With a limited amount of time left in Sierra Leone, Cat and I have written “The List” of all the things we want to do before leaving. Included on this list is, among other things, ETATing in Kenema (tick), eating lobster at Hamilton Beach (tick) and fish carpaccio at Mamba Point (tick). In addition, we planned a “Grand Day Out” in the East End (near the hospital) in order to visit a few “tourist” sites in the area. More of a “Grand Half Day” (as I had to do a ward round in the morning), we set off after a lunch of groundnut stew made by the family who live under the stairs.
First stop was the National Railway Museum in Cline Town. This was set up by a former IMATT colonel. There are no trains anymore in Sierra Leone (although the mining companies are now building a railway to transport the iron ore) but there used to be a railway from Freetown to Pendembu in the east of the country (365km). We had a fantastic guide who told us all about the history of the railway and showed us the restored rolling stock. The best thing was having a go on one of those things that looks like a see saw which you push up and down to move the wheels (if anyone can tell me what those are called I’ll be very grateful!) It was a lot of fun and we were all giggling like little kids when it was our turn.
Next stop was the Star Brewery in Wellington. We had wanted to see around it but alas it turned out that we needed to write to the general manager in advance to arrange a visit. Ah well, wi don try. It was also interesting to drive along the back roads as we saw the “Low Cost Housing” and other areas where many of the patients live.
To end our Grand Day Out we headed to 555 Spot, a bar on Bai Bureh Road where we met up with some of the nurses for a couple of drinks. It was good to see and chat with them outside of work and a nice end to the day. Many thanks to Alusine for driving us around.
Sunday 31 July 2011
Saturday 30 July 2011
Back in ICU
I’ve moved back to ICU for my last two weeks here in Freetown. ICU has moved since I was there before. It is in a new, smaller ward with only ten beds. It is a completely different atmosphere from the old ICU. The children are still extremely sick but we are trying to keep to a maximum of ten children (i.e. one to a bed), meaning that with fewer children to concentrate on they can get far more attention that previously. The nurses are now allocated patients, which almost works as it would at home. There are some continuous saturations monitors (meaning improved monitoring, although Cat and I are still the only staff who switch off the alarms). The children are getting observations done. They are getting their medications. They are getting fed. (All the above at least most of the time). On the ward rounds I almost feel like I’m in a normal ward in the UK.
When I remember back to the old ICU I often walked in with a terribly sense of dread thinking “which child has died in my absence?” or “which child will deteriorate and die in front of my eyes today?” Of course that possibility is still there but somehow everything seems so much more controlled. I’m very pleased to say that a lot of the children who were extremely sick at the beginning of the week were well and being discharged home by the end. The nurses clearly enjoy working there and they seem to know the children so much better than previously. Maybe it also feels more controlled because I am calmer too, more used to dealing with exceptionally sick children, I know what is and what isn’t possible to achieve here, and maybe because I know that I’m only here for a limited time now, so in a week I will not have to worry every day about how many children have died or are dying. For the nurses and doctors (and parents and patients) here, that burden will continue. They will continue to be in my thoughts and prayers.
On a happier note, Friday is Africana Day in Sierra Leone, when everyone wears more traditional clothes, so I wore my outfit to work again yesterday which got me lots of nice comments of “I like your style”. It was a good photo opportunity, so here’s one (hopefully) of me with one of the ICU nurses and a student nurse.
Sunday 24 July 2011
I’m leaving….
I think it has just dawned on me that I’m leaving Sierra Leone in two weeks time. I’ve known my leaving date for a while but I think I’ve been in denial. I’ve said goodbye to so many friends who have already left Sierra Leone (there is now only a select few of my NGO friends left here) and it seems strange to think that in two weeks time I’ll be the one getting on the Pelican water taxi to start my journey home.
I’ve been having a tidying up session this morning, throwing out things I know I won’t need, and sorting everything else into piles of things to take to the hospital, things to leave behind for friends and things I’ll take if I have space (clearly the blue dresses come first!) I’ve been listening to a mixture of Scottish and Salonean music and it’s making me both happy and sad.
I’ve also been looking through cards and messages that friends and family gave me before I left and letters I’ve received while I’ve been here. It makes me realise how lucky I am to have all those people at home and how grateful I am for their support.
It’s strange thinking back to when I left the UK, leaving home for a year. I know a lot of people thought I was crazy (I’ve thought this myself a few times). In the weeks leading up to leaving I was completely distraught at leaving my husband but at the same time I knew it was something I had to do. I cried all the way to the airport and kept trying to remember what on earth possessed me to put my husband and me through so much pain.
What a journey I have been on since then.
I’m so excited about going home to see my husband again, and to see friends and family from home. At the same time I am going to miss Sweet Salone so much; I have grown to love this country and the people, and I really enjoy the simplicity of life here. Once I get over that initial excitement of being home I guess I might find it quite hard to slot back into my life in the UK (particularly at work). It will take a while to hit me exactly how this year has impacted on my life. I guess I’ll need to take some time to reflect on everything I have seen and done and try to use all those experiences in a positive way when I get back home.
For now, it’s back to sorting out my room, enjoying my last few weeks left here and looking forward to the next journey.
I’ve been having a tidying up session this morning, throwing out things I know I won’t need, and sorting everything else into piles of things to take to the hospital, things to leave behind for friends and things I’ll take if I have space (clearly the blue dresses come first!) I’ve been listening to a mixture of Scottish and Salonean music and it’s making me both happy and sad.
