…At least not in Freetown. We’re a balmy 31oC when I’m told that Elgin in Scotland was -18oC last night. I now have an office at work. It comes with an air-conditioning unit (who paid for this I wonder? And why? Why did they not put the money into something more useful like another doctor or nurse?). Anyway, its there, so on it went. I have acclimatised enough to feel cold when it is set at 27oC…. So not sure how I would fare in the UK just now!
Apparently it’s Christmas in 3 days time. It seems to have bypassed me a bit this year. Mostly because I have already had my holidays so am now back to work. Also – its just strange being warm at Christmas. There are a few decorations about but they look decidedly out of place. The hospital’s actually pretty quiet just now – although this is a relative term (I am told that parents keep their children at home at Christmas time even longer than usual – which is saying something). Strange thinking back to this time last year when I was an Acute Reg in the JRH looking after all those bronch babies! There are actually babies with bronchiolitis here – its just that they get treated as pneumonia (i.e. with antibiotics) because according to the WHO cough + fever + tachypnoea = pneumonia. Dr Hull would not be happy. Hopefully happier to know that I go around crossing off all the steroids prescribed for them….!
I am having a happier week than some weeks. None of the children I am actively looking after have died so far. Even the boy who has been unconscious with cerebral malaria for 4 days is still alive at the moment (although clearly it will take a small miracle for him to survive). I’ve even helped to make a few patients better – if the child is better the Mums say “I tell God tenki” which means “Thanks be to God” which is so lovely to hear.
Many thanks for all your Christmas wishes. Mum told me this evening that lots of people have sent cards. Many thanks for these in advance. Unfortunately none of them have arrived! I’ll keep you posted when they do! I’m actually spending Christmas Day on the beach – hopefully having lobster for dinner!
So, from warm and sunny Freetown, I wish you all a very Happy Christmas and all the very best wishes for the New Year!
Wednesday, 22 December 2010
Monday, 20 December 2010
Sunday, 19 December 2010
Holidays!
I’ve had a brilliant and perfect two weeks as Andy came to visit SL (and me, obviously!) I took the two weeks off work so we could spend time together, relax and see a bit more of the country.
As my facebook status said, I could have burst with excitement before he arrived! The plane was delayed unfortunately but everything else went to plan and I met him at the Pelican Water Taxi. He had brought lots of presents – contact lens solution, shampoo, conditioner, shower gel, dried herbs including basil (which you can’t get here), Worcester sauce (which you can, but is really expensive), some DVDs and nice mail and photos from people at home. Many thanks for all your gifts.
We spent the first couple of days relaxing around Freetown – visiting Lumley Beach, Big Market and other sights in the centre of town, and had some fun introducing Andy to the “interesting” public transport system here (see previous blog entries for details on this). We also got to do some fun things for me like eating out in Crown Bakery (choc croissants!) and dinner at Country Lodge (real red wine!)
Tacugama Chimpanzee Sanctuary
We stayed the night at Tacugama, in their beautiful, and romantic treehouse. It also had the advantage (for Andy) of being relatively cool. I even had to have a blanket in bed for the first time in months! Whilst there, we did a couple of walks, including to Charlotte Falls, and of course, the tour of the chimp sanctuary! It was set up 15 years ago, mainly to rescue chimps which had been used as pets; the aim being, eventually, to integrate them back into a normal chimp family. There are currently about 100 chimps in the sanctuary, in different enclosures depending on how well integrated they are. They are amazingly human-like (although much better at acrobatics than us!) and I could have watched them all day. We had a lovely evening eating a Basha chicken with rice and veg on the balcony with a half bottle of wine that Andy got from the plane.
The Hospital
I wanted Andy to see the hospital so he can picture it when I am chatting about it. We had to actually get there first! I decided it would be easier to walk from the town centre than try to get a very slow moving taxi or poda poda there so we walked through the crazy mad streets of PZ in the East End of town, opted to take the slightly longer route of Kissy Road (as it has, at least by some definition of the word, pavements! Unlike Fourah Bay Road, which has sewers where you would expect the pavements to be) and finally arrived at the hospital. I showed Andy around, introducing him to the staff while he snapped away taking photos for me. Everyone was so nice and welcoming to him and were delighted that he was visiting.
It was also Meike and Nadine’s last day at work so we went to their leaving party, held in the library. We started with Christian and Muslim prayers, then everyone feasted on cassava leave with rice and washed it down with a Fanta. Lots of snapping of photos later, then we all piled into the Cap Anamur Land Cruiser for the journey home.
Sugar Loaf Mountain
So, the adventure up the mountain. I fear that I have now had so many adventures up mountains (I’m thinking Mt Mulanje, the volcano Pacaya, Ben Lomond, only to name a few Ros!) that maybe I should stop having adventures up mountains!
