A hectic Tuesday...

Whereas yesterday was nice and quiet, and very productive, today was very noisy and hectic. Yes, I was at the hospital again and even though our new office is further removed from the wards, people still come in and out. That is of course absolutely fine, but just means it’s hard to get a lot done.

First of all, I sent our driver to town to buy some NPA (national power) credit and find out our bank balance. Then a colleague came to create and discuss his work plan. During our meeting a lab technician came to report that the hemocue is reading an error. I took the opportunity to teach him how to dismantle and clean it. Then someone from Mercy Ships called about a team of engineers arriving today to do a full assessment of the hospital’s infrastructure. After my meeting I went to Special Care to check on progress there. The work seems to be completed. There are 14 beds for the mothers and they seem very happy. Unfortunately in the neonatal bit, I only saw 2 nurses instead of 6, which meant a trip up to matron’s office to find out what is going on. I then returned to the office to do some printing for a survey we’re conducting. After that I met with the head of the hospital to talk about a few of the SLICH projects that have been delayed. I am not sure if we actually came to any conclusions! From there I went to the head of maintenance to let him know that the engineers are arriving today. On my way, I found a father in tears, who had thrown himself to the ground. He just lost his child. Soon the mother came out and in floods of tears they tried to console each other. I had to try hard to fight back the tears. I then went up to ER and ICU to see how things were. ER was so full and only a house officer; a few medical students, a few nurses and many student nurses could be seen. I am not sure how they will cope today. ICU was a bit calmer, but still there were some very sick children there. I wanted the nurses to check a blood sugar but they told me the glucose strips are done. I asked for them to go and get a new supply. From there I went back to the office. It’s not even noon yet. There’s still a lot to do.

The afternoon ended up being a primarily clinical afternoon, which is sometimes welcome, but definitely not something I planned for today. I was passing through the ER and overhead a conversation about a patient. Meanwhile I noticed that said patient was gasping and so started ventilating with a bag and mask while others were deciding on a plan for fluids. After 40 minutes of ventilating we were a bit stuck: there was still a heart beat but the pupils were fixed and dilated, telling us that the brain has been starved of oxygen and continuing was futile. After another five minutes of bagging, we stopped and within a minute the heart stopped beating. I explained to the mom what had just happened and watched as tears streamed down her face. I was ready to get out, but two more admissions showed up, and no one else was around. While stabilizing the first one, one of my colleagues walked in. I left soon afterwards; back to the office. Later in the afternoon I had to go back to Special Care to see how many nurses were on late shift and walked right in on resuscitation. I helped where I could. Unfortunately it was another failed attempt.

On my way back to the office at 4 pm I ran into the Engineering team. It was good to chat with them a bit and attempt to explain the complicated water system we have here at the hospital! It’s taken Welbodi 3 years to try and figure it out, so hopefully they’ll be much more successful in the week they’re spending here. I’m looking forward to the recommendations they’ll make. Just after 5, we decided to head home. Another day come and gone. Lots done, but very little crossed off of my to-do list! C’est la vie…

A quieter Monday...

I think today might have been the first time that I waved my colleagues off to the hospital and stayed behind at the Spur Road office on the West side of town. I realized that in order to move forward with Comic Relief, I would need to spend a good chunk of uninterrupted time on it and for today that meant staying away from the clinical world and hiding from the many people that come in and out of the office at the hospital.

So, at 7 am I started work in the office and it was nice and quiet until about 11 am when some others arrived. Fortunately everyone did his or her own thing and my productivity level remained at a high. Internet then cut out, which was annoying, but not a surprise and to be honest, didn’t effect what I was doing anyway. Oh, except for the fact that I was supposed to have a Skype call with one of the Welbodi Director’s. She ended up having to call my phone for a good hour and a half conversation about Comic Relief.

After the Comic Relief call I got a taxi to Connaught Hospital to meet with a radiographer about the ongoing need for a radiology facility at the Maternity and Children’s Hospital. Unfortunately, little progress had been made in the past month or two and our hands are kind of tied. It gave us the opportunity to call up some people in the Ministry to see where they are at with things. Let’s hope there’s progress soon. I was then able to catch my colleagues in the Welbodi car on the way home, which was convenient. And I headed back to the Spur Road office to finish up some work. I was hoping to download a number of documents from googledocs onto my computer, but of course, as soon as I started with the first document, Internet cut out. Go figure. By that time it was 6:30 pm. Time to call it a night!

I spent the evening cooking pasta and pesto, talking to my mom and watching an episode of ER with my colleague. It was in the end a productive day, and I’d say it’s probably worth repeating a day at the Spur Road office in the near future. But tomorrow, it’s back to Ola During...

Another Sunday Summary...

Today was a good day. Actually, this weekend was a good weekend. The fact that I hardly did any work probably helped, although I did spend a fair amount of time getting the car sorted. At least a friend did most of the work and we had fun chatting while getting the job done.

Saturday afternoon I went to a bridal shower for a friend who is traveling home to get married. It was good fun and it was a special time with some long-term friends here. Fortunately it wasn’t a goodbye since she will come back with her husband-to-be in January. Yay.

Sunday school today was amazing. For the first time we split the children into three classes: 2-5 years, 6-10 years and above 10 years. Georgiana and I will be teaching the 6-10 years olds and I have to say, what a brilliant class. I taught them for the first time today and I have to say it was very pleasant teaching a group of children that listened and joined in. Up until now I taught the 2-8 year olds, and that was just too big of an age difference. The small children rarely sat still throughout the class, and every 5 minutes another child was asking to be excused to go pee or get a drink of water. It was nice not to have so many distractions today! We are a bit further away from the church, which means less noise and distractions, and we meet on a big soccer field, which means more space to play! I led them around the field with their eyes closed as we made our way through an obstacle course of chairs. We then had an interactive talk about trusting God and others. It was great. We then did a craft and seeing as we had no idea how the service was progressing, we ended up playing games until we realized people were walking up the road meaning church was out. The kids taught me how to play a Sierra Leonean game called ‘Basket’ which involved quite a lot of jumping. I might need to alter my church attire when teaching Sunday school! Anyway, I am excited about this new class and the potential to teach these children. Plus I think we’ll have a lot of fun too.

After church I walked to a junction about 20 minutes away and met up with a friend and taxi driver Farah. His taxi is in the garage, but he said he’d walk with me up to the next junction where I had arranged to meet Alusine, the Welbodi driver. So, Farah, his son Michael and I trekked up the hill and met up with Alusine about 10 minutes later. We then continued with the 4 of us for another 20 minutes or so down a rocky road to Alusine’s house, a pan body. Much to my surprise, Alusine’s son Momoh ran up to me when I arrived. I was surprised because up until today he had been afraid of me! Maybe the fact that he knew I was bringing him a little toy car helped. It was fun to spend some time with them. I even drank some ‘atya’, which is actually green Chinese gunpowder tea with quite a bit of sugar added to it. I hear that some people even add marijuana to it but was assured this tea had no additives! After another two hours of sitting and chatting about Islam, gardening, and school for the children, etc, it was time to set out. We ended up climbing the hill up to SS Camp, which was a good 20 minutes climb up a rocky path. This is a walk that Alusine makes every morning in order to get a taxi to meet us in Wilberforce where the car is parked. After reaching the top, I said farewell and hopped in a taxi down to Wilberforce.

After a few hours at home, I again got in a taxi and headed to Aberdeen for the monthly international service. It was a nice service followed by a good potluck dinner. And now, it’s 10 pm and I am ready for bed. I have to be up at 6:20 am.

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.”