Sierra Leone can be a very frustrating country to live in. If you have seen the film Blood Diamond, they use the phrase “TIA, this is Africa”. Many people here say, “There is Africa, and then there is Sierra Leone”. But once you know how to do things and how to get things done life here is actually quite simple. Especially if you can live with uncertainties regarding your electricity and water supplies, and you don’t try to do TOO much at one time!
Sierra Leone is not generally a bureaucratic country though. Today however I was subject to my first bit of Red Tape. I was at the UN pool, and the security guards would not let me in the main gate. I was told I had to walk around to the far side of the compound and use the other gate. (I should point out that I would need to walk past the main gate again from the other side of the compound to get to the swimming pool i.e. it was all a waste of time).
It was not the extra bit of exercise I objected to. Nor was I annoyed at the security guards. They were clearly just doing what they had been told to do. What I could not understand was that I have been using that gate for the last six months. No one had objected to me using it before. No one had even told me there was a problem with me using it before. And what’s more, nobody could give me a reason for this strange rule.
The thing that annoyed me the most though – this wasn’t Sierra Leone being it’s frustrating self. This was a rule made by the United Nations. Surely, surely they should be trying to help Sierra Leone develop, not get it stuck further into Red Tape and ridiculous rules. The Salonean security guards, who I have come to know quite well over time, could all understand why I objected to this pointless exercise (they assured me that they were not expecting the President, in which case I might have understood!). Thank goodness someone has some sense. Hopefully they will talk some sense into the UN. These things are sent to try us I’m sure. It certainly tried my patience. Grrrrrrrrr.
(P.S. I wasn’t allowed out the main gate either).
Monday 30 May 2011
Saturday 28 May 2011
Things which will never cease to amaze me
1) How women manage to change their hairdo’s so frequently – and come out of little shacks looking like a million dollars.
2) How women manage to walk along the streets and non-existent pavements in the most incredibly high heels.
3) The brilliant religious tolerance in this country – the rest of the world could really learn from the way that Christians and Muslims interact. At the beginning of meetings everyone says both Muslim prayers and the Lord’s Prayer.
4) How ants get everywhere no matter how much Dettol I wipe around on the kitchen surfaces.
5) How Saloneans can be the friendliest people you’ll ever meet but as soon as they become a waiter/tress they completely forget how to smile and be polite (the exceptions to this are at Mamba Point and Independence Beach Bar where the waiting staff are very friendly!).
6) Just how much it can rain…
7) How excited I am when the NPA (electricity) is on.
8) How little kids can carry immensely heavy jerry cans full of water on their heads.
9) Just how many NGOs there are in Sierra Leone.
10) How come eggs and rice are imported from India.
11) The shocking contrast between dead babies wrapped in lapas at the hospital and the serenity and beauty of the beaches.
12) How some children, against all the odds, get better (which is clearly why I love paediatrics, and why I am here!).
2) How women manage to walk along the streets and non-existent pavements in the most incredibly high heels.
3) The brilliant religious tolerance in this country – the rest of the world could really learn from the way that Christians and Muslims interact. At the beginning of meetings everyone says both Muslim prayers and the Lord’s Prayer.
4) How ants get everywhere no matter how much Dettol I wipe around on the kitchen surfaces.
5) How Saloneans can be the friendliest people you’ll ever meet but as soon as they become a waiter/tress they completely forget how to smile and be polite (the exceptions to this are at Mamba Point and Independence Beach Bar where the waiting staff are very friendly!).
6) Just how much it can rain…
7) How excited I am when the NPA (electricity) is on.
8) How little kids can carry immensely heavy jerry cans full of water on their heads.
9) Just how many NGOs there are in Sierra Leone.
10) How come eggs and rice are imported from India.
11) The shocking contrast between dead babies wrapped in lapas at the hospital and the serenity and beauty of the beaches.
12) How some children, against all the odds, get better (which is clearly why I love paediatrics, and why I am here!).
Skills I have gained – and am still gaining!
VSO’s motto I about “Sharing Skills, Changing Lives”, however I am constantly learning new skills here!
1) How to have a bucket bath and wash myself including my hair with three cups of water.
2) How to get dressed and ready for work in the dark.
3) How to blag lifts around town – all good VSOs can spot a potential lift from a mile away!
4) How to drink beer again. I think that Fred and Cat are quite proud of having got me into drinking beer for the first time since I was at Uni! For volunteers on a budget, Star beer is only Le3000 (about 50p) a bottle from small shops and local bars (Le8000 from Mamba Point!)
5) Krio. I’m by no means fluent but I can certainly get by. It’s a great language – a kind of pidgin English with a bit of French and Spanish thrown in, with its own (fairly complicated) grammar. As I keep saying when people comment on my ability to speak Krio “I de try”.
6) How to negotiate fares with taxi drivers. I’m not great at bargaining for food as I usually get my fruit and veg from the same people and they tend to give me good deals and throw in a bit extra for free. But taxi drivers – I am quite good at arguing with! (the Krio comes in handy here too!)
