The Africa Mercy

I had the privilege of visiting the Mercy Ship this week (payment in kind for helping out at the conference last week). The Mercy Ship is a large floating hospital and community; it is docked at government wharf, about half a mile away from the hospital. It is staying in Sierra Leone for nine months and they are carrying out a large number of operations including, orthopaedics, ophthalmology, plastics, cleft lip and palate operations and other max-fax (maxillo-facial) operations.

After a great dinner of Mexican nachos (Red Meat mmmmmm) I was shown around by my host, Matt (an anaesthetist) and got to see the hospital as well as the living areas on the ship. I was a bit google-eyed at all the equipment in the hospital – its probably better equipped than most UK hospitals I’ve worked in! It was nice seeing some well pre-op patients, obviously very grateful for the work the ship is carrying out. It was also interesting seeing the living areas for this large floating community of 400 people, including Starbucks! Very excitingly I got treated to a hot chocolate! Thanks Matt for your hospitality!

PS You will all be pleased to hear that we now have running water at home again, after 3 weeks without, I will try very hard never to take it for granted again!

Things I’m looking forward to when I go home

I’m going home in two weeks time. For a two week break. Then, just to clarify (which I didn’t on facebook!), I’m coming back to SL for another four months after my break.

Here’s the list of things I’m looking forward to:

1) Spending time with my husband.
2) Meeting new babies and new bumps.
3) Seeing friends and family.
4) Steak, sweet potato, broccoli, courgettes.
5) Andy’s cooking generally.
6) Fresh milk.
7) Turning on a tap and water coming out of it.
8) Flushing a toilet.
9) Having a hot bath (although I will feel very guilty about the amount of water it uses!)
10) Falling asleep on the sofa at home.
11) Spending time with my husband.
12) Knowing that the light will come on when I switch it and that the fridgewill have kept the food cold all day.
13) Cycling in Oxford.
14) Going to Christchurch Cathedral to listen to the choir, to admire the beauty, to reflect, to pray for the babies in SL and to regain some perspective on things.
15) Going to Tescos – although I think I may be a bit shell-shocked at the choice!
16) Getting my hair cut and wearing my hair down (I always wear it up in a bun cause its so hot and sweaty otherwise!)
17) Seeing Beautiful Scotland.
18) Spending time with my husband.
19) Wearing my engagement ring.
20) Printing out some photos of SL to give to my colleagues, neighbours and the little kids who live at the hospital (yes, there is a family who live on the hospital compound).
21) Clean streets, with pavements and no open sewers.
22) Wandering around bookshops.
23) Spending time in nice coffee shops (actually I can do that here – we have Bliss and Oasis which could both rival any coffee shop back home).
24) Did I mention spending time with my husband?

A Very Good News Story

So… you’ll remember the boy with the tension pneumothorax? And you’ll remember that he got discharged home…?

I had probably the best moment of my medical career so far when the little boy and his mother came back to the hospital to see me and to say thanks. I was so overjoyed to see him I had tears in my eyes! It was really special, seeing him smiling and running around, especially as the last time I saw him he was so sick.

Mostly when the children are discharged home safely, its because they presented in time to hospital, before they were too sick, because of dogged perseverance in making sure they get their medicines, because of a bit of attention to detail in fluid management and making sure they get fed, because their mother was educated by the nursing staff to know how to give ORS, because they received their preventative immunisations, because the system, flawed as it is, worked.

Its not very often I get to say I saved someone’s life but I think in this case, along with all my colleagues in ER, I feel justified in saying it. I’ll remember that little boy forever now; I’ll continue thinking of him and his family. He’s made my whole year worth it. You never know - maybe he’ll go on to do great things for this country!

The Mercy Ship Conference

I was privileged to attend and help teach at the 2nd Sierra Leone Nurse Anaesthetists Conference, organised by the lovely people from the Mercy Ship. The ship arrived a couple of weeks ago and a group of anaesthetists came out from the UK to run a three day conference.

We had a great opening ceremony complete with the usual opening prayers – both Christian and Muslim, speeches from representatives of various bodies including the Ministry of Health and Sanitation and the SL Medical and Dental Association, and everyone who was taking part got an individual mention. Nurse anaesthetists had come from all around the country, and some of my nurses from ODCH were also invited.

There are only about 100 doctors working in government service in the country; there are 87 nurse anaesthetists so they add greatly to the capacity of the health service. They train initially as nurses, then as midwives, before doing the anaesthetic course – so they are well trained and experienced by the time they finish. I also think it’s a great thing for nursing advocacy – nurses tend to be seen as being the bottom of the pile when actually they are the backbone of the health service.

