Wednesday, 18 May 2011
VSO Fundraising and Photographs
I spent last week at work being photographed, interviewed, video-ed and photographed a bit more as some girls from VSO-UK had come out to collect some info for a fundraising campaign. I am fairly used to being photographed (my husband is never far from a camera!) and for those of you who know me well, you’ll know I actually quite like it! It was fun being snapped on the ward round with patients and staff. It reminded me of our wedding day, when we did lots of “natural” but posed photos! They also interviewed and photographed one of the medical students (thanks for all your help, and the nice things you said about me!) and one of my patients who had a large empyema and had come back for follow-up. The best thing is that, with any luck, I’ll get some copies of the professional photos as a nice memento of my time working here. So come September you can look out for my cheesy grin in the VSO campaign!
Tuesday, 17 May 2011
The Therapeutic Feeding Centre
The Therapeutic Feeding Centre
I’ve been working in the therapeutic feeding centre (TFC) for a few weeks now. This is where the children are admitted when “the body dry” or “don” (they are malnourished). Most children in SL are slimmer than their counterparts in the UK anyway and to be admitted here they have to be <70% of their expected weight for height AND have a complication such as severe infection or associated swelling. Malnutrition is associated with a very high mortality rate, with children dying from simple and preventable things like low blood sugar levels, hypothermia, infections, anaemia and electrolyte disturbances.
The nurses have all been specially trained in the treatment of malnourished children. They tell me which feeds, and which extra supplements and vitamins the child should get. There are great WHO guidelines/protocols/whatever you want to call them for the investigation and treatment of malnourished children. It’s great that the nurses can follow these guidelines and see the children getting better because of the work they are doing. As a bonus they also get given their prescribed medicines at least most of the time!
There are specially made formula feeds for malnourished children because of the electrolyte disturbances they can get. Unicef (United Nations Children’s Fund) are supposed to provide these feeds. Unfortunately they have stopped supplying our TFC. We have had no therapeutic feeds for about a month. I’m not quite sure why Unicef have run out….
Thankfully the children don’t come to hospital only to starve to death. Another NGO has been providing feeds in the meantime, as a stop gap until Unicef sorts itself out.
Most of the children in TFC have TB. A few are also HIV positive. The official rate of HIV prevalence here is supposed to be about 1-2%. It’s probably a bit higher in reality but still far less than Eastern Africa. We are very lucky in that the Global Fund pay for all TB and HIV treatment (although there are supply problems with these too, but not quite as drastic as the food shortage). We have a great nurse who gives out the TB treatment to the children. To ensure compliance, the treatment is directly observed by the nurse and she is superb at telling the parents that they must keep coming back for the medication every single day.
The children and mothers come back to TFC after they are discharged to be weighed on a weekly basis, and get a new supply of food. The nurses do an educational singing session with the mothers; they are taught about good nutrition and hygiene. It is such a pleasure hearing them sing and it is one of the truly happiest times at the hospital.
I’ve been working in the therapeutic feeding centre (TFC) for a few weeks now. This is where the children are admitted when “the body dry” or “don” (they are malnourished). Most children in SL are slimmer than their counterparts in the UK anyway and to be admitted here they have to be <70% of their expected weight for height AND have a complication such as severe infection or associated swelling. Malnutrition is associated with a very high mortality rate, with children dying from simple and preventable things like low blood sugar levels, hypothermia, infections, anaemia and electrolyte disturbances.
The nurses have all been specially trained in the treatment of malnourished children. They tell me which feeds, and which extra supplements and vitamins the child should get. There are great WHO guidelines/protocols/whatever you want to call them for the investigation and treatment of malnourished children. It’s great that the nurses can follow these guidelines and see the children getting better because of the work they are doing. As a bonus they also get given their prescribed medicines at least most of the time!
There are specially made formula feeds for malnourished children because of the electrolyte disturbances they can get. Unicef (United Nations Children’s Fund) are supposed to provide these feeds. Unfortunately they have stopped supplying our TFC. We have had no therapeutic feeds for about a month. I’m not quite sure why Unicef have run out….
