Quick note from Washington DC...

I arrived in New York on Monday a week ago...at about 2pm. My brother and a friend picked me up and we drove on to DC (a 6 hour drive). That evening Stefan and his girlfriend, Genae, took me on a quick sight seeing trip around the Capitol building and memorials around midnight. It was fun. The next day we hopped in the car and made the 9 hour drive to Kentucky- where we stayed overnight with friends. Then on Wednesday we continued the 14 hour drive to Texas. We spent a week in Texas. Christmas was amazing. We stayed with Genae's family- they were absolutely wonderful. It was a very busy but fun week. More later...

We left Texas last night at 8pm by car and just arrived in Washington DC; 21 hours later! Needless to say its been a long trip. After a quick pizza dinner here Stefan, Genae and I are heading out again- on a 6 hour drive to New Haven, Connecticut where we'll spend New Years eve before flying to Holland. It's been a lot of traveling...but a lot of fun too.

Dutch vacation almost over...

My time in Holland is almost coming to an end. I had a good three weeks here even though it took about a week to get used to life here; the cold(er) weather, the materialism, freedom, not working etc. I felt a little useless in the beginning (especially when thinking about patients waiting outside the clinic in Freetown) but quickly realized it is really nice to have some time for myself and not to have to do anything. I realized how tired I was (am) and that I really did need a break.

Coming here in the holiday season amplifies culture shock. People are frantically buying gifts: MP3 players, cd's, dvd players, perfume, cameras, designer clothes, books, etc. I’m not saying it’s wrong; I just find it hard at times to justify spending a lot of money when I know there are mom’s that come to the clinic that can’t even afford food for their children. I guess the inequality in the world just becomes a reality. I think what concerns me most is that there are people here who do not realize the great need and suffering in places like Sierra Leone.

On a more positive note- the freedom I have felt here has been wonderful; going places on my own, not being surrounded by a huge wall with razor wire, no guards around, etc. I’ve really enjoyed walking and biking to town on my own. Of course I've enjoyed seeing family and friends too.

Anyway, I fly to the USA on Monday for 2 weeks. Then I'll be in NL for 5 days before flying to SL.

New pictures can be found at: http://www.flickr.com/photos/sandralako

Waiting...

When I arrived at the post office yesterday to mail some packages I was confronted with a long line of people…waiting. I took a number from the little number machine: 534. Seeing as it was number 521’s turn I figured I’d wait. I found a bench and there I sat waiting.

While sitting there my mind wandered and travelled back to Freetown; to the mothers waiting all day at the clinic for their children to be seen by me. I realized again how fortunate we are in the West with our excellent access to healthcare (yet still we complain!). And also realized how fast-paced our culture is. We almost find it strange/frustrating to have to wait somewhere for more than 10 minutes. The reminder of moms waiting at the clinic in Freetown from as early as 5am until the clinic opens at 830am (and even then having to wait for hours to be seen by the doctor or wait for lab results) was enough to keep me from becoming irritated. So there I sat waiting…reflecting…until number 534 was called.

Spoiled by friends...

I had already been spoiled by various friends in Amsterdam a week earlier…with yummy dinners, wonderful company and genuine interest in my work abroad, but this past week I was spoiled once again by a group of friends in Arnhem.

It began on Saturday afternoon when I was warmly welcomed by Mirjam and her 8 week old son, Jafeth. What a cutie; within a few minutes he was snuggled up in my arms. Later that evening Mirjam, her husband Stephan and I made our way to Zwolle for a concert, where we met up with more friends of mine (both sisters of Stephan): Jacqueline (her husband is in South Africa for 2 weeks and her 2 sons were sleeping at her parents’ place) and Miranda. They decided to treat me to a Christmas concert put on by Inside Out (a black gospel choir) and Ralph van Manen. It was a fun evening and had a very Christmassy atmosphere.

