I’ve struggled to know how to finish my blog. I guess I don’t like to think of it as being “finished”, because even though I have left Sierra Leone, I know that life and work carry on, both for my colleagues and patients in Freetown and for me in Oxford. I’ve been home for five months now. I’m back working in the neonatal unit in Oxford. What has changed for me? What words can I use to sum up my time in Sierra Leone and the effect it had on me?
There is a lot I miss about Sierra Leone: the fantastic fresh fruit (especially mangoes!), the Atlantic barracuda and lobster, the Bounty Beaches, the heat, Krio, the crazy public transport system, my friends and colleagues.
There’s a lot I’m very grateful for back at home. I’m thankful for the things I’m privileged to have and to be able to do. I’m extremely happy to be back with my husband. To turn on the tap and have water come out. To have a hot shower in the morning. To know the lights will always turn on. I’m also getting very used to having these creature comforts again! I’m also privileged to have had the time I did in Sierra Leone, to have done something, however small for Salone and its children, and to learn so much from them.
I’ve had some hard and very busy shifts in the neonatal unit since I’ve been back. But nothing on the scale of a bad day in Freetown. It seems that I do still measure my day by whether any babies have died.
I sometimes look around the neonatal intensive care unit and think, “Not one of these babies would survive in Sierra Leone”. I have at times found it ethically challenging – in much the same way I did in SL – thinking, how long should we keep going, keep trying to save these extremely preterm babies, and to what kind of life? Mostly however I feel extremely pleased we are able to offer the care we can, and hope that the families have some idea of how lucky they are.
I’ve apparently become something of a VSO cover girl! I haven’t seen myself on TV yet although people do keep telling me they’ve seen the advert. I have however, seen it on YouTube. It’s nice being an advocate for SL and is a lovely reminder for me of the good things that I did.
I have done a few talks for colleagues here about my experiences. I have found it wonderfully therapeutic to have uninterrupted time to talk about it, to a captive audience. Once I start, it’s hard to shut me up! Sometimes it’s hard to explain how I felt at times – to attempt to do this I’ve read out some of the more harrowing of my blogs. Seeing children dying every day was the most difficult thing for me in Sierra Leone and I sorted out some of that in my head through those blogs. Still, it’s something I always found it difficult to come to terms with.
My auntie, a minister, sent me this poem. It has helped me make some sense of the suffering I witnessed, and continues to encourage me day by day.
Into the freedom of wind and sunshine we let you go;
Into the dance of the stars and planets we let you go;
Into the wind’s breath and the hands of the starmaker, we let you go.
We love you, we will always miss you, we want you to be happy and feel you want us to be happy again.
The End
PS. To the amazing people I met and worked with in SL, some of the most inspiring people I have met in my life: I miss you all and I hope to visit you again someday soon. Thank you for all your support in SL. Tenki yah.
Wednesday, 11 January 2012
Sunday, 7 August 2011
Highlights of the Year
Some of my favourite memories from my time in Sierra Leone….
1) Decompressing a tension pneumothorax.
2) Seeing that little boy come back to see me and say thank you.
3) Anytime a mother or father said “I tell God tenki” to me.
4) My birthday – lots of singing “Happy Birthday”, a happy day at hospital, fish carpaccio, red wine and an amazing chocolate cake!
5) Seeing the little girl with pneumococcal meningitis alive and well.
6) Jumping into the IMATT pool at the Royal Wedding Party.
7) Winning the money tree at the IMATT Christmas party.
8) Rugby afternoons with Freya and the IMATT crew.
9) Listening to the beautiful singing of the choir from Wells Cathedral School.
10) Meeting Andy from the Pelican and generally the whole time Andy was here.
11) Getting lost up Sugar Loaf Mountain.
12) Mum and Dad’s visit, especially The Burn’s Supper at IMATT, Banana Island and visiting Connie and Lavan in Kabala.
13) Seeing Andy at Heathrow airport.
14) The Mercy Ship Anaesthetists’ Conference.
15) Being at the Stadium on Independence Day.
16) Seeing Andy whenever Skype video worked (which is not very often!)
17) Seeing a little boy with an empyema coming back for follow-up.
18) Sunsets, great company and fabulous food at Hamilton and Tokeh beaches.
19) Being at Tacugama and Hamilton with Selena.
20) Occasional afternoons when it was quiet enough at the hospital to have fun gossiping with the nurses.
21) Receiving news from home that best friends had had their babies.
22) Seeing the father of a patient with Down Syndrome who came to thank me for putting them in touch with an occupational therapist.
