Survived Monday, again...

Yay, it's Monday evening.
Another "crazy Monday" come and gone.
Seeing as it's already late (after a 12 hour clinic day) I'll be brief.
We met 90 children at the gate this morning.
But only let in 60.
That meant sending 30 children off to who knows where.
Some of them will likely show up tomorrow morning in the line.
Of the 60 we saw, many ended up waiting inside for hours.
Some weren't seen till 6pm.
That's a 12 hour wait for some of them.
It's a crazy world here.

Throughout the day a couple more kids showed up.
Ones we had sent for x-rays the previous week or for admission.
So we ended up seeing 67.
And guess who came back??
Hawa; the little girl I wrote about in my previous post.
She came to say 'thank you' and let me know she had been discharged.
She looked much better.
And her hemoglobin went from 3.9 to 8.4!
That's why we're doing what we're doing.
And that's why I don't mind the long days all too much.
It's all for the kids!

Indecisiveness...

One of my biggest frustrations this week has been my own indecisiveness when it comes to referring patients. I feel like there are times when I am just not sure if I am judging the situation correctly. Having said this I can already tell you that many of these children would be admitted in the West but have to be treated as outpatients here because of lack of bed space at the free NGO and the other option (government hospital) being unaffordable and of lesser quality. So, I suppose when you really think about it, my indecisiveness can be attributed to the poor healthcare infrastructure here, rather than to myself. Sounds like an easy cop out. Let me give you an example.

Hawa has come to my clinic since the age of 5 months. She is now 2 years and 10 months and came in on Tuesday with a 2 day history of fever, swollen feet and convulsions. She didn’t look great and her lab work showed she had malaria and a hemoglobin of 5.7. This is when the decision making comes in; try to refer her for admission or see if she takes her antimalarial medication fine and send her home. The decision was simple; I already knew there was no space at the NGO hospital, so I would try outpatient treatment seeing as the child was stable. She took her antimalarials fine so I told her to come back the next day. 24 hours later she showed up at the clinic looking worse; even puffier, breathing at 60 per minute, on and off nasal flaring. Her hemoglobin had dropped to 4.0 g/dL; time to refer. Praise God there was a bed available at the NGO hospital. I sent her off in a chartered taxi for a 25-30 minute journey. Two days later I went to the NGO hospital and heard that Hawa had been transfused, improved greatly and was discharged early on Friday; a good ending.

So, the dilemma of course is that you just don’t know if the children will survive till the next morning. Fortunately, although Hawa was doing worse on Wednesday, she was still alive and could be referred. But, she could also have died that night. And I would have felt terrible for not referring her on day 1. Then again, my only option of referring was to the government-run hospital. And sometimes the treatment can be questionable and it’s expensive. Again, the never-ending financial burden; money to see the doctor, to buy a notebook for medical notes, for medication, for a blood transfusion etc. Also many people don't like going there 'because so many children die' (in my opinion because many of them go there so late).

The hardest for me is when I decide to treat as an outpatient and see the kids back the next day and then they don’t show up. Did they get worse and go to a hospital overnight, did they get better and not see need for follow-up, did the parents get distracted or worse case scenario: did they die? If they don’t show up I feel like I have misjudged the situation and it's always hard to trace what happened. Bottom line, I'm faced with tough decisions every day and I don’t like this indecisive feeling. All I can do is pray for wisdom and trust these kids into His hands.

Insights into Sierra Leonean football...

Last Saturday the Salone Stars were on the field again; a World cup qualifying match versus Equatorial Guinea, which I learned is the only Spanish speaking country in Africa. Unfortunately even football does not function smoothly in Sierra Leone; apparently the star player, Kallon, had to buy plane tickets for a number of the players to come from Europe; crazy.

We bought tickets earlier in the morning at the police station. I’m not quite sure why they are bought there, but that seems to be the norm. My guess is the police must be making some money off of it. Due to rainy season we decided to go for the expensive i.e. covered seats just in case of some showers, which set me back $10. The cheaper seats are $3.