On Sunday I went to Jacqueline’s church, where her sister-in-law, Carmen, and husband Sjoerd were leading worship. They are also good friends of mine. We spent the rest of the day hanging out together as a group and everyone continued to spoil me. We went to a pancake restaurant for lunch- a very Dutch thing to do- with a 101 different types of pancakes to choose from; delicious to say the least. After that we went for a stroll in Sonsbeek park (the park I used to live near). It was beautiful weather; so quite enjoyable and a bit nostalgic. Then we went back to Stephan and Mirjam’s place where we had a great pizza dinner! But slowly people had to leave to go home. Later Stephan, Mirjam and I watched a movie and talked some more. I really loved being able to cuddle with their baby often- he’s starting to chat a bit and is full of smiles!

On Monday, after a quick visit to the dentist (which only took 10 minutes thank goodness) I met up with Miranda at her place. And she then spoiled me once again by taking me out to a really fancy little place in Sonsbeek park for lunch. After a lovely lunch it was time for me to head back to Middelburg again.

It was SO GOOD to see friends again, but also a bit sad to know that I only see them 1-2 days out of the year. That’s one thing that would be nice to change!

Thanks Stephan, Mirjam, Jafeth, Jacqueline, Justin, Denzel, Carmen, Sjoerd and Miranda! You guys are amazing!

(You can find links to their blogs on the bottom right of my blog)

My first Christmas gift...

While sitting in the train on my way back from Arnhem yesterday my phone rang. This in itself is not very unusual. However, since about 5 people have my new number I was caught by surprise. And it showed up as an 'unknown number'. It was my mom, calling from Freetown with Skype. I got a little worried for a second but seeing as she sounded excited rather than distressed I figured nothing was wrong.

She called to tell me that the mom of a 1 ½ year old patient of mine arrived at the gate with Christmas presents for me and was wondering what she should do with them. Well, I figured she could just put the presents in my room and I’d see them when I get back.

I was wrong. These were not ordinary presents.

I have never received such unique gifts. I received a live chicken! And also a bag of produce- oranges, grapefruits, plantains & cassava root. I can only imagine how much of a sacrifice this gift was for my patient’s family. I am very thankful! Arrangements were quickly made to find a new home for Mr. Chicken and the bag of goodies were divided among the outpatient clinic staff.

Besides enjoying the fact that I was given a chicken, I love knowing that I am building relationships through my work in the outpatient clinic. I hope that what I do goes beyond physical healing and that I have a genuine effect on the lives of the families I meet.

Two choices...in theory...

Quite a few people in Holland have asked me if I really need to work as much as I do. “Can’t you just limit the number of children you see in the clinic?” My answer: “Yes, I can”.

You see, I have two choices at 8:30 am every clinic day.
1) Let in all of the children waiting outside the gate; sometimes up to 65 children, many of who have been waiting since 5 or 6 am.
2) Let in a set amount of children (which I sometimes set at 50) and send the others away.

Problem solved- choose option 2. But it’s not that easy.

In a country such as Holland with a very low child mortality rate of 5 per 1000 and good emergency services this is possible; simply tell the parents to come back in one or two days. (As if people in Holland are waiting in line with their kids at 5am to see the doctor, but you get my point.)

In Sierra Leone the reality is that every child you send away could potentially be dead 24-48 hours later. An all too common childhood illness in Sierra Leone is malaria- the leading cause of under-five mortality (20%). Every child that walks through the gate could potentially have malaria. My fear is that if 15 children are sent away, some of these children may have malaria and some of these children may die or suffer severe consequences because of it. The healthcare system is so poor in Sierra Leone that I am not convinced these children will receive proper treatment in time if I turn them away. Even if we ignore the malaria factor these children are still at greater risk of death. Think about the neonates with sepsis, children that have been sick for some time because they couldn’t afford to go to the doctor, malnourished children, dehydrated children etc. Of course some of the children I see only have a cough, a viral infection, an ear infection, etc.; common illnesses that don’t need immediate attention.

This leaves me with the following question: “Do I want to take the risk, in a country with a child mortality rate of 283 per 1000- where 1 out of 5 children don’t reach the age of 5- and deny a child access to good quality medical care????”

I'm afraid there is no simple answer.

Vacation has begun...

