Oops, I forgot a few things...

In my previous post, Things I like about NL..., I forgot a few important things. So here's an addition to the list:

1. Electricity. Continuous electricity without the noise of a generator. And the possibility of charging my phone or laptop at any time of the day.

2. Brown bread.

3. Stroopwafels. Again, something I don't miss much when away, but now that I've had a stroopwafel this evening, I am reminded of its deliciousness. Must bring some back to Salone.

4. Different vegetables. I enjoyed broccoli & cauliflower last night. Nice change to onions, eggplant, more onions and more eggplant.

Things I like about NL...

Yes, I am in Middelburg again for about a week. Although I have to honestly say that I do miss Sierra Leone. I suppose after 5+ years it really has become home. I miss my flat, the work, my friends, my colleagues, the sun, the liveliness, etc. However, having said that, it’s good to have a break, I’m just happy it’s not a very long one.

So, what do I like about being back? The obvious answer is seeing my sister, brother-in-law and my adorable nieces. One of my nieces has been sick, which is not fun for her, but it’s meant I’ve seen a lot more of her over the past few days! The three of them are a fun bunch and it’s always great to spend time with them. I’ll miss them when I go back for sure.

There are of course more things I like about being back:
1. Seeing friends. (although there are many people I won’t see since I’m only here for a week – sorry!)
2. Riding a bike. I rode a bike yesterday with one of my nieces on the back. Dropped her off at school, and then went to town to do some shopping before picking my niece up again. The freedom of bike riding.
3. Normal traffic. Traffic lights. Stop signs (that people abide by). Bike paths. Crosswalks.
4. Walking. I love the fact that I can go for a walk on my own and not be ‘bothered’ by anyone. No one hissing at me. No one yelling ‘white man, white man’. No one saying ‘will you be my friend’. No one asking for my phone number. Nothing. Just me. Walking.
5. Sidewalks. Which also make the walks much nicer.
6. Food. I actually don’t feel like I miss much, food-wise, when in Sierra Leone, except for more of a variety of food. It’s not until I get back to Holland that I realize there are foods I really like and don’t have in SL – tortillas, cheese, yoghurt, chocolate chip cookies, kiwis, grapes.
7. Milk. Fresh. Cold. Milk.
8. Shopping. Buying basic things like shampoo, contact lenses, etc and of course looking for the odd summery item of clothing in a shop (in winter time!).
9. Internet. Fast internet. People here might complain that it’s slow, but they don’t know slow. This is great.
10. Skype. Thanks to fast internet, I can actually skype with friends/family. YAY.
11. Water. Running freely. Cold. Hot. Lots of it.
12. Shower with great pressure. Enough said.
13. Quiet nights. I’m so thankful not to have to listen to loud music at 3 am in the morning. Although I have to say I do miss hearing Emerson and some of the Nigerian tunes during the day.
14. Well-kept dogs. Again, so nice not to have to hear dogs at midnight. And not to have to worry about getting rabies when walking past them.
15. There’s more I’m sure but this list will have to do for now.

Join our team...

The Welbodi Partnership is currently looking for 2 people to join their team at the Ola During Children's Hospital in Freetown, Sierra Leone as early as July 2011. If you are a doctor, nurse or healthcare manager and interested in volunteering with Welbodi for a year to help improve paediatric care in Sierra Leone, please apply! Not only will you be able to experience healthcare in a developing world, you will also be amazed by the beauty of Sierra Leone - both its people and its beaches are amazing.

Come for a year and make a difference at the Children's Hospital.

For more information go to the following pages:

Information for Healthcare managers

Information for Healthcare professionals (doctors and nurses)

London...

Wow. The last week has been crazy. On Wednesday I had a really long day with a trip to Lungi airport which I'll write more about soon. Then on Friday I ended up having to go in to work from 8-12 to get last minute things done (like sort out documentation for a shipment of lab equipment coming to the hospital!). I left at noon and ended up in a traffic jam on Fourah Bay road, which is not so nice when you still have to go home and pack. However, I knew I didn't have to leave the house until 4pm and that if traffic was really not moving, I could even walk home in 1 1/2 hours! I made it home by 1:30pm and started packing and cleaning. I decided to take a small roll-on suitcase since I couldn't even think of what to take with me other than 2 pairs of jeans, two sweaters, some shirts, toiletries and a few other bits and pieces. I'm planning to take more on the way back!