I’ve also been looking through cards and messages that friends and family gave me before I left and letters I’ve received while I’ve been here. It makes me realise how lucky I am to have all those people at home and how grateful I am for their support.
It’s strange thinking back to when I left the UK, leaving home for a year. I know a lot of people thought I was crazy (I’ve thought this myself a few times). In the weeks leading up to leaving I was completely distraught at leaving my husband but at the same time I knew it was something I had to do. I cried all the way to the airport and kept trying to remember what on earth possessed me to put my husband and me through so much pain.
What a journey I have been on since then.
I’m so excited about going home to see my husband again, and to see friends and family from home. At the same time I am going to miss Sweet Salone so much; I have grown to love this country and the people, and I really enjoy the simplicity of life here. Once I get over that initial excitement of being home I guess I might find it quite hard to slot back into my life in the UK (particularly at work). It will take a while to hit me exactly how this year has impacted on my life. I guess I’ll need to take some time to reflect on everything I have seen and done and try to use all those experiences in a positive way when I get back home.
For now, it’s back to sorting out my room, enjoying my last few weeks left here and looking forward to the next journey.
Saturday 23 July 2011
Sounds, phrases and conversations that will forever remind me of Sierra Leone
(Apologies to any Saloneans for the spelling of Krio words and phrases)
1) “Ow di bodi?” “Di bodi fine, ow yusef?” “I tell God tenki”
2) “Aaaaaayyyyyy!” (an exclamation)
3) “Ebo!” (another exclamation)
4) “Plaintain chips chips”
5) “Col wata day wata day” (cold water there, said by the little kids who carry bags of water to sell in a bucket on their heads)
6) “Aba-daba-daba-daba-deen” (said by the ‘prentice in poda podas heading in the direction of Aberdeen)
7) “Can I have one more Star please?” (said by Fred)
8) “TFC?” “Yes” “OPD?” “Yes” “BBC?” “No” (a conversation I had with Sarah from Cap Anamur)
9) “Sheena Sheena” (what the little kids down our alley call me)
10) “Sowa sowa sowa lay” (the words to the ever present and popular song Waka Waka Baby).
11) The extremely distinctive sound of our gate opening and closing.
12) Beep beep (car horns tooting constantly).
13) The dogs howling at night.
14) “I no chook you” (I’m not going to inject you with anything, said by me to try to stop children crying so I can examine them)
15) “I go beat you” (I’m going to beat you up, said by the nurses to try to stop the children crying so I can examine them)
16) The “Gregorian chant” (as Becky calls it) music in Mamba Point.
17) The lilting sounds of the mocks (the mosque) near our house.
18) The wailing of the mothers outside ER and ICU when their child has died.
19) The beautiful sound of the Atlantic Ocean waves on the beach.
20) Hissssssssssssssssss/Tssss Tsss (used to attract people’s attention)
21) The so loud it’s sometimes scary thunder and massive downpours of rain that accompany it
22) “Oputo oputo” (white person – often shouted as I walk past)
23) “White girl” (ditto)
1) “Ow di bodi?” “Di bodi fine, ow yusef?” “I tell God tenki”
2) “Aaaaaayyyyyy!” (an exclamation)
3) “Ebo!” (another exclamation)
4) “Plaintain chips chips”
5) “Col wata day wata day” (cold water there, said by the little kids who carry bags of water to sell in a bucket on their heads)
6) “Aba-daba-daba-daba-deen” (said by the ‘prentice in poda podas heading in the direction of Aberdeen)
7) “Can I have one more Star please?” (said by Fred)
8) “TFC?” “Yes” “OPD?” “Yes” “BBC?” “No” (a conversation I had with Sarah from Cap Anamur)
9) “Sheena Sheena” (what the little kids down our alley call me)
10) “Sowa sowa sowa lay” (the words to the ever present and popular song Waka Waka Baby).
11) The extremely distinctive sound of our gate opening and closing.
12) Beep beep (car horns tooting constantly).
13) The dogs howling at night.
14) “I no chook you” (I’m not going to inject you with anything, said by me to try to stop children crying so I can examine them)
15) “I go beat you” (I’m going to beat you up, said by the nurses to try to stop the children crying so I can examine them)
16) The “Gregorian chant” (as Becky calls it) music in Mamba Point.
17) The lilting sounds of the mocks (the mosque) near our house.
18) The wailing of the mothers outside ER and ICU when their child has died.
19) The beautiful sound of the Atlantic Ocean waves on the beach.
20) Hissssssssssssssssss/Tssss Tsss (used to attract people’s attention)
21) The so loud it’s sometimes scary thunder and massive downpours of rain that accompany it
22) “Oputo oputo” (white person – often shouted as I walk past)
23) “White girl” (ditto)
Thursday 21 July 2011
Survival of the Fittest
Imagine you are a child in Sierra Leone. Surviving childhood is a challenge. And there are so many challenges to get through. The first occur before you are even born. You are relying on your mother’s health, her education, her attendance at antenatal care, her compliance with antimalarial medication, tetanus immunisations and sleeping under a bed-net while she is pregnant. Then there is the challenge of labour and delivery. Will there be an obstructed labour? Will your mother develop chorioamnionitis? Will she present to health services at all? Will the midwife recognise a problem and alert the obstetrician if she needs a caesarean section? Will the midwives resuscitate you appropriately and take you to the S-C-B-U in a timely fashion? Or will your mother stay with a traditional birth attendant, in labour for days while the fetus (you) gets increasingly distressed, septic and hypoxic?
