that you really hope and pray that time is on your side! There will always be challenges here I know, but hopefully with time, things will get better and run smoothly.

Till next time.

April newsletter

Click on the link for my April 2005 newsletter
http://lakomission.org/cms_exodus/images/stories/sandra/sandraapril2005site.doc