At 350pm Farah, my reliable taxi driver, showed up. We then picked up Shona's parents who had been visiting for 2 weeks and were on the same flight out as me, and headed to the water taxi. We were there by half 4 and it wasn't due to leave until 6pm. Finally we were on the water taxi and crossed over to Lungi. Before getting in the minivan we were all shocked when 6 men were carrying a women over to the boat. Apparently she had been sick for 4 days and her husband was trying to get her on a flight out but the airline wouldn't except her in such a bad condition. She was unconscious and I certainly hope she made it to a decent hospital in Freetown (of which there aren't many!).

I met up with my colleague/boss Tom at the Lungi side which was great, especially since he got me through the check-in line more quickly (with a silver card) and we later went into the business lounge, which isn't super but it has AC which was well worth it. The flight was supposed to leave at 945 but was postponed to 1145, meaning we had a really long wait in the airport. However, the plane was not going to stop for fuel in Malaga, so I guess that was a bonus.

I was so tired after a week with little sleep that I slept most of the flight. I didn't even notice the stewardesses come by with dinner or breakfast and I even missed some hype around a medical emergency which ended up not being a real emergency after all. Like I said, I was tired. Plus they did not call for a doctor, the stewardesses apparently followed a check-list. Anyway, I stayed put the entire flight!

We arrived in London at around 630 am and went to Costa for proper tea and a blueberry muffin. Delicious. We then took a cab to a friend's house - way too expensive - and thinking about the cost in Leones was shocking! After a shower and lovely chat we headed off to central london on the underground and then walked through town (past H&M!!!) to the Royal Society of Medicine on Oxford Street, where I am sitting now. It's a lovely place and quite a change to Freetown. Constant electricity, endless flow of water from the taps, the most amazing lunch with chocolates, raspberries, grapes, bread with cheese, quiche, etc. What a treat! Fortunately it's not so cold today!

We started our Directors meetings at 11 am and continued to 6 pm. It's been good and very productive but I am quite tired now. I'm done for the day, while the 5 directors meet for an hour or so without me. Tomorrow we'll have another day of meetings and then I'll head off to Holland on Monday. I can't wait to see family and friends.

PS: I am amazed at how fast internet is here!!!

Life-saving blood...

While driving past an NGO hospital last week a friend read out a sign painted on the hospital wall stating that patients need to come with their own blood donors. He thought that was very odd but having been here for years it didn’t seem strange to me. I suppose in the developed world, one would not see such a sign.

Every day children come to the hospital with severe anemia, mostly due to malaria. So, not only do they need to receive anti-malarial medication, they often need blood transfusions as well. Unfortunately it can take up to hours if not days for some of the children to receive blood.
The reason for this is that the blood bank runs on a donor replacement system.

Basically, a family member needs to donate a unit of blood to the blood bank in exchange for a unit of screened blood that is stored in the fridge, which will go directly to the patient. Meanwhile the blood donated by the family member will be screened and if uninfected, it is stored in the fridge and used for a patient needing blood at a later time. It sounds simple but unfortunately in practice, the system does not always work. The main problem is that there is often no family member willing to donate; either no one but the mother is around or relatives do not want to donate. And for some reason the blood bank often refuses to take blood from the mothers.

I do not know why, but in general Sierra Leoneans do not like to donate blood. They either assume that by donating they will get infected with something, or are worried about the HIV screen or various other things. This is a problem because it means a child will not receive blood from the bank because the unit taken out is not going to be replaced. And, in all fairness to the blood bank, if this happens too often the blood bank will be depleted.

I have seen in the Emergency Room and ICU countless children in urgent need of blood. Children literally come in with a hemoglobin as low as 1 or 2 g/dL. Some of these children will die if they don’t receive blood within the first hour. It is for these cases that I will take the child’s blood sample and blood request form to the blood bank and ask for a unit from the screened stock, explaining how critically ill the child is. I do end up getting the blood but not without hesitation. And in all fairness, I totally understand the concern because the more we make exceptions, the more relatives will refrain from donating, assuming we will arrange for them to get blood without having to replace it. This is obviously not sustainable.

In December I was asking for blood so often that I decided it was time to replace some of the blood myself. It was time to donate. So, together with Shona (VSO doctor) we headed to the blood bank on a Friday afternoon after lunch thinking we would be in and out in no time. I should have known better. Although it took a while, I have to say we had an interesting experience.