I had organised for a large group of us (first two mistakes – don’t have too big a group, and don’t actually organise anything or its bound to go wrong!) to climb Sugar Loaf. Unfortunately we sort of went up the wrong path (is this sounding familiar to anyone Ros?!) and ended up bashing through the bush to actually find the correct path. By this time we had been climbing for three solid hours. So while Beth, Tash, Alex, Ollie and Marcus continued up the hill, Andy and I made the executive decision to take the all the stragglers back down to the cars. A wise decision I think as everyone made it back down safely with no broken ankles or hypothermia (not that that would really be possible here) or dehydration. And we were back in time for a brilliant Mamba Point Lunch.
Hamilton BeachAndy and I had a lovely few hours at Hamilton Beach, where on the 12th December, we sat out in the sun, swum in the Atlantic Ocean and ate fresh barracuda grilled to order on the barbeque. Andy alas got burned (sorry – I take the blame for the areas of missed sunscreen!) but we got some good photos of the pair of us for Christmas cards at home which Andy has been organising.
Tiwai Island
Following an interesting journey to get there (our hired landrover broke down and we became a tourist attraction for the kids in a small village for about 4 hours, before our driver realised – having sent a mechanic off to Bo with Le100,000 of his own money – that he could drive it in 4 wheel drive, so we carried on again – which must have looked truly bizarre to the children in the village) we finally arrived quite late at Tiwai. Its in a really beautiful spot, very jungley (actually I don’t think that’s a word, but you know what I mean). We stayed in a ready-pitched tent complete with a mattress inside – fairly luxury for camping if you ask me. There was even a working shower (although it was “dribbly” as Andy described it).
We woke early the next morning for the forest walk before breakfast. Expecting this to last about an hour, we were back for breakfast a full two and a half hours later! On the walk we were able to see three different kinds of monkeys, and a huge variety of flora which our guide expertly pointed out. Tiwai is “famous” for having pygmy hippos. They are very shy, only come out a night, and although I believe there are two in London Zoo, they are indigenous only to Sierra Leone, Guinea, Liberia and the Ivory Coast (all the top tourist destinations of West Africa then. I’m kidding obviously.) Alas we didn’t see any.
In the afternoon we had a great boat trip up the river, spotted some birds, some more monkeys, and marvelled at our guide’s command of both English and the Latin names for various trees and plants, especially as he had never been to school.
Dinner was served at a remarkably early 4.30pm (we managed to stave off till 5pm!) so then had an early night before the long (and thankfully less eventful) trip back home.
IMATT
Wonderful IMATT! I have such a lovely time whenever I go there. The one RAF officer there invited us up for dinner so he could get some air force chat. He and his wife were so incredibly hospitable; we had a wonderful meal and great company, as Frankie and Howard (ex-VSOs who stayed on) had also joined us, along with the IMATT doctor and another army officer, who, bizarrely has a cousin from Shetland who I know! It was a really great evening and was a bit like being transported back to the UK (they have a bath! With hot and cold running water!)
Back to Reality
So Andy’s just gone – he did get back by the skin of his teeth though. All the flights home since Friday have been cancelled as Heathrow is closed. So there are a number of stranded VSOs who were looking forward to going home for Christmas. Keep your fingers crossed for them that they manage to get back and enjoy time with their loved ones too. Back to beans and rice for dinner for me. Back to work tomorrow. Back to the daily challenge of getting to and from work. Back to the dying babies. Hopefully also, back to making some of them better, and training the nurses and doctors here to do the same.
As my facebook status said, I could have burst with excitement before he arrived! The plane was delayed unfortunately but everything else went to plan and I met him at the Pelican Water Taxi. He had brought lots of presents – contact lens solution, shampoo, conditioner, shower gel, dried herbs including basil (which you can’t get here), Worcester sauce (which you can, but is really expensive), some DVDs and nice mail and photos from people at home. Many thanks for all your gifts.
We spent the first couple of days relaxing around Freetown – visiting Lumley Beach, Big Market and other sights in the centre of town, and had some fun introducing Andy to the “interesting” public transport system here (see previous blog entries for details on this). We also got to do some fun things for me like eating out in Crown Bakery (choc croissants!) and dinner at Country Lodge (real red wine!)
Tacugama Chimpanzee Sanctuary
We stayed the night at Tacugama, in their beautiful, and romantic treehouse. It also had the advantage (for Andy) of being relatively cool. I even had to have a blanket in bed for the first time in months! Whilst there, we did a couple of walks, including to Charlotte Falls, and of course, the tour of the chimp sanctuary! It was set up 15 years ago, mainly to rescue chimps which had been used as pets; the aim being, eventually, to integrate them back into a normal chimp family. There are currently about 100 chimps in the sanctuary, in different enclosures depending on how well integrated they are. They are amazingly human-like (although much better at acrobatics than us!) and I could have watched them all day. We had a lovely evening eating a Basha chicken with rice and veg on the balcony with a half bottle of wine that Andy got from the plane.
