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.
Tuesday, 3 May 2011
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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