Thankfully the children don’t come to hospital only to starve to death. Another NGO has been providing feeds in the meantime, as a stop gap until Unicef sorts itself out.
Most of the children in TFC have TB. A few are also HIV positive. The official rate of HIV prevalence here is supposed to be about 1-2%. It’s probably a bit higher in reality but still far less than Eastern Africa. We are very lucky in that the Global Fund pay for all TB and HIV treatment (although there are supply problems with these too, but not quite as drastic as the food shortage). We have a great nurse who gives out the TB treatment to the children. To ensure compliance, the treatment is directly observed by the nurse and she is superb at telling the parents that they must keep coming back for the medication every single day.
The children and mothers come back to TFC after they are discharged to be weighed on a weekly basis, and get a new supply of food. The nurses do an educational singing session with the mothers; they are taught about good nutrition and hygiene. It is such a pleasure hearing them sing and it is one of the truly happiest times at the hospital.
Sunday, 8 May 2011
The Freetown Photographic Tour
Yesterday Freya, Banke, Alex and I hired a taxi to have a tour of Freetown to take some snaps (Krio word for photos!). Banke had found some old snaps from the 1960s and we tried to find these places and replicate the pictures. Well, wi don try (we did try). Alas many of the places are no longer here. Or at least, when we asked people if they recognised the places, many did not know where they were or had not heard of them. Life expectancy is under 40 here so it was not surprising really that people had no idea what we were looking for.
We did however find some of the spots and also visited the Sierra Leone Peace and Cultural Monument (and, with any luck, I’ll upload some of the snaps, and others showing what Freetown is like in general).
We did however find some of the spots and also visited the Sierra Leone Peace and Cultural Monument (and, with any luck, I’ll upload some of the snaps, and others showing what Freetown is like in general).
The most useful things for volunteers to have in Sierra Leone
1) A mobile phone – some people have a phone for each of the three networks (because calls between networks are expensive).
2) A laptop with mobile internet (and a long battery life) – this allows precious contact with home and relieves the boredom on long tedious journeys back from work.
3) A head torch (although I know I freak out my housemates by walking around like a cyclops).
4) Lots of batteries to power said torch.
5) A sense of humour.
6) An umbrella – now it’s started raining (although I fear an umbrella would not have survived last nights’ storm!)
7) Patience.
8) A mosquito net (which just reminded me – I hadn’t taken my larium so far today – oops!)
9) So the next one should be – antimalarials!
10) And DEET – much as I hate it – there are more mozzies around now its started raining – and I have been bitten more lately.
11) Humility and respect for others.
12) Supportive friends in Sierra Leone and at home.
13) Phone numbers for friendly and reliable taxi drivers.
14) Lots of energy.
15) Hand sanitizer.
16) Enthusiasm and motivation.
17) Sun tan lotion.
18) A belief in what you are doing and what you are trying to achieve.
(NB. I don’t actually have all these things all the time – I just know that they are very useful in day to day life here!)
2) A laptop with mobile internet (and a long battery life) – this allows precious contact with home and relieves the boredom on long tedious journeys back from work.
3) A head torch (although I know I freak out my housemates by walking around like a cyclops).
4) Lots of batteries to power said torch.
5) A sense of humour.
6) An umbrella – now it’s started raining (although I fear an umbrella would not have survived last nights’ storm!)
7) Patience.
8) A mosquito net (which just reminded me – I hadn’t taken my larium so far today – oops!)
9) So the next one should be – antimalarials!
10) And DEET – much as I hate it – there are more mozzies around now its started raining – and I have been bitten more lately.
11) Humility and respect for others.
12) Supportive friends in Sierra Leone and at home.
13) Phone numbers for friendly and reliable taxi drivers.
14) Lots of energy.
15) Hand sanitizer.
16) Enthusiasm and motivation.
17) Sun tan lotion.
18) A belief in what you are doing and what you are trying to achieve.