The Hospital
I wanted Andy to see the hospital so he can picture it when I am chatting about it. We had to actually get there first! I decided it would be easier to walk from the town centre than try to get a very slow moving taxi or poda poda there so we walked through the crazy mad streets of PZ in the East End of town, opted to take the slightly longer route of Kissy Road (as it has, at least by some definition of the word, pavements! Unlike Fourah Bay Road, which has sewers where you would expect the pavements to be) and finally arrived at the hospital. I showed Andy around, introducing him to the staff while he snapped away taking photos for me. Everyone was so nice and welcoming to him and were delighted that he was visiting.
It was also Meike and Nadine’s last day at work so we went to their leaving party, held in the library. We started with Christian and Muslim prayers, then everyone feasted on cassava leave with rice and washed it down with a Fanta. Lots of snapping of photos later, then we all piled into the Cap Anamur Land Cruiser for the journey home.
Sugar Loaf Mountain
So, the adventure up the mountain. I fear that I have now had so many adventures up mountains (I’m thinking Mt Mulanje, the volcano Pacaya, Ben Lomond, only to name a few Ros!) that maybe I should stop having adventures up mountains!
I had organised for a large group of us (first two mistakes – don’t have too big a group, and don’t actually organise anything or its bound to go wrong!) to climb Sugar Loaf. Unfortunately we sort of went up the wrong path (is this sounding familiar to anyone Ros?!) and ended up bashing through the bush to actually find the correct path. By this time we had been climbing for three solid hours. So while Beth, Tash, Alex, Ollie and Marcus continued up the hill, Andy and I made the executive decision to take the all the stragglers back down to the cars. A wise decision I think as everyone made it back down safely with no broken ankles or hypothermia (not that that would really be possible here) or dehydration. And we were back in time for a brilliant Mamba Point Lunch.
Hamilton BeachAndy and I had a lovely few hours at Hamilton Beach, where on the 12th December, we sat out in the sun, swum in the Atlantic Ocean and ate fresh barracuda grilled to order on the barbeque. Andy alas got burned (sorry – I take the blame for the areas of missed sunscreen!) but we got some good photos of the pair of us for Christmas cards at home which Andy has been organising.
Tiwai Island
Following an interesting journey to get there (our hired landrover broke down and we became a tourist attraction for the kids in a small village for about 4 hours, before our driver realised – having sent a mechanic off to Bo with Le100,000 of his own money – that he could drive it in 4 wheel drive, so we carried on again – which must have looked truly bizarre to the children in the village) we finally arrived quite late at Tiwai. Its in a really beautiful spot, very jungley (actually I don’t think that’s a word, but you know what I mean). We stayed in a ready-pitched tent complete with a mattress inside – fairly luxury for camping if you ask me. There was even a working shower (although it was “dribbly” as Andy described it).
We woke early the next morning for the forest walk before breakfast. Expecting this to last about an hour, we were back for breakfast a full two and a half hours later! On the walk we were able to see three different kinds of monkeys, and a huge variety of flora which our guide expertly pointed out. Tiwai is “famous” for having pygmy hippos. They are very shy, only come out a night, and although I believe there are two in London Zoo, they are indigenous only to Sierra Leone, Guinea, Liberia and the Ivory Coast (all the top tourist destinations of West Africa then. I’m kidding obviously.) Alas we didn’t see any.
In the afternoon we had a great boat trip up the river, spotted some birds, some more monkeys, and marvelled at our guide’s command of both English and the Latin names for various trees and plants, especially as he had never been to school.
Dinner was served at a remarkably early 4.30pm (we managed to stave off till 5pm!) so then had an early night before the long (and thankfully less eventful) trip back home.
IMATT
Wonderful IMATT! I have such a lovely time whenever I go there. The one RAF officer there invited us up for dinner so he could get some air force chat. He and his wife were so incredibly hospitable; we had a wonderful meal and great company, as Frankie and Howard (ex-VSOs who stayed on) had also joined us, along with the IMATT doctor and another army officer, who, bizarrely has a cousin from Shetland who I know! It was a really great evening and was a bit like being transported back to the UK (they have a bath! With hot and cold running water!)
Back to Reality
So Andy’s just gone – he did get back by the skin of his teeth though. All the flights home since Friday have been cancelled as Heathrow is closed. So there are a number of stranded VSOs who were looking forward to going home for Christmas. Keep your fingers crossed for them that they manage to get back and enjoy time with their loved ones too. Back to beans and rice for dinner for me. Back to work tomorrow. Back to the daily challenge of getting to and from work. Back to the dying babies. Hopefully also, back to making some of them better, and training the nurses and doctors here to do the same.
Saturday, 4 December 2010
A Photo - Hopefully!
Oops I forgot to add the photo (kindly taken by Alex) to the last blog - hopefully it will work this time!
Birthday Week
Birthday Week
Its been a good week (especially in comparison to last). It was my birthday on Wednesday; thanks to everyone for your lovely messages. I was teaching the students in the morning and they sung Happy Birthday to me! In fact I was also sung to by lots of the nursing staff. Tash and Alex had come to town to visit the hospital so we had a treat of fried chicken in bread for lunch (makes a change from laughing cow cheese in bread). I managed to do remarkably little work the rest of the day (apart from walking in on an attempted – and failed – resuscitation of a child who had come in gasping). Dying children were not what I wanted on my birthday so I avoided ER and ICU for the rest of the day.