7) How to be incredibly patient (sometimes).
8) How to hiss to gain the attention of waiting staff in restaurants (it’s not seen as rude here, honestly! – although I still don’t like it).
9) How to avoid giving out my phone number to random strangers and turn down offers of marriage (the fact I already have a husband is a very useful excuse here).
10) Wise use of available electricity, to ensure my computer and phone don’t run out of battery.
11) Ensuring I have everything I need under my mosquito net before tucking it in – phone, torch, alarm clock, book, glasses, water.
12) How to manage a ward round complete with journalists, film crews and photopraphers….! (more on this at a later time)
1) How to have a bucket bath and wash myself including my hair with three cups of water.
2) How to get dressed and ready for work in the dark.
3) How to blag lifts around town – all good VSOs can spot a potential lift from a mile away!
4) How to drink beer again. I think that Fred and Cat are quite proud of having got me into drinking beer for the first time since I was at Uni! For volunteers on a budget, Star beer is only Le3000 (about 50p) a bottle from small shops and local bars (Le8000 from Mamba Point!)
5) Krio. I’m by no means fluent but I can certainly get by. It’s a great language – a kind of pidgin English with a bit of French and Spanish thrown in, with its own (fairly complicated) grammar. As I keep saying when people comment on my ability to speak Krio “I de try”.
6) How to negotiate fares with taxi drivers. I’m not great at bargaining for food as I usually get my fruit and veg from the same people and they tend to give me good deals and throw in a bit extra for free. But taxi drivers – I am quite good at arguing with! (the Krio comes in handy here too!)
7) How to be incredibly patient (sometimes).
8) How to hiss to gain the attention of waiting staff in restaurants (it’s not seen as rude here, honestly! – although I still don’t like it).
9) How to avoid giving out my phone number to random strangers and turn down offers of marriage (the fact I already have a husband is a very useful excuse here).
10) Wise use of available electricity, to ensure my computer and phone don’t run out of battery.
11) Ensuring I have everything I need under my mosquito net before tucking it in – phone, torch, alarm clock, book, glasses, water.
12) How to manage a ward round complete with journalists, film crews and photopraphers….! (more on this at a later time)
Sunday 22 May 2011
A Visit to the Tailor
Having been very jealous of my friends’ gorgeous outfits for the Royal Wedding Party, I decided it was time to finally get to a tailor myself. I was given two bits of material for my birthday so went to see Mr Jalloh to get them made into a dress and a skirt (yes it’s taken me nearly six months to organise myself…!)
Two weeks ago I dropped off the material, discussed the designs and got measured. Yesterday I went to pick up my new creations and I just love them! I asked to try them on (as so many women here wander around in bras or with their boobs out I very nearly just got changed in full view of everyone in the shop but my modesty got the better of me). I was shown to the “changing room”. Marks and Spencer’s it was not. But they fit, and they are so lovely. At Le15,000 (£2.50) for the skirt and Le35,000 for the dress (just over £5 – for an exact copy of a dress I had bought from Monsoon for £60!) they are great value too. I now have lots more ideas of things I’d like to get made – I have a feeling this is going to get quite addictive!
Things in Freetown which have a blatant disregard for what we would know as health and safety regulations
1) The roadworks – massive diggers moving around with no barriers, dumping large mounds of sand everywhere, large ditches appearing meaning you have to negotiate a plank of wood to get across, large holes in the road appearing with no barriers….
2) And even though the road has been finished near our house, some of the pavement seems to have collapsed already…
3) Okadas (motorbikes) driving up the wrong side of the dual carriageway meaning that crossing the road is an accident waiting to happen if you don’t look both ways!
4) Taxis and poda podas which would never pass at MOT - with broken doors, broken windscreens, broken speedometers, the list goes on…!
5) The fact that my house has metals bars on all the windows meaning that in the case of a fire we can only get out the front door – or by jumping off the balcony (a good 20ft).
6) The maintenance guys in the hospital welding a space for a new TV in triage (why does triage need a TV?!) with no welding mask, no warning to people trying to walk past and no safety barriers – and sparks flying everywhere!
7) Thirteen people in a taxi designed for five!
8) The open fires in the alley beside our house – and children running around playing nearby.
9) The rat(s?) that run around the sewer outside the Special Care Baby Unit.
10) The open rubbish dumps and open sewers all over town.
11) Taxis driving up and down the road to Mamba Point with no working brakes – and believe me, it is a big hill!
2) And even though the road has been finished near our house, some of the pavement seems to have collapsed already…
3) Okadas (motorbikes) driving up the wrong side of the dual carriageway meaning that crossing the road is an accident waiting to happen if you don’t look both ways!
4) Taxis and poda podas which would never pass at MOT - with broken doors, broken windscreens, broken speedometers, the list goes on…!
5) The fact that my house has metals bars on all the windows meaning that in the case of a fire we can only get out the front door – or by jumping off the balcony (a good 20ft).