23) Being recognised by various patients’ mothers whilst out and about in Freetown, and them thanking me again for helping their children, including the mother of a child who died who I met at Congo Cross and wanted to say thanks for everything I tried to do.
24) Any time we got running water again after being without it.
25) Dancing with friends to Salonean music including Waka Waka Baby and I love my life.
26) Finding out that Susan one of the other VSOs used to work with my Dad in Shetland!
27) The bizarre party at the hospital – dancing with the nurses, doctors, patients and little kids who live under the stairs at the hospital.
28) ETATing in Kenema
29) The Welbodi Quiz at IMATT
30) My last visit to Hamilton eating yummy lobster in the sun (during rainy season).
1) Decompressing a tension pneumothorax.
2) Seeing that little boy come back to see me and say thank you.
3) Anytime a mother or father said “I tell God tenki” to me.
4) My birthday – lots of singing “Happy Birthday”, a happy day at hospital, fish carpaccio, red wine and an amazing chocolate cake!
5) Seeing the little girl with pneumococcal meningitis alive and well.
6) Jumping into the IMATT pool at the Royal Wedding Party.
7) Winning the money tree at the IMATT Christmas party.
8) Rugby afternoons with Freya and the IMATT crew.
9) Listening to the beautiful singing of the choir from Wells Cathedral School.
10) Meeting Andy from the Pelican and generally the whole time Andy was here.
11) Getting lost up Sugar Loaf Mountain.
12) Mum and Dad’s visit, especially The Burn’s Supper at IMATT, Banana Island and visiting Connie and Lavan in Kabala.
13) Seeing Andy at Heathrow airport.
14) The Mercy Ship Anaesthetists’ Conference.
15) Being at the Stadium on Independence Day.
16) Seeing Andy whenever Skype video worked (which is not very often!)
17) Seeing a little boy with an empyema coming back for follow-up.
18) Sunsets, great company and fabulous food at Hamilton and Tokeh beaches.
19) Being at Tacugama and Hamilton with Selena.
20) Occasional afternoons when it was quiet enough at the hospital to have fun gossiping with the nurses.
21) Receiving news from home that best friends had had their babies.
22) Seeing the father of a patient with Down Syndrome who came to thank me for putting them in touch with an occupational therapist.
23) Being recognised by various patients’ mothers whilst out and about in Freetown, and them thanking me again for helping their children, including the mother of a child who died who I met at Congo Cross and wanted to say thanks for everything I tried to do.
24) Any time we got running water again after being without it.
25) Dancing with friends to Salonean music including Waka Waka Baby and I love my life.
26) Finding out that Susan one of the other VSOs used to work with my Dad in Shetland!
27) The bizarre party at the hospital – dancing with the nurses, doctors, patients and little kids who live under the stairs at the hospital.
28) ETATing in Kenema
29) The Welbodi Quiz at IMATT
30) My last visit to Hamilton eating yummy lobster in the sun (during rainy season).
How I Survived
1) With the support of my wonderful husband.
2) With internet access and mobile phone to be able to contact him.
3) Regular emails, facebook messages, thoughts and prayers from great friends and family at home.
4) My great little Welsh flatmate Cat who keeps me sane.
5) Carole, who explained how to get anything done in this country! And who also keeps me sane and gives out great advice.
6) New friends for life who have supported me emotionally through some incredibly tough times here; I am forever indebted to you all and thank you from the bottom of my heart for your friendship – and for putting up with me!
7) By taking malaria prophylaxis and sleeping under a mosquito net.
8) Wonderful visitors – Andy, Mum and Dad and Selena – thank you so much for coming to see me – it has meant so much that you know first hand what I’m talking about!
9) By the Grace of God. I once asked Sandra how she had managed to stay here and keep going for so long, and this was the answer she gave me.
10) The monthly service at International Church – a time for prayer, thought, and reflection (and great buffet bring and share dinner).
11) A bit of escapism - Bliss brunches, beautiful beaches, the UN pool Mamba Point dinners, nights out with friends.
12) By always retaining that bit of hope for the future of the children of Salone.
13) A few creature comforts from home – Earl Grey tea, pesto, the occasional bits of real cheese and chocolate which visitors brought out.
14) A lot of peanut butter.
15) IMATT. The wonderful hospitality at various parties, dinners and rugby games, military chat, great showers and just knowing they were there in times of need (oh and that swimming pool!)
16) Joe our fantastic neighbour who is always there to help with getting water, sorting out our electricity, being an excellent security guard (along with dog Tiger) and friend.
17) By going home for a break in April. I was cracking up a bit in March and was very very grateful for the break.