We went to Mamba Point Restaurant for dinner – Carole and I shared a fantastic selection of prawn tempura, fish carpaccio and a Mexican salad, all washed down with a bottle of real red wine (I say “real” as we often drink somewhat dodgy but none-the-less drinkable red wine from a carton – and this was from a proper bottle). Becky had made a fantastic and very chocolaty cornflake cake with M&Ms (the most chocolate I have had in several months) which came out with huge sparklers on top. It was a brilliant evening and would just have taken my husband being there to make it perfect.
ICU
On Thursday when I arrived on ICU I asked the nursing staff if they were particularly worried about any patients. They promptly pointed me in the direction of a dehydrated and lethargic boy (who thankfully became a lot less lethargic when we started poking needles into him) and a pale and lethargic girl (also not so lethargic when she had her blood sugar checked). This was good as usually the lethargic children here are really properly lethargic – as in they are unconscious – which the next girl turned out to be. Blood sugar 0.6. Weak, thready pulse. Not responding to painful stimulus. She had been admitted the evening before and diagnosed with severe malaria (without a paracheck or malaria slide – as is usual here) and had been transfused with blood but not given any antimalarials…. Several boluses of dextrose, saline and blood (and some antimalarials…) later and in the afternoon she was sat up eating an orange. It was brilliant, especially after last week when I watched four children deteriorate and die in front of my eyes. It was terrible – one baby who had presented with a TWO WEEK history of cough and difficulty breathing – she died within a few hours of admission from severe pneumonia. Who in the UK would watch their child have severe breathing difficulty for two weeks before going to see a doctor? Its so so sad. Another child died of sepsis secondary to an infected injection site. And another two from severe malaria (presumably). I really was starting to feel like the Angel of Death last week. I ask the nurses to prioritise the sickest patients to see first on the ward rounds and spend a lot of time with those patients. Its something I’ve found mentally and emotionally very difficult, especially making the call to stop resuscitating (which of course I never have to do by myself in the UK). We obviously have no proper ICU facilities (1-2l/min of nasal cannulae oxygen is the best we can offer) so you can only get so far down the resuscitation algorithms before knowing there’s nothing else to do. Medically its not a difficult decision, but emotionally its tough.
ETAT Teaching
Also on Thursday Fred and I did some resuscitation scenario-based teaching with the medical officers. It was a good laugh and everyone participated well. Fred played the candidate while I was the instructor as a demonstration for them (scenario-based teaching not something they do much of here). We kept to simple stuff – how to triage, why to triage and that sort of thing. I have a series of interactive lectures called “Emergency Triage and Treatment Plus” which are brilliant for teaching that basic things done well can save lives. Hopefully next time the medical officers will do the scenarios themselves. I will keep you posted.
How to Really Save a Life!
So the way that our blood bank works is that the technicians will give a unit (or however-much) of blood for a pikin (child) if the family provide a donor to replace the blood that they use. A fairly sensible system (the blood is then checked for HIV etc and thrown away if positive). Unfortunately they won’t accept blood from lactating women. Many families are also scared of donating so go and find someone from the street and pay them to donate on their behalf. If it is really an emergency I sometimes send Sandra (from Welbodi) off to the blood bank with the mother, as they are much more likely to give her blood as a priority without waiting for a donor first. We did this twice yesterday (for the same child – who was still alive when I left yesterday having had two episodes of massive haematemesis), so in return Sandra and I went off to donate some blood. A very surreal experience and absolutely nothing like donating in the UK (apart from the massive needle!) He did try to check our PCVs but the centrifuge spun our samples out. He didn’t bother to ask if we were pregnant or lactating either! Anyway, we were treated to some Christmas cheesy music whilst donating and given some free water to rehydrate afterwards (no biscuit though). Cat and Becky had donated last week and Cat even got to hang up her own unit of blood for a child – who was sitting up and eating popcorn the next morning! (So anyone in Freetown reading this, come and donate blood. Anyone at home reading this, go and donate blood).
The IMATT Christmas Party
So minus my unit of blood we went Up the Hill to amazing IMATT for their wonderful Christmas Party. It was brilliant – Christmas tree, cheesy music, even some decorations floating in their swimming pool. The food was ace (barbequed lobster – oh wow!) and the company better. The IMATT people are incredibly hospitable. They live in the lap of luxury (comparatively) and think that VSOs are a bit mad for volunteering (especially as a lot of VSOs live without running water and electricity) so they like looking after us (I think they also like meeting nice young pretty girls….!) Becky and I entered in syndicate into the “Money tree” and amazingly won Le 200,000 between us! This is just over £30 and you should have seen how excited we were! A very fine night indeed.