6) The maintenance guys in the hospital welding a space for a new TV in triage (why does triage need a TV?!) with no welding mask, no warning to people trying to walk past and no safety barriers – and sparks flying everywhere!
7) Thirteen people in a taxi designed for five!
8) The open fires in the alley beside our house – and children running around playing nearby.
9) The rat(s?) that run around the sewer outside the Special Care Baby Unit.
10) The open rubbish dumps and open sewers all over town.
11) Taxis driving up and down the road to Mamba Point with no working brakes – and believe me, it is a big hill!
Wednesday 18 May 2011
Feelings
I was in ICU briefly today looking for some medical students and as I walked through I came across a child who had died. No one was with him. He had clearly died some time before. I called the nurses over to find out who he was. He had actually been an inpatient for more than a week and it was clear from the notes that he had been very sick for the entirety of his admission.
I hadn’t seen this boy at all before; I hadn’t had anything to do with his care. I’ve been covering TFC and out-patients for a while now so hadn’t witnessed any deaths for a little while. I was profoundly touched by his death. I am, of course, touched by all deaths here. No matter what you may think, it never gets easier.
I felt so sad for this boy, for his family. I was so sad thinking his mother would come back to see him, only to find he had died in her absence (I think she had gone to get some food). I also felt sad for the nurses and doctors who had been caring for him. I know how difficult it is when a patient you have been looking after dies.
But also I felt angry. He died in a ward full of patients, but he died alone. The nurses had not seen that he died. He died of malaria – a preventable and curable disease. I’m angry that despite many many years of research and millions of pounds spent, this little parasite is still such a big killer.
I felt frustrated. So many children die here, for multiple reasons. Plasmodium falciparum, the parasite which causes most malaria here, is a really really nasty little bug. It evades the immune system and kills quickly. The children present too late. They don’t get proper monitoring. They are lucky if they get given all their medications. There is a drastic shortage of medical staff. Up-country there is a massive shortage of basic drugs. There are no proper intensive care facilities. But it’s much much bigger than just medical reasons. There are massive political reasons, social and educational reasons. Poverty. Above all poverty. My Dad once sent me an email saying that if I could save the world from malaria I would be a bigger hero than Kate Winslet (this was peri-Titanic!) Well I can save a few children. But I am frustrated that I can’t do more.
I felt annoyed. Why did it take me walking past this child for someone to see that he had died? How long might it have been before anyone else noticed? How long before had he died? Why did this child die? Why is this world so unfair?
There is another feeling – let’s call it “Oh Salone”. Not so much a feeling, more a kind of sighing acceptance that this is the way it is, that this is the way it always will be. I saw a quote once – “The opposite of love is not hate; it is indifference”. I can just about accept what I am not able to change (and really I know I cannot change much at all) but I hope I will never become ambivalent about the future for Salone.
All my emotions and feelings are heightened here. If I feel happy I am on top of the world. If I am angry I want to shout, scream, cry and want to hit someone! I’m still trying to learn to direct my anger, frustration, and annoyance into something more positive.
This evening, my thoughts and prayers are with that little boy’s family and with the many other families in Sierra Leone and the world over who have lost a loved one today.
I hadn’t seen this boy at all before; I hadn’t had anything to do with his care. I’ve been covering TFC and out-patients for a while now so hadn’t witnessed any deaths for a little while. I was profoundly touched by his death. I am, of course, touched by all deaths here. No matter what you may think, it never gets easier.
I felt so sad for this boy, for his family. I was so sad thinking his mother would come back to see him, only to find he had died in her absence (I think she had gone to get some food). I also felt sad for the nurses and doctors who had been caring for him. I know how difficult it is when a patient you have been looking after dies.
But also I felt angry. He died in a ward full of patients, but he died alone. The nurses had not seen that he died. He died of malaria – a preventable and curable disease. I’m angry that despite many many years of research and millions of pounds spent, this little parasite is still such a big killer.
I felt frustrated. So many children die here, for multiple reasons. Plasmodium falciparum, the parasite which causes most malaria here, is a really really nasty little bug. It evades the immune system and kills quickly. The children present too late. They don’t get proper monitoring. They are lucky if they get given all their medications. There is a drastic shortage of medical staff. Up-country there is a massive shortage of basic drugs. There are no proper intensive care facilities. But it’s much much bigger than just medical reasons. There are massive political reasons, social and educational reasons. Poverty. Above all poverty. My Dad once sent me an email saying that if I could save the world from malaria I would be a bigger hero than Kate Winslet (this was peri-Titanic!) Well I can save a few children. But I am frustrated that I can’t do more.
I felt annoyed. Why did it take me walking past this child for someone to see that he had died? How long might it have been before anyone else noticed? How long before had he died? Why did this child die? Why is this world so unfair?
There is another feeling – let’s call it “Oh Salone”. Not so much a feeling, more a kind of sighing acceptance that this is the way it is, that this is the way it always will be. I saw a quote once – “The opposite of love is not hate; it is indifference”. I can just about accept what I am not able to change (and really I know I cannot change much at all) but I hope I will never become ambivalent about the future for Salone.