As the only paediatrician there I helped out with the workshop on ABC in Sick Children and did a short lecture and ran a workshop on neonatal resuscitation (photos to follow at some point). It was really interesting hearing everyone’s views and experiences of neonatal resusc here – lots of people asked questions about ethics and when to stop resuscitating. We also got to dispel a few myths – such as using IM dexamethasone, and holding babies upside down by their ankles and slapping them to resuscitate them! I know from experience though that its one thing for a group of British doctors to come and tell someone something and entirely another trying to implement it!

The conference was a whole lot of fun, good to meet up with people from the UK and give them a bit of local perspective on things and great for me to have some time away from the wards!

Cleaning Day

Its early Saturday morning and I’ve come into hospital for a meeting with people from the Mercy Ship before the conference I’m helping at next week. Its still before 8 o’clock – but I’ve come in so early because its Cleaning Day. Everyone is cleaning the streets so there’s a curfew on public transport. Luckily one of my colleagues got a pass from the hospital allowing him to travel and he gave me a lift over here.

It’s most bizarre. There was no traffic! It only took us 15 minutes to get here! And people are out, cleaning the streets. It seems to be the antithesis of the cleaner’s strike at the hospital. Quite unbelievable just how much rubbish there is too!

My colleague told me that during times of military rule (as has happened several times in the past) the Cleaning Day was enforced by soldiers on the streets – and that anyone found out walking was given a broom to help out!

A Happy Ward Round
Yesterday I had a really Happy Ward Round. I arrived on ICU and asked the nurses my usual questions of “How was the night? Did any patients die? Is there anyone who’s really sick who needs to be seen first?” I was delighted to hear that the night had been quiet, no one had died and there were no patients who they triaged as emergencies and needed to be dealt with asap. Sure enough I looked around and I saw a lot of happy smiling faces, children sitting up and crying, or eating and drinking. I didn’t know where to start! It was lovely chatting to the Mums without having to give any bad news, and even better hearing “I tell God tenki” that their child was getting better.

Quiz Night
Last night we went to a quiz night held at IMATT in aid of the Vaginal Fistula Unit at Aberdeen Women’s Centre. For non-medical people, the centre cares for women who develop an abnormal hole between the vagina and other parts of the body e.g. the bladder or rectum following obstructed labour (when “the road no there” – as it is said in Krio). Check out www.freedomfromfistula.org.uk for more info.

It was a really fun night with rounds on general knowledge, sport, geography and various picture rounds. And guess what – we won! All thanks to Dave and his amazing sporting knowledge I have to add. And all with the usual wonderful IMATT hospitality, we had a great night.

More things which are weird but normal
1) That Aberdeen is pronounced as “Abadeen” instead of “Hayberdeen”.
2) Drinking water out of little bags that you bite the corner off.

Stuff that's probably weird but I now find perfectly normal

1) White land cruisers with NGO logos on them.
2) People carrying stuff on their heads – like water, large baskets of fruit, plantain chips, piles of clothes, . Other friends have seen someone carrying a fire on their head, and someone else carrying a pair of flipflops (when he was barefooted!)
3) Wondering whether the electricity is going to be on when I get up every morning.
4) Lights that go dim every now and again, even when the electricity is on.
5) The fact that you can buy anything you want from the side of the road on the way home – people pass by the car selling plantain chips, popcorn, biscuits, soft drinks, towels, facecloths, CDs, ladles, tin openers, weighing scales, games of monopoly, the list goes on…
6) Roadworks meaning that the path to the main road changes every day – often involving a crossing a plank to get across a ditch.
7) Roadworks also meaning that you can walk as close as you want to a large digger doing its work without anyone screaming “health and safety!”
8) That I can often get online in the car on the way back from work and go on facebook chat but I have no running water currently.
9) The internet being really sloooooowwwww.
10) And other times not being able to get online at all!
11) Wearing a money belt at work – it’s a safe place to keep cash and my phone/calculator/torch.
12) No hot water (currently no running water – although I don’t feel that’s normal yet!)
13) Women carrying their babies on their backs, with their little feet sticking out either side – its sooooo cute!
14) Little kids carrying babies on their backs – even cuter!
15) Hardly any pavements anywhere, so constantly dodging traffic and sewers.
16) Night time noises – dogs constantly barking, the mosque at 5am, “crazy man” who often starts shouting in the middle of the night, cars tooting their horns.
17) Sleeping under a mosquito net.
18) Taxis and poda podas which are so so battered and worn you would be surprised if they would pass an MOT – but still they keep on going.
19) There are no landlines here – just mobiles (but only pay as you go – no contracts)!
20) Everyone being known (esp in phone address books) by their NGO e.g. Shona VSO, Becky Welbodi.
21) The term “flashing” meaning to ring someone and hang up so they will phone you back. Or to give someone your phone number, as in “I’m flashing you now”.
22) Never wondering what the weather or the temperature will be today.
23) The fact that taxis go where they want, not where you want!
24) Traffic!!! ! So bad on Monday that I walked most of the way home. I’d do it every day but it does take two hours to walk all the way.
25) That, when the vice president is being driven home from work (he lives about half a mile away from us) the police stop all the other traffic so his entourage can pass on the wrong side of the road (which clearly makes the rest of the traffic even worse than normal!)
26) Laughing cow cheese and boiled egg is a great lunchtime combination in white bread.
27) Strange combinations of chickpeas and sardines make wonderful dinners.
28) Being in an ethnic minority and it being constantly pointed out to me by people calling “White Girl”.
29) Constantly being dusty, a bit sweaty and never ever getting my feet totally clean (even when we do have running water!)