Bliss Christmas Fair
The morning we headed to Bliss for the Christmas Fair in aid of St Joseph’s school for the hearing impaired in Makeni. Zoe and Theo were volunteering at the “guess the weight of the cake” and “guess how many skittles in the jar” stand. I pondered long and hard over how heavy the cake was in comparison to preterm babies. I guessed 1325g – and guess what! - I just found out I won! All I need now is the Spanish Air Traffic Controllers to stay at work and get my husband here tomorrow and it’ll be the perfect weekend!
Its been a good week (especially in comparison to last). It was my birthday on Wednesday; thanks to everyone for your lovely messages. I was teaching the students in the morning and they sung Happy Birthday to me! In fact I was also sung to by lots of the nursing staff. Tash and Alex had come to town to visit the hospital so we had a treat of fried chicken in bread for lunch (makes a change from laughing cow cheese in bread). I managed to do remarkably little work the rest of the day (apart from walking in on an attempted – and failed – resuscitation of a child who had come in gasping). Dying children were not what I wanted on my birthday so I avoided ER and ICU for the rest of the day.
We went to Mamba Point Restaurant for dinner – Carole and I shared a fantastic selection of prawn tempura, fish carpaccio and a Mexican salad, all washed down with a bottle of real red wine (I say “real” as we often drink somewhat dodgy but none-the-less drinkable red wine from a carton – and this was from a proper bottle). Becky had made a fantastic and very chocolaty cornflake cake with M&Ms (the most chocolate I have had in several months) which came out with huge sparklers on top. It was a brilliant evening and would just have taken my husband being there to make it perfect.
ICU
On Thursday when I arrived on ICU I asked the nursing staff if they were particularly worried about any patients. They promptly pointed me in the direction of a dehydrated and lethargic boy (who thankfully became a lot less lethargic when we started poking needles into him) and a pale and lethargic girl (also not so lethargic when she had her blood sugar checked). This was good as usually the lethargic children here are really properly lethargic – as in they are unconscious – which the next girl turned out to be. Blood sugar 0.6. Weak, thready pulse. Not responding to painful stimulus. She had been admitted the evening before and diagnosed with severe malaria (without a paracheck or malaria slide – as is usual here) and had been transfused with blood but not given any antimalarials…. Several boluses of dextrose, saline and blood (and some antimalarials…) later and in the afternoon she was sat up eating an orange. It was brilliant, especially after last week when I watched four children deteriorate and die in front of my eyes. It was terrible – one baby who had presented with a TWO WEEK history of cough and difficulty breathing – she died within a few hours of admission from severe pneumonia. Who in the UK would watch their child have severe breathing difficulty for two weeks before going to see a doctor? Its so so sad. Another child died of sepsis secondary to an infected injection site. And another two from severe malaria (presumably). I really was starting to feel like the Angel of Death last week. I ask the nurses to prioritise the sickest patients to see first on the ward rounds and spend a lot of time with those patients. Its something I’ve found mentally and emotionally very difficult, especially making the call to stop resuscitating (which of course I never have to do by myself in the UK). We obviously have no proper ICU facilities (1-2l/min of nasal cannulae oxygen is the best we can offer) so you can only get so far down the resuscitation algorithms before knowing there’s nothing else to do. Medically its not a difficult decision, but emotionally its tough.
ETAT Teaching
Also on Thursday Fred and I did some resuscitation scenario-based teaching with the medical officers. It was a good laugh and everyone participated well. Fred played the candidate while I was the instructor as a demonstration for them (scenario-based teaching not something they do much of here). We kept to simple stuff – how to triage, why to triage and that sort of thing. I have a series of interactive lectures called “Emergency Triage and Treatment Plus” which are brilliant for teaching that basic things done well can save lives. Hopefully next time the medical officers will do the scenarios themselves. I will keep you posted.
How to Really Save a Life!
So the way that our blood bank works is that the technicians will give a unit (or however-much) of blood for a pikin (child) if the family provide a donor to replace the blood that they use. A fairly sensible system (the blood is then checked for HIV etc and thrown away if positive). Unfortunately they won’t accept blood from lactating women. Many families are also scared of donating so go and find someone from the street and pay them to donate on their behalf. If it is really an emergency I sometimes send Sandra (from Welbodi) off to the blood bank with the mother, as they are much more likely to give her blood as a priority without waiting for a donor first. We did this twice yesterday (for the same child – who was still alive when I left yesterday having had two episodes of massive haematemesis), so in return Sandra and I went off to donate some blood. A very surreal experience and absolutely nothing like donating in the UK (apart from the massive needle!) He did try to check our PCVs but the centrifuge spun our samples out. He didn’t bother to ask if we were pregnant or lactating either! Anyway, we were treated to some Christmas cheesy music whilst donating and given some free water to rehydrate afterwards (no biscuit though). Cat and Becky had donated last week and Cat even got to hang up her own unit of blood for a child – who was sitting up and eating popcorn the next morning! (So anyone in Freetown reading this, come and donate blood. Anyone at home reading this, go and donate blood).