When we arrived, we parked at what looked like a car wash. We were rudely greeted by a bunch of young guys who continuously called us white girls “baby”. We were annoyed and quickly moved along. After some pushing and shoving, and one pick-pocketing attempt, we made our way into the stadium area. After entering we noticed that many vehicles were parked just outside of the stadium so we decided to move the car. The policemen were quick to tell us that we should beg one of them to ‘watch’ the car for us. As if. Nice try.

We made our way to the stands and were entertained long before the game officially started; the teams warming up, the referees running back and forth along the midfield line, the police marching band playing with a man at the front twirling a baton and marching with his knees practically touching his chin, men dressed in crazy Sierra Leonean colored outfits, and lots of noise from people in the crowd. During the game we filled our stomachs with peanuts, meat on sticks, soda and bagged water.

The game was great. Sierra Leone won 2-1. There was lots of lively discussion throughout the game by the multitudes of Sierra Leoneans watching on; arguing, disagreeing, cheering the team on. Just after the second goal the Stars fouled and a penalty was allotted to the opposing team. When the penalty was scored, silence fell over the stadium. I guess there were no supporters for the other team and I almost felt bad for them. Half way through the game the score board stopped working, not a surprise there. And as the game came to an end the riot police made their appearance and lined up around the outskirts, just in case the fans would storm the field. It remained peaceful and we soon made our way home, stuck in traffic along the way, only to be passed up by the football teams in their buses being escorted by police vans with sirens and flashing lights. Of course a couple of taxis and local mini buses turned on their hazards and followed them, piggy backing off of the easy way through traffic. We were good and remained stuck in traffic for awhile. Oh Salone, I love it!

Busy Wednesday...

Wednesday used to be a bit of a ‘breather’ in between busy clinic days; a day to compose myself, process the first half of the week, gear up for the second half. Well, it’s changed a bit. Wednesday is still REVIEW day but this week for some crazy reason (patients being more sick than usual?!) I had 32 patients keeping me busy all day, which also meant I did not get any admin done! Not that I am a huge fan of admin, but it does need to get done; maybe this weekend??! I must say it was a very interesting day, kids of all ages, with a large variety of conditions; many doing better, a few worse. Let me give you a run down by age:

2 month olds: Twins coming for weight check-up and vaccines. A happy wheezer, coming for third day in a row, finally improving. A baby who is not gaining weight for an unknown reason and needs more tests done.
3 months olds: Boy with a heart defect in a country with no treatment possibilities, coming for check up to see if he’s gaining weight. Girl with cleft lip & heart defect coming for her regular 2 week check-up until possible surgery on the Africa Mercy.
4 months olds: Complex case with encephalocele & hydrocephalus who I had to inform that she will no longer be able to have surgery on the ship. A happy set of twins looking well and gaining weight.
5 months: Bronchitis case finally on the mend after a few days of consecutive follow-up.
6 months: Child with a bulging fontanelle; usually a danger sign but this was a happy & well child! Little girl who was quite sick 2 weeks ago with sepsis due to a widespread skin infection, referred for admission and now discharged and much better.
9 months: Child with pneumonia who is improving. Cleft palate patient coming for her monthly check-up before surgery on the ship in October. Child treated for malaria last week but still has malaria parasites so now starting quinine.
11 months: Another pneumonia case (it’s pneumonia season!) doing better.
1 year olds: Girl who came 4 consecutive days last week with malaria and anemia (Hb 4.5), bravely treating as outpatient, now with Hb 7.0. Another patient coming for her third day in a row with malaria and anemia, slowly recovering. Child with persistent cough and chest signs, possible tuberculosis, trying a second antibiotic and then may need an x-ray. A malnourished child eating only porridge made out of biscuits, gaining 200g in the last 9 months who will need a lot of follow up.
2 year old: Child with many problems including malaria, chest infection, foot drop, malnutrition looking quite ill but there was no bed at NGO hospital so I am continuing to treat as outpatient.
3 year olds: Girl who started malaria treatment yesterday and also had anemia which today dropped to 3.9 and so she needed urgent referral. Child with eye problem referred to opthamologist in town.
4 year old seen yesterday with many malaria parasites, very lethargic but praise God much better today.
5 year old with malaria last Thursday, quite sick, a bit confused, took oral treatment well and now a week later much better besides mild anemia.
6 year old with malaria and anemia and now very painful limbs, possible sickle cell case?
7 year olds: Girl with facial mass since birth wondering if we’ll be able to help her on the ship. Another girl diagnosed with malaria yesterday, very lethargic, lying down on my office floor, looking much brighter today.
8 year old who was very sick 8 days ago (possible with tapeworm?), weighing 14 kg and now much better coming with a bag of bananas and oranges to say thanks.
12 year old with lump on face inquiring about treatment options.
29 year old coming to hear she is booked for cleft palate surgery on the Africa Mercy.