PS. My Mum added another comparison from last week’s blog about the differences between Oxford Children’s Hospital and ODCH – that children in Oxford all have cuddly toys. At ODCH the only furry animals have long tails and run along the open sewers outside the hospital!

PPS The little boy with the tension pneumothorax survived and has been discharged home.

Differences.....

Last week I was in a shared taxi carrying a total of seven people: the driver, two children in the front seat, a man with another child, another man and me in the back. None of us were wearing seatbelts.

On my last day working at the JRH in Oxford last year, a family came in having been in a road traffic accident on the M40. There were three children and four adults in that car and none of them were wearing seatbelts. The youngest child was seriously injured (but survived), the others were luckier and not injured so badly. I remember being so angry at the parents for putting their children at risk like this. That family had just moved to the UK from a less developed country and did not know the law (or a bit of common sense when you’re travelling at 70mph) and it was clearly a cultural issue.

It got me thinking about other differences between Freetown and Oxford, especially ODCH and the JRH.

1) The public perception of the definition of ER (Emergency Room). In the JRH parents bring their children in with snotty noses. Here the children are triaged as proper emergencies before they arrive in the ER.
2) The definition of ICU (intensive care unit). The children here are just as sick as children in PICU at home (or, more likely, sicker). Clearly our facilities and monitoring is much more basic but in many ways we are lucky to have oxygen concentrators and IV fluids.
3) When a cardiac arrest page goes off at the JRH, the following people come running: acute paeds reg, PICU reg, PICU consultant, acute paeds SHO, resusc officer, anaesthetic reg, anaesthetic consultant, operating department assistant, ER SHO, ER reg, ER consultant and usually one poor nurse running around trying to get all the equipment that everyone asks for. At the last cardiac arrest I was at at the JRH there was also a cardiothoracic surgeon and a whole cardiac bypass team. In ODCH there is no paging system so the “arrest team” tends to be made up of anyone who is standing there or can be shouted at to come and help.
4) EMLA. In the JRH we use a local anaesthetic cream before inserting IV lines into children and have to wait an hour for it to work. Here there are fabulous nurses who can cannulate a stone and have no qualms about shaving off children’s hair to use scalp veins and just hold them still (or they’re so ill they don’t need to be held still).
5) Bed managers. Thankfully, they don’t exist here. We just pile the patients in, two, or sometimes three to a bed, if needed.
6) Breast feeding. Everyone does it (nearly everyone anyway). They are absolute experts - and there’s no trying to hide – every mother gets those “bobbies” out in full view of everyone to feed their pikin.
7) Infection control. We do have an “isolation room” here, for children with tetanus and measles. Probably most children we admit would qualify for an isolation room at the JRH. But we have no plastic aprons, not enough gloves and not enough running water. Oh and most children here with measles also have severe pneumonia – meaning they need oxygen – meaning they need to be in ICU instead of isolation. It’s a balance of risk.
8) Expectant mothers smoking outside the maternity hospital. I’ve never seen it happen here (hooray!)
9) Security measures. In the JRH all medical and nursing staff have little swipe badges to get in or out of wards, and a video buzzer to let parents in and out. Here we have volunteer security guards at the main doors. They are of variable effectiveness – the children are only supposed to have one carer with them during the day, so the poor fathers usually get left outside. Meanwhile, the ladies selling fried chicken and doughnuts manage to get in….
10) Coffee shops. As you walk into the Children’s Hospital there is a coffee shop selling Starbucks. The staff there knew me so well they would hand me my coffee as I walked towards them in the morning….! Here we have a little shack that sells white bread and laughing cow cheese, a “chicken lady” (who sells fried chicken) and the ladies in triage who sell a wide assortment of food including doughnuts with a boiled egg inside (yes they taste as disgusting as they sound). No coffee though. However…. A Starbucks has just arrived - floating about a mile away from the hospital – on the Africa Mercy, The Mercy Ship!