The IMATT Christmas Party
So minus my unit of blood we went Up the Hill to amazing IMATT for their wonderful Christmas Party. It was brilliant – Christmas tree, cheesy music, even some decorations floating in their swimming pool. The food was ace (barbequed lobster – oh wow!) and the company better. The IMATT people are incredibly hospitable. They live in the lap of luxury (comparatively) and think that VSOs are a bit mad for volunteering (especially as a lot of VSOs live without running water and electricity) so they like looking after us (I think they also like meeting nice young pretty girls….!) Becky and I entered in syndicate into the “Money tree” and amazingly won Le 200,000 between us! This is just over £30 and you should have seen how excited we were! A very fine night indeed.
Bliss Christmas Fair
The morning we headed to Bliss for the Christmas Fair in aid of St Joseph’s school for the hearing impaired in Makeni. Zoe and Theo were volunteering at the “guess the weight of the cake” and “guess how many skittles in the jar” stand. I pondered long and hard over how heavy the cake was in comparison to preterm babies. I guessed 1325g – and guess what! - I just found out I won! All I need now is the Spanish Air Traffic Controllers to stay at work and get my husband here tomorrow and it’ll be the perfect weekend!
Monday, 22 November 2010
Hospital Life
Despite only having had my medical registration for two weeks, I had actually been “working” on Ward 1 for several weeks before that. “Working” meaning doing the ward rounds with the Sierra Leonean medical officer, reviewing patient with them, making management decisions, sending children home. Basically everything apart from actually signing prescriptions and doing procedures.
Having now got my registration I can now (ethically and legally) sign prescriptions and have managed to put in a total of one cannula (the nurses put in most of them, they just get a doctor if they’re struggling).
Ward 1
Ward 1 is for the more “stable” children. There are usually about 50 patients on the ward to see on the round, which is hard work. No one really gets a proper clerk in when they are seen in emergency…. So there is a lot of guesswork going on… The main diagnoses are “severe malaria”, “severe malaria with severe anaemia”, “diarrhoea with severe dehydration” and “severe pneumonia”. Also the occasional sickle cell crisis (accompanied by severe malaria) or “query meningitis”. Also we’ve recently had a measles outbreak. The lack of proper clerk-ins and proper history taking is frustrating. Frustrating also as, without an interpreter, I can’t do a full history (although I can get by with the basics of fever/vomiting/diarrhoea/etc). It would all be a lot easier if they got a proper history taken by whoever sees them first!
There are some great nurses on ward 1 although they’re terribly disorganised. The crazy pharmacy system doesn’t help – the doctor prescribes the medication on one drug chart, the nurses on the ward round copy this onto another bit of paper, which the doctor then signs. The nurses take this to one of two pharmacies and pick up a supply of medication, supposedly to last two days. The parents keep the drugs (and needles and syringes…) in a bag by the child’s bed so you have to check whether they’ve got enough every day. Then when the nurse actually gives the medication they write out a whole new list on a completely separate chart! Its absolutely mad and I have never come across a child yet who has had their full amount of prescribed drugs given to them. Its so sad when we do actually have the drugs here!
FrustrationsLast week I moved onto ICU. Or at least partly moved onto ICU. After we finally finished that ward round (at 2pm – the medical officer was 2 hours late…), Johnny the nurse from ward 1 came to find me and said there was no doctor on ward 1 at all and could I come to see those patients!
(Just to clarify here – I am not on the medical officers’ rota, and the idea is that I am supposed to be working WITH them and not INSTEAD of them (we’re into “sustainable” development here) – there are enough of them to cover a ward each).
It was somewhat soul-destroying and I asked him to triage their sickest patients and take them to ER to be reviewed by a doctor. The following day (a Muslim holiday) I was sure there would be no doctor covering ward 1 so went back there. Although most of the children hadn’t been seen in a shocking 4-5 days (!) thankfully most were fine and I got to send a lot of them home.
With my limited Krio it takes me much longer to see patients than the doctors here (and I’m much more thorough too – although obviously I’m biased!) so the ward rounds are soul-destroyingly long. Its really really hard work being on the wards all the time – its very hot and sweaty. I also have to do something I never have before – to check that the children are actually getting the medical they are prescribed! It’s a bizarre (and really really sad) thing, seeing quinine written up twice a day and finding they haven’t received it for 36+ hours.
I enjoy seeing the individual patients though and get the instant reward of being able to treat them and although the mortality figures are shockingly high I have been involved with a few little miracles, which keeps up the morale.
An Inspiring Afternoon
Last week the Welbodi team directors were here visiting from the UK (The Welbodi Partnership is a UK-based NGO working to improve standards of child health care in ODCH by providing equipment, training and developing the postgraduate paediatric training system). I joined them and one of the SL medical officers (Ish) for a brainstorming session on ideas to reduce child mortality. The mortality rate is currently about 13% for the whole hospital, 34% for SCBU. It was a really inspiring session and brilliant to get Ish’s point of view on everything. He has just passed the first part of his postgraduate exams and he helped to set up Welbodi, along with a British medical student (now ST1 in paeds).