We wanted the technician to go through the usual procedure to make sure we were fit to donate so he proceeded to check our hemoglobin with the Hemocue. Unfortunately it was not working. He pulled out a color card, which literally was a piece of paper with various shades of red painted on it. I questioned this method and suggested he use the centrifuge for a spun hematocrit. We were rather unfortunate once again as the blood spilled out of the capillary tubes while spinning in the centrifuge. What are the odds? Since I had recently had my blood checked at home, I knew my hemoglobin was okay and we decided to go ahead with the donation.

After the blood grouping, we reclined on the two makeshift beds and got as comfortable as we could knowing a large bore needle was about to be put into our veins. We were more at ease when the technician started playing Christmas tunes from his cell phone. He inserted the needle with ease and it was amazing to see my blood flowing into a blood bag, knowing that it could potentially save a child’s life. It felt incredible to be able to help in such a tangible way and be a part of a child’s healing process. It also made me feel good to know I was giving a unit to the blood bank rather than just taking.

I later learned that my blood had been given to two different children and although I don’t know who they are or what the outcomes were, I know that I helped those children. I will definitely donate as often as I can at Children’s and I definitely recommend that people come to the hospital to donate blood. It is a very worthy cause. Seriously, if you come and donate let me know and I’ll buy you a coke while you recover. And, if you’re not in Sierra Leone, donate at your local blood bank. A unit of blood can impact someone’s life. It can mean the difference between life and death.

First posted @ http://blogs.bmj.com/bmj/2011/02/11/sandra-lako-life-saving-blood/

Discoveries...

I kind of surprise myself when I tell people I’ve been in Sierra Leone for 5 years. Has it really been that long? Yes, it has - I arrived almost 6 years ago and took an 11-month break. In many ways this feels like home, but in some ways it does not because no matter how long I am here, I am still a “white man” and don’t blend in with the crowd. People still ask for my number all the time, ask to be my friend, beg for money, etc. And sometimes I wish it would stop. Honestly, there have been expats here for years now, you think Sierra Leoneans would be used to it by now and not have to call out “white man” or “white women” or “hey you” or “baby” all the time. But they do. And I should just get used to it staying like that. (sigh)

So, although I’ve been here for a while, I still discover things all the time. Here are some of the most recent:

There’s a little shop at the petrol station just down the road, which I’ve gone to in the past to buy cornflakes or oats when I run out and can’t get to the supermarket. Just last week I discovered that they sell both fruit juices and chocolate bars. Yum. And the chocolate bars are cheaper than at the supermarkets. As you can imagine, my chocolate intake has increased over the past week and I love it.

I’ve also discovered the weirdness of cravings and about three new popcorn stands. Last week after work we drove past a popcorn stand on Fourah Bay road the smell of popcorn lingered and was amazing. All of a sudden I had an intense craving for popcorn but we had already driven too far. Then we hit traffic. My craving got worse and we weren’t moving. I actually rarely crave foods, so this was quite bizarre but I really felt like I had to have popcorn then and there. It wasn’t going to happen. Finally we were moving again and passed another stand. Seeing as we were finally moving along, I didn’t want to stop traffic and we carried on. My craving got worse. Then a little while later we spotted another stand and pulled over and my driver hopped out and bought two bags of popcorn for Le 1,000 (25 cents). O happy day. It must have been the salt I was craving on a hot and sweaty day. I bought popcorn three days in a row.

Something else I found out is that my last name is also a Sierra Leonean name, found mainly in the Magburaka area. Go figure. Funnily there’s even a doctor at the maternity hospital with the same last name. The Lako’s are from the Temne tribe, so I think I better start learning some Temne.

I also tried a new snack I had never seen before, a snack that looks like a bracelet but is eatable and made out of groundnut (peanuts) and spices. It is crunchy and has quite a taste. The lady in triage at the registration desk actually showed me this snack for the first time since it is her sister that sells them. It’s always nice to try a new snack.

I also discovered the awkwardness of sharing the front seat in a taxi. The taxis I take to Regent are often quite full. Regent is a little ways out and so the taxi drivers want to get the most out of the trip. Understandable. Up until recently I always ended up on the back seat with 3 or 4 other people. However, recently I have been stuck in the front seat with another passenger. It’s not bad at all if you’re on the car door side, but when stuck in the middle it is terrible. How awkward to be squashed up against someone on your right and to be right up against the gears, with the driver resting his arm on your leg as he shifts gear. Not so pleasant. I guess this was a discovery that taught me to sit in the back seat to Regent from now on.