All my emotions and feelings are heightened here. If I feel happy I am on top of the world. If I am angry I want to shout, scream, cry and want to hit someone! I’m still trying to learn to direct my anger, frustration, and annoyance into something more positive.
This evening, my thoughts and prayers are with that little boy’s family and with the many other families in Sierra Leone and the world over who have lost a loved one today.
Selena’s Visit
At the same time as the VSO visit my great friend Selena also came to visit. Unfortunately I had to work much of the time she was here but she was able to chill out prior to her trip to Malawi (she had the most epic journey to get here – Glasgow-London-Nairobi-Accra-Lungi – and then the Pelican water taxi to Freetown – on her way to Malawi its Lungi-Accra-Nairobi-Lilongwe then the long drive to Blantyre!)
We had a very relaxing weekend with a night at Tacugama Chimp Sanctuary and a night at Hamilton Beach. We had a lovely meal at Tacugama; a rotisserie chicken (which the pesky cats tried their best to get their mitts on, and teeth into!) with stir fry veg and rice, accompanied by a couple of Star beers. It was so cool there I had to use a blanket to sleep! We had a short walk and got to see the chimps again in the morning before heading off to Hamilton. I hadn’t been there for a while and had forgotten just how good the barracuda is. We were joined by Fred, Freya, Laura, Dave, Kath, Carole, Cat, Phillin, Ziggy and Sarah at various points during the weekend and had a chilled out time reading, swimming and eating above-mentioned fish!
Thanks so much Selena for coming to see me – it wasn’t exactly a short detour on your way to Blantyre, and it was just brilliant to be able to catch up and show you a small bit of Sweet Salone!
VSO Fundraising and Photographs
I spent last week at work being photographed, interviewed, video-ed and photographed a bit more as some girls from VSO-UK had come out to collect some info for a fundraising campaign. I am fairly used to being photographed (my husband is never far from a camera!) and for those of you who know me well, you’ll know I actually quite like it! It was fun being snapped on the ward round with patients and staff. It reminded me of our wedding day, when we did lots of “natural” but posed photos! They also interviewed and photographed one of the medical students (thanks for all your help, and the nice things you said about me!) and one of my patients who had a large empyema and had come back for follow-up. The best thing is that, with any luck, I’ll get some copies of the professional photos as a nice memento of my time working here. So come September you can look out for my cheesy grin in the VSO campaign!
Tuesday 17 May 2011
The Therapeutic Feeding Centre
The Therapeutic Feeding Centre
I’ve been working in the therapeutic feeding centre (TFC) for a few weeks now. This is where the children are admitted when “the body dry” or “don” (they are malnourished). Most children in SL are slimmer than their counterparts in the UK anyway and to be admitted here they have to be <70% of their expected weight for height AND have a complication such as severe infection or associated swelling. Malnutrition is associated with a very high mortality rate, with children dying from simple and preventable things like low blood sugar levels, hypothermia, infections, anaemia and electrolyte disturbances.
The nurses have all been specially trained in the treatment of malnourished children. They tell me which feeds, and which extra supplements and vitamins the child should get. There are great WHO guidelines/protocols/whatever you want to call them for the investigation and treatment of malnourished children. It’s great that the nurses can follow these guidelines and see the children getting better because of the work they are doing. As a bonus they also get given their prescribed medicines at least most of the time!
There are specially made formula feeds for malnourished children because of the electrolyte disturbances they can get. Unicef (United Nations Children’s Fund) are supposed to provide these feeds. Unfortunately they have stopped supplying our TFC. We have had no therapeutic feeds for about a month. I’m not quite sure why Unicef have run out….
Thankfully the children don’t come to hospital only to starve to death. Another NGO has been providing feeds in the meantime, as a stop gap until Unicef sorts itself out.
Most of the children in TFC have TB. A few are also HIV positive. The official rate of HIV prevalence here is supposed to be about 1-2%. It’s probably a bit higher in reality but still far less than Eastern Africa. We are very lucky in that the Global Fund pay for all TB and HIV treatment (although there are supply problems with these too, but not quite as drastic as the food shortage). We have a great nurse who gives out the TB treatment to the children. To ensure compliance, the treatment is directly observed by the nurse and she is superb at telling the parents that they must keep coming back for the medication every single day.
The children and mothers come back to TFC after they are discharged to be weighed on a weekly basis, and get a new supply of food. The nurses do an educational singing session with the mothers; they are taught about good nutrition and hygiene. It is such a pleasure hearing them sing and it is one of the truly happiest times at the hospital.
I’ve been working in the therapeutic feeding centre (TFC) for a few weeks now. This is where the children are admitted when “the body dry” or “don” (they are malnourished). Most children in SL are slimmer than their counterparts in the UK anyway and to be admitted here they have to be <70% of their expected weight for height AND have a complication such as severe infection or associated swelling. Malnutrition is associated with a very high mortality rate, with children dying from simple and preventable things like low blood sugar levels, hypothermia, infections, anaemia and electrolyte disturbances.