We then went for a wander around the slum behind the hospital. Unbelievably grim it was. Open sewers everywhere, you really had to watch where you put your feet! Houses so tightly packed together, flies and mosquitoes all around. Lots of open fires. Its no wonder we see so much malaria/TB/diarrhoea/burns. We met with the chief and sat with him and a number of others and asked their opinions of the hospital. They had so much to say about the hospital and it was so interesting to hear from them directly. They had concerns that, even though health care is supposed to be free, they were still being asked for bribes by the nursing staff! They also felt they were not treated with respect and their concerns dismissed unless a child was in extremis. It was really interesting (and sad) to hear all their points of view and how vehemently they expressed their opinions. These people were certainly not apathetic about their children’s health and health care!
Some Interesting Stats (pulled from the WHO Sierra Leone Country Cooperation Strategy Paper 2008-2013)
Sierra Leone ranks as the least developed country in the world, based on its 2007 Human Development Report ranking of 177 out of 177 countries. The country is extremely resource poor. With a GDP per capita (PPP) of US$ 700; it ranked 102 out of 108 countries in the Human Poverty Report, with Human Poverty Index (HPI) of 51.72. Nearly half of the working age population engages in subsistence agriculture.
With an under-five mortality rate of 267/1000 live births, Sierra Leone has the highest
under-five mortality in the world, and malaria is the number one cause of deaths. For the entire population, malaria burden is very heavy: malaria cases were more than 500 per 1000 population in 2003 and about 330 per 1000 in 2007. The disease accounted for about half (48%) of all outpatient consultations, and remains a major threat to socioeconomic development. In children under five years, the disease accounted for 50%-60% of all admissions, and about a third of the children may die (case fatality rate of between 16%-33%).
HIV and AIDS are fast becoming threats to social and economic development in Sierra Leone. The national sero-prevalence survey conducted in 2005 estimated a rate of 1.53% compared to 0.9% in 2002. The highest prevalence among women occurred in the 20-24 years age group (2.0%) whereas males between 35-39 years had the highest prevalence (3.5%). Prevalence in urban areas was 2.1% compared to 1.3% in rural areas, and about 47% of the total numbers of infections were new infections.
The burden of tuberculosis is increasing in Sierra Leone. Between 2004 and 2007, the number of registered TB cases in the country almost doubled, in spite of a case detection rate of about 50% (the WHO target is 75%). This is further complicated by the recent emergence of multi-drug resistant tuberculosis (MDR-TB). The TB/HIV co-infection is also an issue of concern: the prevalence of rate TB/HIV co-infection is 11.6%. However, the defaulter rate has been declining and the treatment success rate has increased, from 83% in 2004 to 87% in 2007.
Sierra Leone is ranked as having the highest under-five mortality rate in the world, with almost one out of every three children dying before reaching the age of five.
The trend has not changed significantly in the past eight years. The three main causes of under-five mortality are malaria, diarrhoea and pneumonia and they account for
over a quarter of all childhood deaths. Malnutrition plays a significant role, as 57% of the deaths would not have occurred if the children were not malnourished. Neonatal death accounts for 20% of the overall under-five mortality rate, an indication of poor quality care during labour, delivery, and immediate postnatal period.
Having now got my registration I can now (ethically and legally) sign prescriptions and have managed to put in a total of one cannula (the nurses put in most of them, they just get a doctor if they’re struggling).
Ward 1
Ward 1 is for the more “stable” children. There are usually about 50 patients on the ward to see on the round, which is hard work. No one really gets a proper clerk in when they are seen in emergency…. So there is a lot of guesswork going on… The main diagnoses are “severe malaria”, “severe malaria with severe anaemia”, “diarrhoea with severe dehydration” and “severe pneumonia”. Also the occasional sickle cell crisis (accompanied by severe malaria) or “query meningitis”. Also we’ve recently had a measles outbreak. The lack of proper clerk-ins and proper history taking is frustrating. Frustrating also as, without an interpreter, I can’t do a full history (although I can get by with the basics of fever/vomiting/diarrhoea/etc). It would all be a lot easier if they got a proper history taken by whoever sees them first!
There are some great nurses on ward 1 although they’re terribly disorganised. The crazy pharmacy system doesn’t help – the doctor prescribes the medication on one drug chart, the nurses on the ward round copy this onto another bit of paper, which the doctor then signs. The nurses take this to one of two pharmacies and pick up a supply of medication, supposedly to last two days. The parents keep the drugs (and needles and syringes…) in a bag by the child’s bed so you have to check whether they’ve got enough every day. Then when the nurse actually gives the medication they write out a whole new list on a completely separate chart! Its absolutely mad and I have never come across a child yet who has had their full amount of prescribed drugs given to them. Its so sad when we do actually have the drugs here!
FrustrationsLast week I moved onto ICU. Or at least partly moved onto ICU. After we finally finished that ward round (at 2pm – the medical officer was 2 hours late…), Johnny the nurse from ward 1 came to find me and said there was no doctor on ward 1 at all and could I come to see those patients!