And if you need admission to S-C-B-U for hypoxic ischaemic encephalopathy, or septicaemia, will you get your medications? Will you get fed? Will you be kept warm or will you die of hypothermia? Will you get an infection from the baby in the cot next to you? Will you die of iatrogenic causes such as hyponatraemia, hypokalaemia or gentamicin toxicity because we can’t measure electrolytes and drug levels?
And if you are a premature baby your chances are even lower. However, the power for survival sometimes amazes me. We currently have a 700g baby said to be “9 months” (I don’t believe them, the baby is definitely premature and no one ever knows the true gestation). He is four days old and still remarkably feisty. He has a long long way to go, but it really is survival of the fittest.
If you make it past all that you are doing fairly well to start with. Then you go home with your family, provided your mother has survived childbirth – she has a one in eight chance over her lifetime of not making it.
If your mother hasn’t survived, you’ll be cared for by relatives, usually an auntie or granny. You won’t be breast fed, meaning you’ll probably get formula milk which has been watered down too much by unclean water. A recipe for malnutrition. And gastroenteritis. And if you make it to six months of age (starting complimentary foods) then you’ll have to fight with all the other children (once the men have eaten) for your share.
Meanwhile, if your mother did survive and you’re being breast fed, that’s a good start. Next you’ll have to ensure you get immunised (protecting you against polio, various causes of pneumonia and meningitis, TB – to a certain extent, hepatitis B, whooping cough, diphtheria and tetanus). The next thing to worry about is that dreaded Anopheles mosquito. Have your family got an insecticide treated bed-net? Do you sleep under it, protecting you from malaria? Or do your family find it too hot (the most common reason cited for not sleeping under bed-nets)? If you develop a fever or have a convulsion, will your family know that might mean malaria or another severe infection? Will they take you to a health clinic or hospital? Or will they take you to someone in the neighbourhood with a supply of medications and give you an unidentified injection (which could be quinine or ampicillin or gentamicin or none of the above)? Or will they take you to a traditional healer, buy some “native herbs” and suggest you are a witch or that it is “devil business”? Will they take you early to health care or will they wait until you are unconscious and moribund?
You’ve survived malaria/meningitis/typhoid/whatever severe infection you had (the hospital doesn’t really know what illness you had as they don’t have the lab tests, and anyway no one told your mother what was wrong with you). Next you worry about the terrible overcrowding in your house, the dreadful lack of sanitation and clean drinking water. Oh and in the rainy season all that extra water flooding into your house, along with all the sewage.
Once rainy season is over you might start playing with friends, which means playing near open fires, risking massive burns. Or maybe you’ll play on the road and get knocked over by an okada or poda poda.
Congratulations, you’ve made it to five years of age! You’re one of the lucky ones. You’re doing better than one in seven children in the country (this figure varies every time I read it from one in four to one in seven). Still you’ll probably get malaria several times a year, probably not as severely though. You’ll need to get to school, then your siblings are born (let’s hope your Mum survives those pregnancies too).
Let’s say you get uneventfully through school, and into your teenage years. But your childhood comes to an abrupt end. Here comes the next challenge: pregnancy. And so it starts again….
And if you need admission to S-C-B-U for hypoxic ischaemic encephalopathy, or septicaemia, will you get your medications? Will you get fed? Will you be kept warm or will you die of hypothermia? Will you get an infection from the baby in the cot next to you? Will you die of iatrogenic causes such as hyponatraemia, hypokalaemia or gentamicin toxicity because we can’t measure electrolytes and drug levels?
And if you are a premature baby your chances are even lower. However, the power for survival sometimes amazes me. We currently have a 700g baby said to be “9 months” (I don’t believe them, the baby is definitely premature and no one ever knows the true gestation). He is four days old and still remarkably feisty. He has a long long way to go, but it really is survival of the fittest.
If you make it past all that you are doing fairly well to start with. Then you go home with your family, provided your mother has survived childbirth – she has a one in eight chance over her lifetime of not making it.
If your mother hasn’t survived, you’ll be cared for by relatives, usually an auntie or granny. You won’t be breast fed, meaning you’ll probably get formula milk which has been watered down too much by unclean water. A recipe for malnutrition. And gastroenteritis. And if you make it to six months of age (starting complimentary foods) then you’ll have to fight with all the other children (once the men have eaten) for your share.
Meanwhile, if your mother did survive and you’re being breast fed, that’s a good start. Next you’ll have to ensure you get immunised (protecting you against polio, various causes of pneumonia and meningitis, TB – to a certain extent, hepatitis B, whooping cough, diphtheria and tetanus). The next thing to worry about is that dreaded Anopheles mosquito. Have your family got an insecticide treated bed-net? Do you sleep under it, protecting you from malaria? Or do your family find it too hot (the most common reason cited for not sleeping under bed-nets)? If you develop a fever or have a convulsion, will your family know that might mean malaria or another severe infection? Will they take you to a health clinic or hospital? Or will they take you to someone in the neighbourhood with a supply of medications and give you an unidentified injection (which could be quinine or ampicillin or gentamicin or none of the above)? Or will they take you to a traditional healer, buy some “native herbs” and suggest you are a witch or that it is “devil business”? Will they take you early to health care or will they wait until you are unconscious and moribund?
You’ve survived malaria/meningitis/typhoid/whatever severe infection you had (the hospital doesn’t really know what illness you had as they don’t have the lab tests, and anyway no one told your mother what was wrong with you). Next you worry about the terrible overcrowding in your house, the dreadful lack of sanitation and clean drinking water. Oh and in the rainy season all that extra water flooding into your house, along with all the sewage.