So all in all a busy & productive day!

Laundry time...

Tuesday night = laundry night.
As usual, I almost forgot. I suppose getting home from work at 745pm doesn't help matters when I am signed up for a 630pm laundry slot! But it's washed and now ready to go in the dryer. I thought I'd post the above picture for fun. In Salone laundry is left to dry in a multitude of places: on the ground, on rocks, on a line, on old cars, in trees, over razor wire, etc. I'm thankful for the dryer :)

charity: water...

It's always exciting to hear what friends are doing around the world. As I was on my way to church this morning I saw more woman and children than usual on the road with big yellow jerry cans on their heads; on their way to collect water. I guess maybe the rains haven't been quite as heavy this week and they've run out of water on their compounds. Or maybe the Guma Valley Water Company shut off the water supply to this area; it wouldn't be the first time. So now, these people, some being children around the age of 5 or 6 need to walk around trying to find the nearest source of water- usually a stand pipe in the area, or a broken water pipe. Or worse, sometimes they break a water line to get to water! As we headed out we had two ladies knocking on our gate asking for water.

This got me thinking about a friend who has started a non profit organization called charity: water; bringing clean, safe drinking water to people in developing nations. He is actually in Ethiopia right now- where they are starting to dig a well at a school there. Anyway, it's a great organization and you should check it out at http://www.charitywater.org/ There will be some video footage of the drilling as well. Exciting, life changing work...

Patient rescheduled...

Good news!
Shortly after writing my last post I received an email (in response to mine) from my friend on the ship in charge of scheduling patients. And, guess what?! There are still some open slots in the schedule and my patient is booked for surgery in November. Yay. I'm happy she'll have one more chance to go to Liberia for surgery. I'll see her again on Wednesday and tell her the news.

Overwhelming day...

Strange how a single day can bring out so many emotions. From laughter to tears. From frustration to enjoyment. An eventful day in too many ways. Days here can easily take you from one end of the spectrum to another. Today was one of those days. Actually this week seems to be one of those weeks...

Today it started when I had to turn children away at the gate at 8 this morning - frustration & guilt.
Then 2 children I had seen yesterday with a lot of malaria, came for review; only slightly better - concern.
A child shows up that I referred to Children's Hospital a few weeks ago looking great - joy.
Cleft palate patient missed her appointment for surgery on the Africa Mercy, showing up at our place a day after her surgery was scheduled - annoyance, frustration once again.
One of my staff goes missing and I found out after 1 1/2 hours she's at the bank - irritation.
Starting to film for our new clinic video in a nearby compound - excitement.
An expat lady comes with 3 patients instead of the arranged 1 patient - aagghhhh.
I found out 2 staff knew that the missing staff member was at the bank and lied to me - anger.
Hilarious conversation on the way home from work in the car - laughter.
Preparing worship for a Sunday evening service - contentment
Getting on facebook and wishing some friends were nearby - loneliness.
Struggling to understand decisions that are being made - anger, sadness, confusion, tears.
Holding on to the fact that God has everything under control - hope.
He has His hands on my patients, He has my future in His hands - peace.