The nurses have all been specially trained in the treatment of malnourished children. They tell me which feeds, and which extra supplements and vitamins the child should get. There are great WHO guidelines/protocols/whatever you want to call them for the investigation and treatment of malnourished children. It’s great that the nurses can follow these guidelines and see the children getting better because of the work they are doing. As a bonus they also get given their prescribed medicines at least most of the time!
There are specially made formula feeds for malnourished children because of the electrolyte disturbances they can get. Unicef (United Nations Children’s Fund) are supposed to provide these feeds. Unfortunately they have stopped supplying our TFC. We have had no therapeutic feeds for about a month. I’m not quite sure why Unicef have run out….
Thankfully the children don’t come to hospital only to starve to death. Another NGO has been providing feeds in the meantime, as a stop gap until Unicef sorts itself out.
Most of the children in TFC have TB. A few are also HIV positive. The official rate of HIV prevalence here is supposed to be about 1-2%. It’s probably a bit higher in reality but still far less than Eastern Africa. We are very lucky in that the Global Fund pay for all TB and HIV treatment (although there are supply problems with these too, but not quite as drastic as the food shortage). We have a great nurse who gives out the TB treatment to the children. To ensure compliance, the treatment is directly observed by the nurse and she is superb at telling the parents that they must keep coming back for the medication every single day.
The children and mothers come back to TFC after they are discharged to be weighed on a weekly basis, and get a new supply of food. The nurses do an educational singing session with the mothers; they are taught about good nutrition and hygiene. It is such a pleasure hearing them sing and it is one of the truly happiest times at the hospital.
Sunday 8 May 2011
The Freetown Photographic Tour
Yesterday Freya, Banke, Alex and I hired a taxi to have a tour of Freetown to take some snaps (Krio word for photos!). Banke had found some old snaps from the 1960s and we tried to find these places and replicate the pictures. Well, wi don try (we did try). Alas many of the places are no longer here. Or at least, when we asked people if they recognised the places, many did not know where they were or had not heard of them. Life expectancy is under 40 here so it was not surprising really that people had no idea what we were looking for.
We did however find some of the spots and also visited the Sierra Leone Peace and Cultural Monument (and, with any luck, I’ll upload some of the snaps, and others showing what Freetown is like in general).
We did however find some of the spots and also visited the Sierra Leone Peace and Cultural Monument (and, with any luck, I’ll upload some of the snaps, and others showing what Freetown is like in general).
The most useful things for volunteers to have in Sierra Leone
1) A mobile phone – some people have a phone for each of the three networks (because calls between networks are expensive).
2) A laptop with mobile internet (and a long battery life) – this allows precious contact with home and relieves the boredom on long tedious journeys back from work.
3) A head torch (although I know I freak out my housemates by walking around like a cyclops).
4) Lots of batteries to power said torch.
5) A sense of humour.
6) An umbrella – now it’s started raining (although I fear an umbrella would not have survived last nights’ storm!)
7) Patience.
8) A mosquito net (which just reminded me – I hadn’t taken my larium so far today – oops!)
9) So the next one should be – antimalarials!
10) And DEET – much as I hate it – there are more mozzies around now its started raining – and I have been bitten more lately.
11) Humility and respect for others.
12) Supportive friends in Sierra Leone and at home.
13) Phone numbers for friendly and reliable taxi drivers.
14) Lots of energy.
15) Hand sanitizer.
16) Enthusiasm and motivation.
17) Sun tan lotion.
18) A belief in what you are doing and what you are trying to achieve.
(NB. I don’t actually have all these things all the time – I just know that they are very useful in day to day life here!)
2) A laptop with mobile internet (and a long battery life) – this allows precious contact with home and relieves the boredom on long tedious journeys back from work.
3) A head torch (although I know I freak out my housemates by walking around like a cyclops).
4) Lots of batteries to power said torch.
5) A sense of humour.
6) An umbrella – now it’s started raining (although I fear an umbrella would not have survived last nights’ storm!)
7) Patience.
8) A mosquito net (which just reminded me – I hadn’t taken my larium so far today – oops!)
9) So the next one should be – antimalarials!
10) And DEET – much as I hate it – there are more mozzies around now its started raining – and I have been bitten more lately.
11) Humility and respect for others.
12) Supportive friends in Sierra Leone and at home.
13) Phone numbers for friendly and reliable taxi drivers.
14) Lots of energy.
15) Hand sanitizer.
16) Enthusiasm and motivation.
17) Sun tan lotion.
18) A belief in what you are doing and what you are trying to achieve.
(NB. I don’t actually have all these things all the time – I just know that they are very useful in day to day life here!)
Tuesday 3 May 2011
A Small Miracle
Before I went on holiday we had a 1yr and 6 month old girl who was admitted to ICU. She was “sick bad bad wan” and was one of a long line of very sick patients in ICU at that time. It was a depressing and very stressful time to be working there.