Once rainy season is over you might start playing with friends, which means playing near open fires, risking massive burns. Or maybe you’ll play on the road and get knocked over by an okada or poda poda.
Congratulations, you’ve made it to five years of age! You’re one of the lucky ones. You’re doing better than one in seven children in the country (this figure varies every time I read it from one in four to one in seven). Still you’ll probably get malaria several times a year, probably not as severely though. You’ll need to get to school, then your siblings are born (let’s hope your Mum survives those pregnancies too).
Let’s say you get uneventfully through school, and into your teenage years. But your childhood comes to an abrupt end. Here comes the next challenge: pregnancy. And so it starts again….
The Year in Numbers
So the countdown is here. I am nearly at the end of my placement. I am leaving Sierra Leone and will be back home in the UK after 18 sleeps (including the night on the plane). Here’s my year in numbers (so far – I hope I will pack in a few things yet!):
6 trips to Hamilton Beach
4 visitors from home
2 trips to Tokeh Beach
21 books (so far!)
8 visits to IMATT
3 housemates
27 medical students
1 visit to the Mercy Ship (and therefore 1 Starbucks)
2 visits from photographers/journalists
3000 – how much a Star costs at Big Brother
8000 – how much a Star costs at Mamba Point
80-100 lengths at the swimming pool (per visit)
410 – weight in grams of the smallest baby I have seen here (died aged 16 hours).
700 – weight in grams of the smallest baby I have seen survive here (still alive just now and 4 days old – so still a long, long way to go).
2 trips up Sugar Loaf Mountain (one more successful than the other!)
8 tailored dresses
2 tailored Africana outfits
2 tailored tops
3 tailored skirts
2 blood donations (so far – I’m hoping to get in another before I leave)
5 weeks with no running water
13 - highest number of people I have been in a taxi with
84 blog posts (this one included)
Countless - patients, sad memories, happy memories and new friends.
6 trips to Hamilton Beach
4 visitors from home
2 trips to Tokeh Beach
21 books (so far!)
8 visits to IMATT
3 housemates
27 medical students
1 visit to the Mercy Ship (and therefore 1 Starbucks)
2 visits from photographers/journalists
3000 – how much a Star costs at Big Brother
8000 – how much a Star costs at Mamba Point
80-100 lengths at the swimming pool (per visit)
410 – weight in grams of the smallest baby I have seen here (died aged 16 hours).
700 – weight in grams of the smallest baby I have seen survive here (still alive just now and 4 days old – so still a long, long way to go).
2 trips up Sugar Loaf Mountain (one more successful than the other!)
8 tailored dresses
2 tailored Africana outfits
2 tailored tops
3 tailored skirts
2 blood donations (so far – I’m hoping to get in another before I leave)
5 weeks with no running water
13 - highest number of people I have been in a taxi with
84 blog posts (this one included)
Countless - patients, sad memories, happy memories and new friends.
Monday 18 July 2011
Stop Press!
A quick blog to update you on the success of the Welbodi Quiz – we raised Le4,370,000, which is just over one thousand US dollars! Hopefully also a photo attached of the quiz organising team (minus Fred who took the photo). And the answer to the question is that Juba is the capital of South Sudan (the newest country in the world).
Fun at the Beach (despite the rain….)
The day after the Quiz a group of us headed to Hamilton Beach for the night. Unfortunately it rained on and off for most of the afternoon but that didn’t stop us from enjoying the atmosphere at Samso’s (sitting under the new shelter rather than on the beach!), or stop us from swimming in the idyllic Atlantic. I had a fantastic lobster and chips for dinner, then we played some fun games including a game called “Werewolf” – a tactical game of bluffing and trust (or not trusting anyone!) where we found out which of our friends were good liars….!
I organised a hut to stay in instead of camping in case of rain. Unfortunately there was indeed a massive storm overnight. Unfortunately there was a leak in our hut. Unfortunately it was right above my bed. My mattress got quite wet – I ended up flipping it over so I could dry off a bit! (Quite why I didn’t just try to move the bed I’m not sure).
It was still raining in the morning but we had a birthday breakfast for Cat followed by a long swim (hard work swimming against that drift!) Finally the sun came out (and finally I took off my cardigan) and lunch was barracuda and chips (the fish in SL really is world class) followed by chocolate birthday cake made by Becky and Hannah.
All in all a great weekend filled with friends, food and fun!
I organised a hut to stay in instead of camping in case of rain. Unfortunately there was indeed a massive storm overnight. Unfortunately there was a leak in our hut. Unfortunately it was right above my bed. My mattress got quite wet – I ended up flipping it over so I could dry off a bit! (Quite why I didn’t just try to move the bed I’m not sure).
It was still raining in the morning but we had a birthday breakfast for Cat followed by a long swim (hard work swimming against that drift!) Finally the sun came out (and finally I took off my cardigan) and lunch was barracuda and chips (the fish in SL really is world class) followed by chocolate birthday cake made by Becky and Hannah.
All in all a great weekend filled with friends, food and fun!
Sunday 17 July 2011
The Welbodi Quiz
On returning from Kenema there was little time for resting as on Friday evening we held the long-awaited fundraising quiz in aid of The Welbodi Partnership (www.welbodipartnership.org) at IMATT. For those of you who haven’t heard my little crusade for Welbodi, I work with the wonderful people from Welbodi in the Children’s Hospital. They are developing paediatric post-graduate training for doctors (currently there is no postgraduate training in SL), in-service paediatric training for nursing staff (again, no specialist children’s nursing training in the country) and developing other systems within the hospital (things like medical records, electricity and running water).