18) By knowing that I would be able to go home, to my wonderful husband, at the end of the year.
2) With internet access and mobile phone to be able to contact him.
3) Regular emails, facebook messages, thoughts and prayers from great friends and family at home.
4) My great little Welsh flatmate Cat who keeps me sane.
5) Carole, who explained how to get anything done in this country! And who also keeps me sane and gives out great advice.
6) New friends for life who have supported me emotionally through some incredibly tough times here; I am forever indebted to you all and thank you from the bottom of my heart for your friendship – and for putting up with me!
7) By taking malaria prophylaxis and sleeping under a mosquito net.
8) Wonderful visitors – Andy, Mum and Dad and Selena – thank you so much for coming to see me – it has meant so much that you know first hand what I’m talking about!
9) By the Grace of God. I once asked Sandra how she had managed to stay here and keep going for so long, and this was the answer she gave me.
10) The monthly service at International Church – a time for prayer, thought, and reflection (and great buffet bring and share dinner).
11) A bit of escapism - Bliss brunches, beautiful beaches, the UN pool Mamba Point dinners, nights out with friends.
12) By always retaining that bit of hope for the future of the children of Salone.
13) A few creature comforts from home – Earl Grey tea, pesto, the occasional bits of real cheese and chocolate which visitors brought out.
14) A lot of peanut butter.
15) IMATT. The wonderful hospitality at various parties, dinners and rugby games, military chat, great showers and just knowing they were there in times of need (oh and that swimming pool!)
16) Joe our fantastic neighbour who is always there to help with getting water, sorting out our electricity, being an excellent security guard (along with dog Tiger) and friend.
17) By going home for a break in April. I was cracking up a bit in March and was very very grateful for the break.
18) By knowing that I would be able to go home, to my wonderful husband, at the end of the year.
Saturday, 6 August 2011
What Have I Achieved?
That’s it. I don don. I finished my placement at Ola During Children’s Hospital yesterday. When I was interviewed for the BBC by Fergus Walsh he asked what my legacy would be when I left Sierra Leone. I gave him a very blank look before answering. This, of course is the question which I have been asking myself all year. What have I been doing here? What have I achieved?
I can write a long list of patients I have treated, families I have spoken with, students I have taught, doctors and nurses I have worked with, health care workers I have trained in triage, nurse anaesthetists I have trained in neonatal resuscitation, audits I have completed and meetings I have attended.
These are of course quite personal achievements for me, things that I have done (and in NGO speak – would probably count more as “activities” than “outputs” or “achievements”). So perhaps it is better to ask what has changed at the hospital in the time I have been there.
On a day-to-day basis it is very difficult to see change. Especially with daily frustrations of staff coming to work late or not at all, patients presenting very late, babies being brought to S-C-B-U hours after they were born, the incredibly annoying pharmacy system (you have to re-prescribe all medications every day; it’s the bane of my life and the biggest waste of time), patients not receiving their medications, babies not being fed, patients not having regular observations, patients not being reviewed and asking people to do things again and again and again (only to find later it is not done).
However, over the time I have been here, I think that standards have improved. “Small small” as we say in Krio. Some (subjective) examples: many nurses are incredibly hard working, motivated and eager to learn. More children are receiving more of their medications. Observations are taken more regularly. The lab has certainly improved. The doctors are holding (more or less) regular morbidity and mortality meetings and other educational meetings. A perinatal meeting with the midwives has started. Children are prescribed quinine three times a day instead of twice a day. Standards of history taking and documentation are better. The under-5s clinic is now triaging their patients so the sickest children are seen first and transferred to hospital as soon as possible. ICU and ER have moved to a new location and there are now saturations monitors for children in ICU. There is more oxygen available for children in respiratory distress. There is running water more regularly (not all the time though!) Clearly there’s still a lot to do, but one step at a time.
(NB. Most of these changes have nothing to do with me being here but as a result of lots of people working together).
In reality I have not achieved very much in terms of change that can be measured. The mortality rate in the hospital is the same as when I arrived. It takes longer than a year and more than one person to make that sort of change.
So what did I say to Fergus Walsh? What is my personal “legacy?” The answer I gave him was the work I have done with the medical students. Twenty seven medical students who I have helped to train in paediatrics. They will graduate next year and become house officers here in Sierra Leone, rotating through the Children’s Hospital. Hopefully some of them will decide to become paediatricians, and to stay in Sierra Leone, and to share some of the skills I have taught them with others.
I can write a long list of patients I have treated, families I have spoken with, students I have taught, doctors and nurses I have worked with, health care workers I have trained in triage, nurse anaesthetists I have trained in neonatal resuscitation, audits I have completed and meetings I have attended.