This little girl had pneumococcal meningitis. She was one of the first patients I have been able to make a definitive diagnosis for, as she had an LP and was part of a WHO surveillance study so we were able to get a definite result. Despite initially getting a bit better, she then became sicker and sicker. She started, and continued fitting. She regressed developmentally. She continued to have high fevers. She started having profuse diarrhoea. I was giving up hope. She did however get her antibiotics. Every day. The nurses on ICU made sure she received her meds and made sure that she got her IV fluids or got fed properly. But she didn’t seem to be getting any better. And then she disappeared. None of the nurses knew what happened to her and I thought that the family had absconded with her. I thought she would die, or be very disabled as a consequence of her meningitis.
Today, more than a month after I last saw her, she turned up in outpatients with her mother. She had developed a fever again. She has malaria. But she is back to her normal self; walking, talking, playing. I tell God tenki.
This little girl had pneumococcal meningitis. She was one of the first patients I have been able to make a definitive diagnosis for, as she had an LP and was part of a WHO surveillance study so we were able to get a definite result. Despite initially getting a bit better, she then became sicker and sicker. She started, and continued fitting. She regressed developmentally. She continued to have high fevers. She started having profuse diarrhoea. I was giving up hope. She did however get her antibiotics. Every day. The nurses on ICU made sure she received her meds and made sure that she got her IV fluids or got fed properly. But she didn’t seem to be getting any better. And then she disappeared. None of the nurses knew what happened to her and I thought that the family had absconded with her. I thought she would die, or be very disabled as a consequence of her meningitis.
Today, more than a month after I last saw her, she turned up in outpatients with her mother. She had developed a fever again. She has malaria. But she is back to her normal self; walking, talking, playing. I tell God tenki.
Sunday 1 May 2011
The Patient Journey
My father-in-law has been for a check-up a year after his knee replacement. He sent me this email and kindly allowed me to share his thoughts.
“Shona, I got thinking yesterday about the differences in what we take for granted here and where you are regarding hospitals. I got a paper form, paid £10 and flew to Glasgow, met by an NHS minibus, was seen by the X-ray people in about 15 minutes of checking in at reception, was seen by the nurse about ten minutes later who had my case history and x-rays, did a few checks of my knee, and that was me done, very slick and professional, oh just by chance I met Mr Picard who did my op and thanked him for making my life easier. I stayed in a 4* hotel, ate lots of good food at cheap prices, in a room that was big by any standard, en-suite, 21” applemac with digital freeview TV channels, all for the sum of £10. This morning I had a full breakfast before being driven in the same NHS minibus to the airport for the flight home, it made me think of you in SL and I admit I felt almost ashamed of what I just accepted as the norm.”
In the UK, this is known as The Patient Journey. The NHS making sure that not only do you receive good care, but that it is as slick and efficient as it can be.
Here’s how it works in ODCH: When the child arrives (probably having travelled by poda poda), they register and get seen by the triage nurses. If they are triaged as “emergency” they get sent straight to the emergency where (hopefully) they are seen and treatment administered straight away. That’s provided that the doctors and nurses are available. If they are triaged as “priority” they get seen in our out-patients department. There they wait a variable amount of time before being seen. No one complains about waiting. If they are “routine” they get sent to the Under-5s clinic about a mile away (another poda poda journey for the family to pay for).
If the child needs an x-ray they go to another hospital, about 2 miles away very early one morning. Not in an ambulance, but in another poda poda. The x-ray department can only take 10 x-rays per day. If they run out, the patient needs to go another day. The family return to the other hospital to pick up the x-ray the following day (more poda poda journeys….) There is an ambulance – but usually it’s used for transporting staff around instead of patients.
The wards are often more than full. It’s not unusual to have two children to a bed. The mothers sleep on the bed with them, or underneath. There are no single rooms. The children do get provided with three meals a day (rice and cassava leaf). I’ll not go into details of the patient toilets… but they’re not en suite anyway! Wards 1 and 3 and the play room do all have TVs, which the patients, parents and nurses all crowd around in the afternoons.
But I don’t want people reading this to feel guilty or ashamed about what we have at home. I often feel that way even with the things I have here compared to my colleagues and neighbours. I’m trying to learn to stop feeling guilty, and to feel thankful for all the things we do have and have the luxury to take for granted, and to try my best to help those that I can. If I felt guilty all the time there’s no way I could enjoy going to beaches or to IMATT parties…! I would like people to think about it as my father-in-law did, and to be grateful for what we have at home. Or to use what we do have to help others. If you want to help the children in Sierra Leone – donate money to the Welbodi Partnership (www.welbodipartnership.org) who I work alongside in the hospital. You can also donate money to VSO although the money doesn’t go direct to the children – it would go towards sending more people like me out to other places to share their skills.