While we were in Kenema, Fred, Becky and Sandra had been busily organising questions (with some cross-continental help from Andy and Banke), guest lists and raffle prizes. On Friday we headed up the hill to IMATT to do some last minute organising and sorting out the layout of the bar for the evening. We then had time for a quick swim in the rain followed by a Hot Shower (it was amazing! – thanks Jenny!) and some lengthy pondering over which of my multitude of tailored blue dresses to wear for the evening.
Guests soon started arriving and I got busy selling raffle tickets which was fun as I got to be a social butterfly speaking to people while selling the tickets. Carole was our quiz-master and we had some fun rounds including topical questions on African geography (the capital of the newest country in the world, anyone?) and a music round with song words translated into Krio.
The raffle was drawn while Fred and I marked the quiz. There were some fantastic raffle prizes – thanks to everyone who donated them. Cat decided she wouldn’t use her raffle prize of a free gym session so we auctioned it off – a great idea which ended with some very high bidding and a fierce battle between two people! And finally, we got to announce the quiz winners - congratulations to the team “4 Nations” who won by a mere half a point!
It was a brilliant evening – I will update you on how much we raise when I find out the total. Anyone can of course still donate money if you wish! Well done to the wonderful Welbodi’s for organising such a great night and thanks so much to everyone at IMATT, especially Jenny for making the evening possible.
While we were in Kenema, Fred, Becky and Sandra had been busily organising questions (with some cross-continental help from Andy and Banke), guest lists and raffle prizes. On Friday we headed up the hill to IMATT to do some last minute organising and sorting out the layout of the bar for the evening. We then had time for a quick swim in the rain followed by a Hot Shower (it was amazing! – thanks Jenny!) and some lengthy pondering over which of my multitude of tailored blue dresses to wear for the evening.
Guests soon started arriving and I got busy selling raffle tickets which was fun as I got to be a social butterfly speaking to people while selling the tickets. Carole was our quiz-master and we had some fun rounds including topical questions on African geography (the capital of the newest country in the world, anyone?) and a music round with song words translated into Krio.
The raffle was drawn while Fred and I marked the quiz. There were some fantastic raffle prizes – thanks to everyone who donated them. Cat decided she wouldn’t use her raffle prize of a free gym session so we auctioned it off – a great idea which ended with some very high bidding and a fierce battle between two people! And finally, we got to announce the quiz winners - congratulations to the team “4 Nations” who won by a mere half a point!
It was a brilliant evening – I will update you on how much we raise when I find out the total. Anyone can of course still donate money if you wish! Well done to the wonderful Welbodi’s for organising such a great night and thanks so much to everyone at IMATT, especially Jenny for making the evening possible.
Saturday 16 July 2011
ETATing in Kenema
Cat and I went to Kenema this week to do some training for the nursing staff on Emergency Triage and Treatment in children. We had been saying for a long time that we should arrange a visit to Susan and Dickya (two VSO nurse trainers) so we finally managed to arrange it.
We got up early Sunday morning (by early I mean 4am!) to catch the government bus to Kenema. Apart from the near-fight over seats before we set off (the bus driver told the people fighting to “shut up, we’re travelling as a family, let’s pray for a safe journey” and they all did!) it was one of the more pleasant journeys on African public transport I have over made. Individual seats, a bit of leg room, and there was only one chicken (and no goats). We made it to Kenema by lunchtime and were met by Dickya, Susan and Vasile (another VSO who is working in agriculture). After lunch and a rest we were joined by Cedric (another VSO doctor) and had a last planning session and delegation of jobs for the course.
So on Monday we started the three day course! Nurses and community health officers had come from the paediatric department, the under 5s clinic and out-patients in Kenema, along with two nurse tutors from the polytechnic and three nurses from another hospital in Pujehan. We had sessions on how to triage, recognition of essential signs and symptoms, paediatric basic life support, airway, breathing, circulation, coma, convulsions and dehydration. The most fun part of the course was doing “Skills Stations” where the participants got to practice new skills such as resuscitation, triage, vital signs and how to put in NG tubes. We used scenario-based teaching which was new to many but they picked it up very quickly. It was also great to see that many nurses suggested ways in which systems need to change within their hospitals to provide a triage system to improve paediatric care.
We passed the evenings with Susan, Dickya, Cedric and Neil (who had joined us from Pujehan after getting over his bout of malaria)playing table tennis and eating some fantastic food (a combination of Sri Lankan – as Susan’s husband is Sri Lankan - and Phillipino food, and a great spaghetti bolognese made with corned beef – tastier than you would imagine!) I got a small reminder of home too – Fatorma (the house help) has Auld Lang Syne as his ring tone!
I also did something I hadn’t done so far in Sierra Leone – as our transport back to Vasile’s house each night was an okada (motorbike)! There are no taxis or poda podas in Kenema so I no choice but to use them. (Note to my Mum - you’ll be pleased to know I borrowed Susan’s helmet and clearly have survived to tell the tale).
On the last evening we held a surprise birthday party for Susan (whose birthday is while she is home in the UK) and leaving party for Neil.
On the final day of the course we held sessions on how to implement ETAT in the participants’ respective work-places. This stimulated lively discussion and lots of good suggestions from all involved. Susan and Dickya are going to follow up the training now we are back in Freetown so I hope the momentum will continue to enable improvements in paediatric care in Kenema and Pujehan.
For the finale Dickya suggested using the word PIKIN (the Krio word for child) to stand for:
P – Participatory
I – Interesting
K – Knowledge-enriching
I – Interactive
N – Nourishing (not just intellectually but also physically with breakfast and lunch provided!)