(Just to clarify here – I am not on the medical officers’ rota, and the idea is that I am supposed to be working WITH them and not INSTEAD of them (we’re into “sustainable” development here) – there are enough of them to cover a ward each).
It was somewhat soul-destroying and I asked him to triage their sickest patients and take them to ER to be reviewed by a doctor. The following day (a Muslim holiday) I was sure there would be no doctor covering ward 1 so went back there. Although most of the children hadn’t been seen in a shocking 4-5 days (!) thankfully most were fine and I got to send a lot of them home.
With my limited Krio it takes me much longer to see patients than the doctors here (and I’m much more thorough too – although obviously I’m biased!) so the ward rounds are soul-destroyingly long. Its really really hard work being on the wards all the time – its very hot and sweaty. I also have to do something I never have before – to check that the children are actually getting the medical they are prescribed! It’s a bizarre (and really really sad) thing, seeing quinine written up twice a day and finding they haven’t received it for 36+ hours.
I enjoy seeing the individual patients though and get the instant reward of being able to treat them and although the mortality figures are shockingly high I have been involved with a few little miracles, which keeps up the morale.
An Inspiring Afternoon
Last week the Welbodi team directors were here visiting from the UK (The Welbodi Partnership is a UK-based NGO working to improve standards of child health care in ODCH by providing equipment, training and developing the postgraduate paediatric training system). I joined them and one of the SL medical officers (Ish) for a brainstorming session on ideas to reduce child mortality. The mortality rate is currently about 13% for the whole hospital, 34% for SCBU. It was a really inspiring session and brilliant to get Ish’s point of view on everything. He has just passed the first part of his postgraduate exams and he helped to set up Welbodi, along with a British medical student (now ST1 in paeds).
We then went for a wander around the slum behind the hospital. Unbelievably grim it was. Open sewers everywhere, you really had to watch where you put your feet! Houses so tightly packed together, flies and mosquitoes all around. Lots of open fires. Its no wonder we see so much malaria/TB/diarrhoea/burns. We met with the chief and sat with him and a number of others and asked their opinions of the hospital. They had so much to say about the hospital and it was so interesting to hear from them directly. They had concerns that, even though health care is supposed to be free, they were still being asked for bribes by the nursing staff! They also felt they were not treated with respect and their concerns dismissed unless a child was in extremis. It was really interesting (and sad) to hear all their points of view and how vehemently they expressed their opinions. These people were certainly not apathetic about their children’s health and health care!
Some Interesting Stats (pulled from the WHO Sierra Leone Country Cooperation Strategy Paper 2008-2013)
Sierra Leone ranks as the least developed country in the world, based on its 2007 Human Development Report ranking of 177 out of 177 countries. The country is extremely resource poor. With a GDP per capita (PPP) of US$ 700; it ranked 102 out of 108 countries in the Human Poverty Report, with Human Poverty Index (HPI) of 51.72. Nearly half of the working age population engages in subsistence agriculture.
With an under-five mortality rate of 267/1000 live births, Sierra Leone has the highest
under-five mortality in the world, and malaria is the number one cause of deaths. For the entire population, malaria burden is very heavy: malaria cases were more than 500 per 1000 population in 2003 and about 330 per 1000 in 2007. The disease accounted for about half (48%) of all outpatient consultations, and remains a major threat to socioeconomic development. In children under five years, the disease accounted for 50%-60% of all admissions, and about a third of the children may die (case fatality rate of between 16%-33%).
HIV and AIDS are fast becoming threats to social and economic development in Sierra Leone. The national sero-prevalence survey conducted in 2005 estimated a rate of 1.53% compared to 0.9% in 2002. The highest prevalence among women occurred in the 20-24 years age group (2.0%) whereas males between 35-39 years had the highest prevalence (3.5%). Prevalence in urban areas was 2.1% compared to 1.3% in rural areas, and about 47% of the total numbers of infections were new infections.
The burden of tuberculosis is increasing in Sierra Leone. Between 2004 and 2007, the number of registered TB cases in the country almost doubled, in spite of a case detection rate of about 50% (the WHO target is 75%). This is further complicated by the recent emergence of multi-drug resistant tuberculosis (MDR-TB). The TB/HIV co-infection is also an issue of concern: the prevalence of rate TB/HIV co-infection is 11.6%. However, the defaulter rate has been declining and the treatment success rate has increased, from 83% in 2004 to 87% in 2007.
Sierra Leone is ranked as having the highest under-five mortality rate in the world, with almost one out of every three children dying before reaching the age of five.
The trend has not changed significantly in the past eight years. The three main causes of under-five mortality are malaria, diarrhoea and pneumonia and they account for
over a quarter of all childhood deaths. Malnutrition plays a significant role, as 57% of the deaths would not have occurred if the children were not malnourished. Neonatal death accounts for 20% of the overall under-five mortality rate, an indication of poor quality care during labour, delivery, and immediate postnatal period.
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