“Shona, I got thinking yesterday about the differences in what we take for granted here and where you are regarding hospitals. I got a paper form, paid £10 and flew to Glasgow, met by an NHS minibus, was seen by the X-ray people in about 15 minutes of checking in at reception, was seen by the nurse about ten minutes later who had my case history and x-rays, did a few checks of my knee, and that was me done, very slick and professional, oh just by chance I met Mr Picard who did my op and thanked him for making my life easier. I stayed in a 4* hotel, ate lots of good food at cheap prices, in a room that was big by any standard, en-suite, 21” applemac with digital freeview TV channels, all for the sum of £10. This morning I had a full breakfast before being driven in the same NHS minibus to the airport for the flight home, it made me think of you in SL and I admit I felt almost ashamed of what I just accepted as the norm.”
In the UK, this is known as The Patient Journey. The NHS making sure that not only do you receive good care, but that it is as slick and efficient as it can be.
Here’s how it works in ODCH: When the child arrives (probably having travelled by poda poda), they register and get seen by the triage nurses. If they are triaged as “emergency” they get sent straight to the emergency where (hopefully) they are seen and treatment administered straight away. That’s provided that the doctors and nurses are available. If they are triaged as “priority” they get seen in our out-patients department. There they wait a variable amount of time before being seen. No one complains about waiting. If they are “routine” they get sent to the Under-5s clinic about a mile away (another poda poda journey for the family to pay for).
If the child needs an x-ray they go to another hospital, about 2 miles away very early one morning. Not in an ambulance, but in another poda poda. The x-ray department can only take 10 x-rays per day. If they run out, the patient needs to go another day. The family return to the other hospital to pick up the x-ray the following day (more poda poda journeys….) There is an ambulance – but usually it’s used for transporting staff around instead of patients.
The wards are often more than full. It’s not unusual to have two children to a bed. The mothers sleep on the bed with them, or underneath. There are no single rooms. The children do get provided with three meals a day (rice and cassava leaf). I’ll not go into details of the patient toilets… but they’re not en suite anyway! Wards 1 and 3 and the play room do all have TVs, which the patients, parents and nurses all crowd around in the afternoons.
But I don’t want people reading this to feel guilty or ashamed about what we have at home. I often feel that way even with the things I have here compared to my colleagues and neighbours. I’m trying to learn to stop feeling guilty, and to feel thankful for all the things we do have and have the luxury to take for granted, and to try my best to help those that I can. If I felt guilty all the time there’s no way I could enjoy going to beaches or to IMATT parties…! I would like people to think about it as my father-in-law did, and to be grateful for what we have at home. Or to use what we do have to help others. If you want to help the children in Sierra Leone – donate money to the Welbodi Partnership (www.welbodipartnership.org) who I work alongside in the hospital. You can also donate money to VSO although the money doesn’t go direct to the children – it would go towards sending more people like me out to other places to share their skills.
The Royal Wedding Party
As Salone continues to celebrate its 50th Birthday, back in the UK everyone was celebrating Kate and Wills’ wedding. Alas we didn’t get the bank holiday but I did get invited to a Royal Wedding Party at IMATT. Jenny and Andy had gone all out and organised loads of Kate and Wills bunting (so we went from a world of green, white and blue, to one of red, white and blue!) They had even downloaded clips of the wedding from YouTube (apparently the internet at IMATT is good enough to get YouTube – not that I’m jealous…!) which were shown as a continuous loop. So I got to see The Dress and The Kiss. Many people had made a big effort with their outfits and costumes – there were pirates, brides, a St George, Posh and Becks and some beautiful dresses made by local tailors. My effort was some Kate and Wills flags and a tiara I had brought from home.
There was great food, great company, great music, and all the usual fantastic IMATT hospitality. The night ended in somewhat legendary fashion – with most of the remaining guests ending up, fully dressed, in the swimming pool (only semi-voluntarily I have to add!) I was very grateful to Zoe who had somehow brought not one but two extra changes of clothes with her!
Thank you so much to Andy and Jenny for organising it all and for looking after us all – you certainly know how to throw a party!
Happy Birthday Free Health Care!
Wednesday 27th April 2011 also marked a year since the introduction of free health care for all under-5s and pregnant and lactating women in Sierra Leone. It’s a year which has seen a lot of changes in the health service. The doctors and nurses went on strike for an increase in their salaries to make up for the loss of income from charging patients. The number of admissions to the hospital more than doubled in 2010 compared to five years ago. There have been many teething problems with the initiative. For example, there is still a drastic shortage of drugs in many areas up-country. Or they got sent unsuitable drugs e.g. anaesthetic drugs being sent to peripheral health care units. There is a drastic human resource crisis. There are no where near enough doctors, clinical health officers or nurses working in government services to provide the care that increased access demands. Some doctors and nurses, alas, still try to charge patients. Education is a massive issue; many patients still ask me how much the drugs and tests will cost.
And there’s a question of sustainability. Free Health Care is mostly being paid for by DfID (the department for international development). The means you – the UK taxpayer. DfID pay for me to be here too. The Salonean government can’t pay for this by itself – and despite diamonds and iron ore, it will be many many years (if ever) before the government will be able to pay for it. And no matter how many patients I see while I am here, when I leave there will be one fewer doctor in government service. I could stay in the hospital 24/7 and I could not save every child in Sierra Leone. Which is why I far prefer teaching, training and capacity building (sorry for the NGOish language!) I teach 27 medical students – they will graduate next year and I just hope that most of them will stay working here, and go on to become paediatricians.