We then pluralized it to make the word PIKINDEM (which means children) as it was time to move on from what we’ve learned by becoming:
DEVELOPED individually
EMPOWERED as a group and
MOTIVATED to make a difference.
I thought this really summed up the whole course and, along with a ceremony to give out certificates, was a great way to finish up a fun three days. Thank you so much to everyone in Kenema for your hospitality.
Saturday 9 July 2011
This is getting very addictive….
Time for a cheerier blog. I have been spending a lot of time visiting Mr Jalloh the tailor. I have some lovely new outfits and I am hoping there will be some photos. This is only a selection (and more currently being made)! Friday is Africana day here and everyone wears traditional outfits, like the long outfit I am wearing. One of the doctors commented that I often wear skirts I have had made here to work but that I should get a full outfit made to wear like everyone else. So I wore it to work on Friday – I think that I impressed the doctors, nurses and parents and even did the ward round in sweltering hot S-C-B-U.
How do you measure your day?
How do you measure how good, bad, successful or unsuccessful your day has been? It turns out that I now measure my day by whether I have electricity and running water, and whether (and how many) any babies or children have died.
Tuesday was possibly one of the worst days I have had here. Four babies died in S-C-B-U. Three within about half an hour of each other just after the ward round had finished and another one an hour or so later. And that was only while I was there; one had died in the early morning before I arrived and another died in the evening.
It was awful. I felt terrible. I kept questioning – what else should I have done? Should I have kept resuscitating for longer? Why did these babies die? Why all at the same time? On the same day? Why all this suffering? What else should I have done? Several nurses even said to me “Don’t look so upset Shona, it’s not your fault”. I know deep down it’s not my personal fault, but that doesn’t make me feel any better.
And if it feels like that for me, how does it feel for the nurses on the ward, who will have to keep going back to work day after day, year after year? The culture of death is different here (it’s very much part of life, and it’s always “God’s Will”) but it can’t help but affect you, watching so many children die.
And if it’s like that for health care workers, what is it like for the parents and families?
Everyone here knows the statistics of child mortality. I know that there are probably children dying in the hospital while I write this blog, while I’m asleep at night, while I’m on the beach or enjoying myself with friends. But those deaths won’t affect me in the same way, because I’m not there to witness them. And I am lucky that I am able to escape physically and mentally, that I am able to reflect on it, put it all away and move on so I can go back in the next day.
Many of my friends here have very frustrating jobs working in the slow moving Ministries of Health and Sanitation or various other organisations. I met a friend on Tuesday evening who was telling me about his unproductive day. He realised “I’m telling the wrong person.” I was glad however to escape my bad day to hear about his!
I also have a running joke with my husband about who “wins” for having the worst day. I teasingly tell him off for complaining about the bus running late or the coffee machine breaking. Clearly it’s all relative to the context and everyone is allowed to moan and to have a bad day. Clearly there are also many people who suffer greatly in the UK.
I’m sure it’s not normal to measure your day by how many children have died. That’s why I don’t mind hearing about other people’s little moans. I’m sure that when I go back to the UK I will still be impatient when I have to wait in a long queue (I can stand for ages here at the bank without batting an eyelid) or annoyed if something doesn’t go to plan. But I hope that when I am annoyed or frustrated with something trivial at home, I will be able to put those things into context. I will remember those babies and how I felt and how I imagine their families feel. I can’t imagine anything being worse than that.
(Thank you - to Fred for extricating me from S-C-B-U on Tuesday and taking me for lunch and for putting up with me not being very good company, to Becky for allowing me to vent on the way home, to Sandra for your kind words of support, to Dave and Laura for cheering me up at the beach and to Andy for virtual hugs and for reassuring me that the coffee machine is now working).
Tuesday was possibly one of the worst days I have had here. Four babies died in S-C-B-U. Three within about half an hour of each other just after the ward round had finished and another one an hour or so later. And that was only while I was there; one had died in the early morning before I arrived and another died in the evening.
It was awful. I felt terrible. I kept questioning – what else should I have done? Should I have kept resuscitating for longer? Why did these babies die? Why all at the same time? On the same day? Why all this suffering? What else should I have done? Several nurses even said to me “Don’t look so upset Shona, it’s not your fault”. I know deep down it’s not my personal fault, but that doesn’t make me feel any better.
And if it feels like that for me, how does it feel for the nurses on the ward, who will have to keep going back to work day after day, year after year? The culture of death is different here (it’s very much part of life, and it’s always “God’s Will”) but it can’t help but affect you, watching so many children die.
And if it’s like that for health care workers, what is it like for the parents and families?
Everyone here knows the statistics of child mortality. I know that there are probably children dying in the hospital while I write this blog, while I’m asleep at night, while I’m on the beach or enjoying myself with friends. But those deaths won’t affect me in the same way, because I’m not there to witness them. And I am lucky that I am able to escape physically and mentally, that I am able to reflect on it, put it all away and move on so I can go back in the next day.
Many of my friends here have very frustrating jobs working in the slow moving Ministries of Health and Sanitation or various other organisations. I met a friend on Tuesday evening who was telling me about his unproductive day. He realised “I’m telling the wrong person.” I was glad however to escape my bad day to hear about his!
I also have a running joke with my husband about who “wins” for having the worst day. I teasingly tell him off for complaining about the bus running late or the coffee machine breaking. Clearly it’s all relative to the context and everyone is allowed to moan and to have a bad day. Clearly there are also many people who suffer greatly in the UK.