Finally another post from me! It's been a little while I know and I'll try to post more frequently. You'd think that it'd be easy to post since I'm on vacation, however, internet has not quite been as accessible as I expected. But here we go...

I arrived in Holland Saturday evening after a 25 hour journey. There was no reason for it to have taken that long- we're talking an 8 minute helicopter ride, a 5 1/2 hour plane trip to London and a 45 minute plane trip to Amsterdam. However, it really did take me 25 hours. It started with a 5 hour wait at the Lungi Airport. However, I met a South African lawyer there and converation about poverty, corruption, legal aid (or lack of it), etc. in Sierra Leone was quite interesting. I arrived in London at 445am! There wasn't much else to do except find a bench and lay down and try to sleep. But the fear of waking up and finding out that I missed my flight or seeing that my bags were gone kept me up. I shopped around a little- but that's not the greatest with a suitcase either. At least there were interesting conversations taking place around me :) I was happy to finally board the Easy Jet flight at 1pm and make my way to Holland. On arrival in Amsterdam I was surprised to see my mom there to pick me up! She was in the area visiting her mom and thought she'd meet me so that we could make the 2 1/2 hour train journey to Middelburg together. It was nice to have some company. And she brought a 1 liter pack of milk for me- so I enjoyed lots of REAL (versus powdered!) milk on the train.

When I arrived in M'burg I was picked up by my almost 2 year old niece, Zoey, and her dad at the station. I have to say that Zoey was more interested in seeing the train, nevertheless it was fun to see her! She's so cute and quite the toddler now; very chatty and playful. And of course I met Esmee, my new niece. She is very small but precious. Obviously the picture posted is of me and Esmee. I'm sure I'll be posting more pics soon.

Anyway, I am having a good time in Holland. And I'll be writing more about that. I have to be honest- culture shock is a reality and I'm still trying to give things a place. More on that later.

A controlled experiment...

(click on pictures for larger view)

Introduction: A couple of weeks ago we needed to get some blood work done on one of the VVF patients and on one of our expatriate staff; tests that we can’t do in our smallish lab at the center. So, our local lab tech took blood specimens, put them in a ziploc bag with a request form and handed them over to the driver who then took the samples to a lab in town. Later that same day the driver drove back into town to pick up the results. Well, the results that came back weren’t quite what we expected. Both ladies had very low sodium levels; pretty much incompatible with life. We decided we better stick with bedside case management and not rely on the results. It made me wonder…can we rely on other labs to do our blood work? And that’s when it all began. Phase One of the experiment was instigated.

Phase One: I decided to have my blood tested at the same lab (picture:right arm). Since I was feeling fine, I figured the results would be normal. Wrong. Again the results were not what we expected; I too had a low sodium. Not as bad as the others but pretty close to putting me in a coma! All of a sudden I wasn’t feeling to well anymore. This led to Phase Two of the experiment.

Phase Two: Having checked one lab in town I thought it was only right to check both of our ‘referral’ labs in town. And we needed a control lab; a lab we can rely on. So I chose a lab that I was pretty sure would give accurate results. Being the sole investigator in this experiment made me the guinea pig, or should I say pin cushion! In phase two I again willingly provided some of my precious blood (picture:left arm). This time my blood was being scattered throughout Freetown- having to go to three different locations.

Results: Maybe we should just skip to the conclusion. By now I guess I should say that the results were what we expected as none of the labs gave the same results. Two of the three labs (one of which was the ‘control’ lab) pretty much concluded that I was near death (with a sodium as low as 113.2 mmol/l). The third lab however fortunately confirmed that my sodium levels were normal and that I would be okay; but can we trust this result?

Conclusion: Maybe it is not so wise to get your blood tested in Sierra Leone; at least not your sodium and potassium levels. No, seriously, if I would have been in a hospital here and the docs would have started treating me because of these results I would have probably died because my actually normal sodium and potassium levels would have been sky high because of treatment.

Final word: it was a fun experiment.

NB: Normal levels: sodium 135-155 mmol/l & potassium 3.4-5.3 mmol/l