Despite its problems, I think that Free Health Care is a great scheme. It clearly has a long way to go. Increasing access to basic health care can only be good for the long term public health of the country. I continue to have great hope for the future of Sierra Leone. I think that, in the long run, it will be worth the investment.
And there’s a question of sustainability. Free Health Care is mostly being paid for by DfID (the department for international development). The means you – the UK taxpayer. DfID pay for me to be here too. The Salonean government can’t pay for this by itself – and despite diamonds and iron ore, it will be many many years (if ever) before the government will be able to pay for it. And no matter how many patients I see while I am here, when I leave there will be one fewer doctor in government service. I could stay in the hospital 24/7 and I could not save every child in Sierra Leone. Which is why I far prefer teaching, training and capacity building (sorry for the NGOish language!) I teach 27 medical students – they will graduate next year and I just hope that most of them will stay working here, and go on to become paediatricians.
Despite its problems, I think that Free Health Care is a great scheme. It clearly has a long way to go. Increasing access to basic health care can only be good for the long term public health of the country. I continue to have great hope for the future of Sierra Leone. I think that, in the long run, it will be worth the investment.
Independence!
Sierra Leone has been gearing up to celebrate its 50th Birthday. Since I’ve been back form my holiday the streets have been adorned with green, white and blue bunting and everything from stones at the side of the road, to trees have also been painted. Lots of companies, shops, banks etc have had huge banners hanging up outside saying “Congratulations Mama Salone!” Many diaspora have also returned from abroad to help celebrate.
Fireworks were advertised for Tuesday evening (the eve of independence) so a large group of us gathered at the beach for dinner while awaiting the expected fireworks. So we waited… and we waited… Unfortunately the fireworks were not to be (we did all wonder what happened to the budget for the fireworks... or whose pocket(s) it had gone into….) but we still had a fun night.
Wednesday 27th April marked 50 years since independence and it was a great celebration for all Saloneans. With some friends I headed down to the stadium to see some parading and soak in the atmosphere. If you’ve followed my blog, you’ll remember that my last experience of the stadium was not a good one (football match somewhat reminiscent of Hillsborough….) so I was a bit apprehensive about going there again. However it was just the opposite of last time – there was a great atmosphere, everyone wearing green, white and blue; people selling merchandise like t-shirts, flags, badges, jewellery; and it wasn’t at all crowded. We saw the army march out; everyone sung the National Anthem and President Ernest Bai Koroma inspected the army. It was a fantastic atmosphere and I felt so privileged to be there to share the day.
The theme for independence as a whole has been about looking forward and working towards a new Sierra Leone. I hope the great atmosphere and feelings of hope will continue and inspire Saloneans that they are able to change their country for the better (without spoiling the many great things about this country).
Fireworks were advertised for Tuesday evening (the eve of independence) so a large group of us gathered at the beach for dinner while awaiting the expected fireworks. So we waited… and we waited… Unfortunately the fireworks were not to be (we did all wonder what happened to the budget for the fireworks... or whose pocket(s) it had gone into….) but we still had a fun night.
Wednesday 27th April marked 50 years since independence and it was a great celebration for all Saloneans. With some friends I headed down to the stadium to see some parading and soak in the atmosphere. If you’ve followed my blog, you’ll remember that my last experience of the stadium was not a good one (football match somewhat reminiscent of Hillsborough….) so I was a bit apprehensive about going there again. However it was just the opposite of last time – there was a great atmosphere, everyone wearing green, white and blue; people selling merchandise like t-shirts, flags, badges, jewellery; and it wasn’t at all crowded. We saw the army march out; everyone sung the National Anthem and President Ernest Bai Koroma inspected the army. It was a fantastic atmosphere and I felt so privileged to be there to share the day.
The theme for independence as a whole has been about looking forward and working towards a new Sierra Leone. I hope the great atmosphere and feelings of hope will continue and inspire Saloneans that they are able to change their country for the better (without spoiling the many great things about this country).
Blood Donation
It had been four months since Sandra and I went to donate blood (Omar the blood transfusion technician will only let women donate every four months - instead of every three - for reasons we are yet to fathom…!). So on Easter Friday we both headed to the blood bank to donate again. This time he did check our haemoglobins before letting us donate (a healthy 13.5 for me – the highest Hb I have seen in a long time – usually I’m pleased if its above 6 in my patients…!) We are always on the look out for people to donate blood here – we often need blood in an emergency and if the family are unable to donate, we need extra units available to give to sick children and mothers (our blood bank also supplies blood to the maternity hospital). It really can be life saving. So anyone in Freetown – come and give us your blood! I’m hoping there might be some pictures this time (I left out the gory picture of the huge needle but that’s my blood!).
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