I’m sure it’s not normal to measure your day by how many children have died. That’s why I don’t mind hearing about other people’s little moans. I’m sure that when I go back to the UK I will still be impatient when I have to wait in a long queue (I can stand for ages here at the bank without batting an eyelid) or annoyed if something doesn’t go to plan. But I hope that when I am annoyed or frustrated with something trivial at home, I will be able to put those things into context. I will remember those babies and how I felt and how I imagine their families feel. I can’t imagine anything being worse than that.
(Thank you - to Fred for extricating me from S-C-B-U on Tuesday and taking me for lunch and for putting up with me not being very good company, to Becky for allowing me to vent on the way home, to Sandra for your kind words of support, to Dave and Laura for cheering me up at the beach and to Andy for virtual hugs and for reassuring me that the coffee machine is now working).
Saturday 2 July 2011
Thursday
Thursday was a bizarre day, full of contrasts. Here’s what I did:
I went to the S-C-B-U in the morning ready to start the ward round. I saw a couple of babies with one of the nurses before the entourage of medical and nursing students arrived. The patients were both very sick. S-C-B-U is bursting at the seams at the moment. The babies are literally squeezed in next to each other. One of the sickest patients arrested and died. Not much fun trying to resuscitate one moribund baby while trying to stretch across another one. If anyone ever tells me in the future that the JR NICU has no space I might scream at them. I spoke briefly with the relatives of the baby who died, and then had to carry on with the ward round. (I’m still not quite sure how I do this, and believe me, it is very strange. I always wish I could just take a few minutes to be by myself after a baby dies).
I saw a set of beautiful preterm twins (I think about 32 weeks but not certain) with their mother and both grandmothers. Twin 2 doing well, Twin 1 (the little one, about 1kg) not so well. I saw about six other patients in a space the size of a cupboard. Complete with entourage of medical and nursing students. More reviewing of patients and I finished the ward round (feeling a bit faint – it is soooo hot in S-C-B-U), and went to the lab to chase up some results (we did seven lumbar punctures on Tuesday!)They weren’t ready yet.
I spoke with one of the TFC nurses as I crossed the car park – she is a relative of Baby Number Three from last week’s blog. He died the night after I wrote my blog. I said “Oshya”.
I saw a few out-patients. I admitted one of them (try not to admit if at all possible – there’s so little space and I’m so worried they’ll get a hospital acquired infection).
I went to meet Sandra, Fred, Becky and Matt (the Welbodi team) for lunch outside. Egg sandwich today (wrapped in newspaper; usually the sandwiches are wrapped in confidential letters from some Ministry or other or research questionnaires (which have been filled in) or invoices, or children’s maths books or some other interesting thing) followed by some fried chicken as I was still hungry.
I was just finishing my chicken when my phone rang – “Dr Shona, emergency in S-C-B-U” was all I heard. Despite me telling the nurses they can call me or the medical officer if there is a problem, they have never called me before! I ran off to find that Twin 1 had arrested. We tried resuscitating but to no avail. She died. I was very sad. I’m still wondering what else I could or should have done for that baby. But I was inspired by the courage of her family, who said they now needed to concentrate on Twin 1 and thanked me for everything we had tried to do.
I saw the remaining sickest patient again. He had grade 3 hypoxic ischaemic encephalopathy and was aspirating his secretions. Not a lot I could do for him more than oxygen, IV fluids and antibiotics. Even the suction is broken. I spoke with his auntie and his father so they understood how sick he was.
In the afternoon one of the other VSO doctors Ginny had organised a party for the patients and staff in the room where ICU and ER were (they’ve moved to a new location last month). A brass band from the Ballanta Music School held a concert (their opening song was Michael Jackson’s “Heal the World” – strange choice I thought, a bit incongruous! – but they were very good). It was Rafael’s birthday so we all sung “Happy Birthday” to him. Then there was a DJ, playing all the Salonean favourites. Everyone was up dancing, enjoying themselves, nurses, doctors, patients, the little kids who live on the hospital compound. I have so many memories of being in that room, where so many children died, with so much suffering. It was a very strange feeling, dancing with my colleagues and having fun, while reflecting on all those memories. And knowing that so many families are still suffering.
I spent the afternoon going back and forth between the party and S-C-B-U, amazed at the contrast between the two. I often marvel at the contrasts in this country, between the incredible poverty and the incredible beauty of the beaches. Never have a felt it as acutely as Thursday. However, the doctors and nurses deserve to have some fun once in a while so I danced along with them.
I went to the tailor to pick up some more dresses – unfortunately he hadn’t quite finished them but we checked how they fit and I dropped off some more material to get (yet) another outfit made. I walked home as it was starting to rain.
Carole came around for a drink – we sat on the balcony looking at the beautiful view drinking Real Red Wine (courtesy of Carole) and biscuits and cheese (courtesy of Cat).
We went to Independence Beach Bar for drinks and dinner for Rafael’s birthday. It was POURING with rain and we all got drenched running from Carole’s car into the bar. I never quite dried out again. I was so cold (strange being cold in SL!) after I got wet that I had to borrow a jumper! Unfortunately the barbeque went out in the rain so we had to wait two hours for dinner – although it was worth the wait. I was still cold and wet when we got home and even wore a jumper and wrapped myself in a big towel to go to bed!
A day of contrasts indeed.