That’s it for now. I’ll be on the lookout for more new and exciting things in Salone.

The world I live in...

Oh no. It’s been an entire month since I’ve blogged, shame on me. I think this has probably been my busiest month ever, both at work and socially. That and still not having an Internet connection at home make blogging a bit more of an effort. So, to those of you who check this page regularly, sorry for my lack of blog posts, as they would say in Krio – “Oshya”. I will do my best to get into the habit again. Seriously, I love blogging and find it’s a good way to ‘escape’ the craziness of my world here.

So, what’s happening in my world?

Work has been really busy with a pre-accreditation that took place earlier this week, meeting with people at the Ministry of Health, checking out support services at Connaught (the main government hospital), helping organize some of the postgraduate training sessions with the residents on Tuesday and Thursday afternoons, signing contracts with national staff, trying to get the x-ray unit up and running, renewing my registration with the Sierra Leone Medical Council, attempting unsuccessfully to get someone’s container released containing items for the hospital lab, working on getting duty free concession for the oxygen concentrators, preparing for the Welbodi Directors’ meeting next weekend, compiling statistics, facilitating a Mercy Ships/Children’s Hospital partnership, and last but certainly not least (although it’s what I’ve unfortunately spent the least time on) sneaking on to the wards now and then to see patients.

There you have it, my work in a nutshell. Well, all of the above plus attempting to solve any immediate problems or small crisis that come my way. They are probably as diverse as the above. Some examples are: nurses coming to the office for connecting pieces for oxygen concentrators or batteries for pulse oximeters, trying to track down one of the doctors when rounds aren’t underway by 9, going into locked consultation rooms in the evenings looking for blank patient charts and prescription pads to put in the ER for the new admissions when ER runs out, running to the blood bank to get blood for a critically ill child, searching for the generator man when we have a power cut so that the babies in Special Care continue receiving oxygen and the list goes on. Honestly, there is never a dull moment.

So, besides work I have been about as busy in the evenings and weekends. I tend to get home at 6, 630 or 7 depending on when I get out of the hospital and what traffic is like and then sometimes have a 10 minute turnaround at home before heading out again. Someone said recently that they get quite bored here. What? Really? Not a chance. I feel like I’m hardly home. I am not even quite sure what I do every evening but I suppose there are various friends I visit, I’m often at the Aberdeen Women’s Centre (formerly Mercy Ships in Aberdeen), Tuesday evening women’s group, Wednesday evening house group, often out for dinner on a Saturday evening, catching up with Sierra Leonean colleagues, birthday dinners, goodbye dinners, beach trips, church, international service and the list goes on. The social life gives me a boost of energy although I have to say that as of late I have been quite tired as well. I suppose everything has piled up a bit and I’ve reached my limit. That might explain my need to buy a small Cadbury chocolate bar after work everyday last week. Desperate measures. Honestly, the last few weeks have been both very difficult and very good. An odd statement, I know, but that’s what life is like here. It’s an interesting world.

Happy New Year...

Best wishes for 2011.

I hope that I will be able to keep up with blogging a bit better in 2011. I realize I have not been posting very much. Not having internet at the house plus the busyness at work has made it difficult to post regularly. But, a go try!

Life is good. I had a wonderful holiday time, although I did work Christmas Eve, Boxing Day and New Year's Eve but hey, a hospital never shuts down right. Many of my national colleagues had to work, and since I had plenty to do, I figured I would carry on as well.

I did take three days off to go to Banana island which was fantastic. I also took Monday January 3rd off which was a public holiday and enjoyed a day at Lakka Beach with my expat colleagues. Around Christmas time there was a flurry of activities and I spent time celebrating with friends. New Year's was also spent with friends in Aberdeen and a countdown to midnight at Alex's restaurant. Good fun! I then went to the Ma Dengh beach festival on the evening of the 1st with my colleague Emily (visiting from UK for 10 days) and watched Emerson perform live! Very entertaining.

It's been a good start to 2011 and I look forward to a great year with lots of excitement. I'll still report back on 2010 since I have yet to write about my blood giving experience, the cleaner's strike, our adventure up the wrong mountain and my success in tracking monkeys. More soon.