These are of course quite personal achievements for me, things that I have done (and in NGO speak – would probably count more as “activities” than “outputs” or “achievements”). So perhaps it is better to ask what has changed at the hospital in the time I have been there.
On a day-to-day basis it is very difficult to see change. Especially with daily frustrations of staff coming to work late or not at all, patients presenting very late, babies being brought to S-C-B-U hours after they were born, the incredibly annoying pharmacy system (you have to re-prescribe all medications every day; it’s the bane of my life and the biggest waste of time), patients not receiving their medications, babies not being fed, patients not having regular observations, patients not being reviewed and asking people to do things again and again and again (only to find later it is not done).
However, over the time I have been here, I think that standards have improved. “Small small” as we say in Krio. Some (subjective) examples: many nurses are incredibly hard working, motivated and eager to learn. More children are receiving more of their medications. Observations are taken more regularly. The lab has certainly improved. The doctors are holding (more or less) regular morbidity and mortality meetings and other educational meetings. A perinatal meeting with the midwives has started. Children are prescribed quinine three times a day instead of twice a day. Standards of history taking and documentation are better. The under-5s clinic is now triaging their patients so the sickest children are seen first and transferred to hospital as soon as possible. ICU and ER have moved to a new location and there are now saturations monitors for children in ICU. There is more oxygen available for children in respiratory distress. There is running water more regularly (not all the time though!) Clearly there’s still a lot to do, but one step at a time.
(NB. Most of these changes have nothing to do with me being here but as a result of lots of people working together).
In reality I have not achieved very much in terms of change that can be measured. The mortality rate in the hospital is the same as when I arrived. It takes longer than a year and more than one person to make that sort of change.
So what did I say to Fergus Walsh? What is my personal “legacy?” The answer I gave him was the work I have done with the medical students. Twenty seven medical students who I have helped to train in paediatrics. They will graduate next year and become house officers here in Sierra Leone, rotating through the Children’s Hospital. Hopefully some of them will decide to become paediatricians, and to stay in Sierra Leone, and to share some of the skills I have taught them with others.
Thursday, 4 August 2011
Things that have changed about me this year
1) I am more tanned than I have ever been in my life.
2) I have learned to be incredibly patient, but also how to be angry.
3) I have become a lot more sceptical about aid – that’s not to say I don’t agree with it (clearly I wouldn’t be here, nor on the BBC website, if didn’t agree with it!); just that I have learned to question how it is given, how it is implemented and what is actually achieved.
4) I have found that I really enjoy writing my blog!
5) I have learned a LOT about my own limitations, and the limitations of medical science.
6) I am very appreciative of simple things: running water, electricity, time, friends, family, health, laughter, hugs.
7) I hardly ever wear any make-up any more. (I am fairly sure this will change back as soon as I get back to Oxford though!)
8) I am better at coping when things don’t go quite to plan.
9) I am not fazed in the slightest when the electricity goes off.
10) I don’t allow myself to become frustrated at the slow internet.
11) I am much better at coping when the water goes off.
12) I now like drinking beer (but only Star).
13) I have accepted what I cannot change.
2) I have learned to be incredibly patient, but also how to be angry.
3) I have become a lot more sceptical about aid – that’s not to say I don’t agree with it (clearly I wouldn’t be here, nor on the BBC website, if didn’t agree with it!); just that I have learned to question how it is given, how it is implemented and what is actually achieved.
4) I have found that I really enjoy writing my blog!
5) I have learned a LOT about my own limitations, and the limitations of medical science.
6) I am very appreciative of simple things: running water, electricity, time, friends, family, health, laughter, hugs.
7) I hardly ever wear any make-up any more. (I am fairly sure this will change back as soon as I get back to Oxford though!)
8) I am better at coping when things don’t go quite to plan.
9) I am not fazed in the slightest when the electricity goes off.
10) I don’t allow myself to become frustrated at the slow internet.
11) I am much better at coping when the water goes off.
12) I now like drinking beer (but only Star).
13) I have accepted what I cannot change.
Blood Donation Mark Three
It’s been nearly four months since Sandra and I last went to give blood on Easter Friday. I really wanted to give blood again before I leave Sierra Leone (it’s on “The List”), so yesterday Becky and I headed to the blood bank to donate. Sandra is away and we missed you! My Hb was 11.4g/dl (theoretically a bit low to give) but I persuaded Omar to let me donate anyway (something tells me it might be a very long time before I can donate again in the UK). More pictures hopefully attached!
Sunday, 31 July 2011
A Grand Day Out
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.
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.
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