I went to the S-C-B-U in the morning ready to start the ward round. I saw a couple of babies with one of the nurses before the entourage of medical and nursing students arrived. The patients were both very sick. S-C-B-U is bursting at the seams at the moment. The babies are literally squeezed in next to each other. One of the sickest patients arrested and died. Not much fun trying to resuscitate one moribund baby while trying to stretch across another one. If anyone ever tells me in the future that the JR NICU has no space I might scream at them. I spoke briefly with the relatives of the baby who died, and then had to carry on with the ward round. (I’m still not quite sure how I do this, and believe me, it is very strange. I always wish I could just take a few minutes to be by myself after a baby dies).
I saw a set of beautiful preterm twins (I think about 32 weeks but not certain) with their mother and both grandmothers. Twin 2 doing well, Twin 1 (the little one, about 1kg) not so well. I saw about six other patients in a space the size of a cupboard. Complete with entourage of medical and nursing students. More reviewing of patients and I finished the ward round (feeling a bit faint – it is soooo hot in S-C-B-U), and went to the lab to chase up some results (we did seven lumbar punctures on Tuesday!)They weren’t ready yet.
I spoke with one of the TFC nurses as I crossed the car park – she is a relative of Baby Number Three from last week’s blog. He died the night after I wrote my blog. I said “Oshya”.
I saw a few out-patients. I admitted one of them (try not to admit if at all possible – there’s so little space and I’m so worried they’ll get a hospital acquired infection).
I went to meet Sandra, Fred, Becky and Matt (the Welbodi team) for lunch outside. Egg sandwich today (wrapped in newspaper; usually the sandwiches are wrapped in confidential letters from some Ministry or other or research questionnaires (which have been filled in) or invoices, or children’s maths books or some other interesting thing) followed by some fried chicken as I was still hungry.
I was just finishing my chicken when my phone rang – “Dr Shona, emergency in S-C-B-U” was all I heard. Despite me telling the nurses they can call me or the medical officer if there is a problem, they have never called me before! I ran off to find that Twin 1 had arrested. We tried resuscitating but to no avail. She died. I was very sad. I’m still wondering what else I could or should have done for that baby. But I was inspired by the courage of her family, who said they now needed to concentrate on Twin 1 and thanked me for everything we had tried to do.
I saw the remaining sickest patient again. He had grade 3 hypoxic ischaemic encephalopathy and was aspirating his secretions. Not a lot I could do for him more than oxygen, IV fluids and antibiotics. Even the suction is broken. I spoke with his auntie and his father so they understood how sick he was.
In the afternoon one of the other VSO doctors Ginny had organised a party for the patients and staff in the room where ICU and ER were (they’ve moved to a new location last month). A brass band from the Ballanta Music School held a concert (their opening song was Michael Jackson’s “Heal the World” – strange choice I thought, a bit incongruous! – but they were very good). It was Rafael’s birthday so we all sung “Happy Birthday” to him. Then there was a DJ, playing all the Salonean favourites. Everyone was up dancing, enjoying themselves, nurses, doctors, patients, the little kids who live on the hospital compound. I have so many memories of being in that room, where so many children died, with so much suffering. It was a very strange feeling, dancing with my colleagues and having fun, while reflecting on all those memories. And knowing that so many families are still suffering.
I spent the afternoon going back and forth between the party and S-C-B-U, amazed at the contrast between the two. I often marvel at the contrasts in this country, between the incredible poverty and the incredible beauty of the beaches. Never have a felt it as acutely as Thursday. However, the doctors and nurses deserve to have some fun once in a while so I danced along with them.
I went to the tailor to pick up some more dresses – unfortunately he hadn’t quite finished them but we checked how they fit and I dropped off some more material to get (yet) another outfit made. I walked home as it was starting to rain.
Carole came around for a drink – we sat on the balcony looking at the beautiful view drinking Real Red Wine (courtesy of Carole) and biscuits and cheese (courtesy of Cat).
We went to Independence Beach Bar for drinks and dinner for Rafael’s birthday. It was POURING with rain and we all got drenched running from Carole’s car into the bar. I never quite dried out again. I was so cold (strange being cold in SL!) after I got wet that I had to borrow a jumper! Unfortunately the barbeque went out in the rain so we had to wait two hours for dinner – although it was worth the wait. I was still cold and wet when we got home and even wore a jumper and wrapped myself in a big towel to go to bed!
A day of contrasts indeed.
The Lab
I have got to dedicate a blog to the boys and girl who work in the lab at the hospital. We have a semi-functioning lab. And it’s got much much better in the time that I’ve been here. The list of tests we can request are as follows: haemoglobin, PCV, white blood cell count and differential, malaria rapid test and malaria smears, WIDAL (the most unspecific and insensitive test for typhoid), urinalysis and microscopy, stool microscopy, sickling test, HIV antibody test, Hepatitis B surface antigen, CSF microscopy (but only a white blood cell count and gram stain – no red cell count or culture!) and they have recently started doing protein, albumin and bilirubin.
The lab staff are also the phlebotomists (they take the children’s blood). They (usually) know the meaning of urgent - Joseph particularly is brilliant at running straight to the ward to take urgent bloods when I ask. I can request a haemoglobin and get a result back less than 30 minutes. On the other hand – a bilirubin (which neonatal SHO’s in the UK can do in a matter of minutes) takes a full day…. I’m always just a bit dubious about quality control too - I’ve never yet seen an abnormal white blood cell count!
The staff are unfailingly keen, friendly and helpful. I am usually in the lab at least once a day to chase up results and (although they don’t always find said results…) they really try hard to help me. They don’t let me speak English when I go to ask them anything, so they have taught me loads of Krio too.
To the boys and girl in the lab; thanks for your help and keep up your smiles, enthusiasm and good work!
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