(NB. I don’t actually have all these things all the time – I just know that they are very useful in day to day life here!)
Tuesday, 3 May 2011
A Small Miracle
Before I went on holiday we had a 1yr and 6 month old girl who was admitted to ICU. She was “sick bad bad wan” and was one of a long line of very sick patients in ICU at that time. It was a depressing and very stressful time to be working there.
This little girl had pneumococcal meningitis. She was one of the first patients I have been able to make a definitive diagnosis for, as she had an LP and was part of a WHO surveillance study so we were able to get a definite result. Despite initially getting a bit better, she then became sicker and sicker. She started, and continued fitting. She regressed developmentally. She continued to have high fevers. She started having profuse diarrhoea. I was giving up hope. She did however get her antibiotics. Every day. The nurses on ICU made sure she received her meds and made sure that she got her IV fluids or got fed properly. But she didn’t seem to be getting any better. And then she disappeared. None of the nurses knew what happened to her and I thought that the family had absconded with her. I thought she would die, or be very disabled as a consequence of her meningitis.
Today, more than a month after I last saw her, she turned up in outpatients with her mother. She had developed a fever again. She has malaria. But she is back to her normal self; walking, talking, playing. I tell God tenki.
This little girl had pneumococcal meningitis. She was one of the first patients I have been able to make a definitive diagnosis for, as she had an LP and was part of a WHO surveillance study so we were able to get a definite result. Despite initially getting a bit better, she then became sicker and sicker. She started, and continued fitting. She regressed developmentally. She continued to have high fevers. She started having profuse diarrhoea. I was giving up hope. She did however get her antibiotics. Every day. The nurses on ICU made sure she received her meds and made sure that she got her IV fluids or got fed properly. But she didn’t seem to be getting any better. And then she disappeared. None of the nurses knew what happened to her and I thought that the family had absconded with her. I thought she would die, or be very disabled as a consequence of her meningitis.
Today, more than a month after I last saw her, she turned up in outpatients with her mother. She had developed a fever again. She has malaria. But she is back to her normal self; walking, talking, playing. I tell God tenki.
Sunday, 1 May 2011
The Patient Journey
My father-in-law has been for a check-up a year after his knee replacement. He sent me this email and kindly allowed me to share his thoughts.
“Shona, I got thinking yesterday about the differences in what we take for granted here and where you are regarding hospitals. I got a paper form, paid £10 and flew to Glasgow, met by an NHS minibus, was seen by the X-ray people in about 15 minutes of checking in at reception, was seen by the nurse about ten minutes later who had my case history and x-rays, did a few checks of my knee, and that was me done, very slick and professional, oh just by chance I met Mr Picard who did my op and thanked him for making my life easier. I stayed in a 4* hotel, ate lots of good food at cheap prices, in a room that was big by any standard, en-suite, 21” applemac with digital freeview TV channels, all for the sum of £10. This morning I had a full breakfast before being driven in the same NHS minibus to the airport for the flight home, it made me think of you in SL and I admit I felt almost ashamed of what I just accepted as the norm.”
In the UK, this is known as The Patient Journey. The NHS making sure that not only do you receive good care, but that it is as slick and efficient as it can be.
Here’s how it works in ODCH: When the child arrives (probably having travelled by poda poda), they register and get seen by the triage nurses. If they are triaged as “emergency” they get sent straight to the emergency where (hopefully) they are seen and treatment administered straight away. That’s provided that the doctors and nurses are available. If they are triaged as “priority” they get seen in our out-patients department. There they wait a variable amount of time before being seen. No one complains about waiting. If they are “routine” they get sent to the Under-5s clinic about a mile away (another poda poda journey for the family to pay for).
If the child needs an x-ray they go to another hospital, about 2 miles away very early one morning. Not in an ambulance, but in another poda poda. The x-ray department can only take 10 x-rays per day. If they run out, the patient needs to go another day. The family return to the other hospital to pick up the x-ray the following day (more poda poda journeys….) There is an ambulance – but usually it’s used for transporting staff around instead of patients.
The wards are often more than full. It’s not unusual to have two children to a bed. The mothers sleep on the bed with them, or underneath. There are no single rooms. The children do get provided with three meals a day (rice and cassava leaf). I’ll not go into details of the patient toilets… but they’re not en suite anyway! Wards 1 and 3 and the play room do all have TVs, which the patients, parents and nurses all crowd around in the afternoons.
But I don’t want people reading this to feel guilty or ashamed about what we have at home. I often feel that way even with the things I have here compared to my colleagues and neighbours. I’m trying to learn to stop feeling guilty, and to feel thankful for all the things we do have and have the luxury to take for granted, and to try my best to help those that I can. If I felt guilty all the time there’s no way I could enjoy going to beaches or to IMATT parties…! I would like people to think about it as my father-in-law did, and to be grateful for what we have at home. Or to use what we do have to help others. If you want to help the children in Sierra Leone – donate money to the Welbodi Partnership (www.welbodipartnership.org) who I work alongside in the hospital. You can also donate money to VSO although the money doesn’t go direct to the children – it would go towards sending more people like me out to other places to share their skills.
“Shona, I got thinking yesterday about the differences in what we take for granted here and where you are regarding hospitals. I got a paper form, paid £10 and flew to Glasgow, met by an NHS minibus, was seen by the X-ray people in about 15 minutes of checking in at reception, was seen by the nurse about ten minutes later who had my case history and x-rays, did a few checks of my knee, and that was me done, very slick and professional, oh just by chance I met Mr Picard who did my op and thanked him for making my life easier. I stayed in a 4* hotel, ate lots of good food at cheap prices, in a room that was big by any standard, en-suite, 21” applemac with digital freeview TV channels, all for the sum of £10. This morning I had a full breakfast before being driven in the same NHS minibus to the airport for the flight home, it made me think of you in SL and I admit I felt almost ashamed of what I just accepted as the norm.”
In the UK, this is known as The Patient Journey. The NHS making sure that not only do you receive good care, but that it is as slick and efficient as it can be.
Here’s how it works in ODCH: When the child arrives (probably having travelled by poda poda), they register and get seen by the triage nurses. If they are triaged as “emergency” they get sent straight to the emergency where (hopefully) they are seen and treatment administered straight away. That’s provided that the doctors and nurses are available. If they are triaged as “priority” they get seen in our out-patients department. There they wait a variable amount of time before being seen. No one complains about waiting. If they are “routine” they get sent to the Under-5s clinic about a mile away (another poda poda journey for the family to pay for).
If the child needs an x-ray they go to another hospital, about 2 miles away very early one morning. Not in an ambulance, but in another poda poda. The x-ray department can only take 10 x-rays per day. If they run out, the patient needs to go another day. The family return to the other hospital to pick up the x-ray the following day (more poda poda journeys….) There is an ambulance – but usually it’s used for transporting staff around instead of patients.
The wards are often more than full. It’s not unusual to have two children to a bed. The mothers sleep on the bed with them, or underneath. There are no single rooms. The children do get provided with three meals a day (rice and cassava leaf). I’ll not go into details of the patient toilets… but they’re not en suite anyway! Wards 1 and 3 and the play room do all have TVs, which the patients, parents and nurses all crowd around in the afternoons.
But I don’t want people reading this to feel guilty or ashamed about what we have at home. I often feel that way even with the things I have here compared to my colleagues and neighbours. I’m trying to learn to stop feeling guilty, and to feel thankful for all the things we do have and have the luxury to take for granted, and to try my best to help those that I can. If I felt guilty all the time there’s no way I could enjoy going to beaches or to IMATT parties…! I would like people to think about it as my father-in-law did, and to be grateful for what we have at home. Or to use what we do have to help others. If you want to help the children in Sierra Leone – donate money to the Welbodi Partnership (www.welbodipartnership.org) who I work alongside in the hospital. You can also donate money to VSO although the money doesn’t go direct to the children – it would go towards sending more people like me out to other places to share their skills.
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