Today after handing over Callum and I followed Dr. ABD on his rounds in the male and female wards. There were a lot of surgical cases, and Dr. ABD really seemed to be rushing through to get to surgery. He said a couple times that he hoped to finish early today so he can go to town and get his internet modem fixed. Sometimes I feel like even the people who really care and are invested in helping the hospital run and save patients fall into little slumps where they’re so frustrated with the patient care that others are offering that they sort of say, “Screw it, I’m not going to try anymore.”
Today was I think the fullest surgery day since I’ve been here. Nine surgeries, with an appendectomy, a bowel repair, a hernia repair, an abdominal exploration, a cervical exam that proved to be stage four cancer, a cervical exam that looked fine, but probably means that it’s bladder cancer, two wound care cases that were infected hernia repair incisions, and an acute abdomen exploration.
The first abdominal exploration was for a man who’s had all kinds of problems and surgeries. He first had a hernia that needed repairing. That was repaired, but then he got an infection in his abdomen and they had to cut him open almost from top to bottom. Because the incision was so large, they put in a catheter, but one night in his sleep he accidently tried to pull it out, causing it to get blocked. It was blocked so badly that they had to go back in through the large abdominal incision to cut open the bladder and remove the catheter that way. They put in a new catheter and closed the bladder and abdomen, and put a drain from the abdominal cavity out. Yesterday they found that urine was draining from the abdominal cavity drain, which is really bad, and that no urine was draining from the catheter. The abdomen was opened, and there was pus and infection everywhere, and it was definitely pretty far progressed. They closed the bladder with three layers of securers, which is an extra layer more than normal. The chances that he can come back from this are pretty slim, even though he’s on lots of antibiotics and medicine.
The two cervical exams went smoothly and quickly, with the women reacting to the duck clamps in a very similar fashion that women in the U.S. react when they have to go through a similar exam. For the first women, it was extremely painful because she had stage four cervical cancer. The second women looked normal, which is good, but probably means that it’s some sort of major bladder infection, or possibly cancer in the bladder.
After inspecting two incisions from hernia repairs that weren’t looking so great, a woman with acute abdominal pain was brought in for abdominal exploration. It was very difficult for Dr. Erdi to get a proper history out of the woman, because she wouldn’t say what kind of pain she had and when the pain started. Eventually it came out that she’s pregnant, and had attempted an at home abortion with chemicals. The baby is fine, but her stomach and GI tract is not. When they opened up her abdomen, tons of bile and stomach fluid spilled out. She had a decent sized whole in the stomach, and a couple minor and one major intestinal perforations. They were repaired, but it took quite a while. She made herself very sick, and Dr. Erdi says that if the baby survives it will be a miracle.
After surgery, I was so exhausted that I took a nap. After my nap we had a nice dinner with one of Dr. Erdi’s old friends who’s in the area. Now we’re planning our BBQ for Saturday night, and it sounds like a lot of the people we’ve invited can come! I’m pretty excited. Soon I think we’re going to watch a movie then probably head to bed.
This post is dedicated to unborn fetus that wasn’t wanted by it’s mother, I pray that it survives.
Thursday, June 30, 2011
Day Twenty-two: Another Very Busy Day 06.29
Today at Morning Handover we discovered that the triplets had been born in the night! At first we were frustrated, because they said they would call us so we could see the births, but when the midwife read the report of what happened, it became clear that labor was incredibly fast. She had the first of the triplets in the ward, so they didn’t even have time to get her into the birthing room. They are all healthy thus far, and of good weight. 2.4 kg, 2.3 kg, and 1.8 kg. That is 5.3 lbs, 5 lbs, and 4 lbs. The last one was the smaller one, and that one is being monitored and the mother has been instructed to feed that baby first, as much as it wants, then move on to the other two, so that we can hopefully get his weight up. All three are boys, and they don’t name children until they’re about a week old and they are either baptized or go through some sort of naming ceremony, depending on the parents beliefs. So right now we are calling them Conteh baby 1, 2, or 3. Conteh is the father’s last name. Here in Sierra Leone, women keep the surname of their father when they are married, but all the children get their father’s name, whether he’s around or not.
On Wednesday mornings all the CHOs and head nurses join Dr. ABD, Dr. Erdi, and Dr. Abel on Big Rounds, where they review cases that are special in some way. This morning two of the CHOs didn’t show up, and after waiting for Dr. ABD for a couple minutes, Dr. Erdi found out from a nurse that Dr. ABD went to Freetown with Marcel without telling her! She was pretty upset, since that means a lot more work for her.
So we quickly went through big rounds, and didn’t really see anything that incredibly interesting. Then Dr. Erdi did rounds in maternity ward while Hasinatu and Alpha, the two CHOs who bothered to show up for work today, did rounds in the other wards. Dr. Erdi told them to make sure to make lists of patients that she was supposed to review. While Dr. Erdi was doing rounds in the female ward, we basically just cooed at the triplets. They are so cute!!!
Again from 11h00 to 13h00 I worked on my project. I am almost halfway done, and it’s definitely clear that there are more cases of Hepatitis then HIV. Once I have all the lab data, I’m going to go through the patient records to find that patients who tested positive for either HIV or Hep B. Hopefully I finish it before I go, or it may not be very useful.
After working on my project, I went back to the hospital to follow Dr. Erdi some more. We reviewed the patients that needed reviewing, and had to perform and D and C, which is a cleaning of the uterus to remove tissues that shouldn’t be there, whether they are a partially aborted pregnancy or a mola pregnancy. I got to scrub in on that one! It was pretty cool, and Dr. Erdi really let me help, so that was cool.
We were called down to the Maternity ward to check on an infant with an odd mass on his head, which Dr. Erdi thought was a hematoma, which is when blood collects in a tissue due to clotting. When she attempted to drain it, it turned out to be filled with puss, which class for a small incision to be made and the pus drained. Once that was done, Dr. Erdi let us feel the skull. Since baby’s heads grow so quickly and have so much growing to do, the skull bones are not fused and are fairly pliable, and they started to grow in such a way as to make room for the sac of pus. Where the pus had been the skull was slightly indented. Dr. Erdi said that very soon the skull would begin to grow normally, and go back to its normal shape.
After that, we went down to the TFC to check on a couple children there that needed review. One child’s hands and one foot were so swollen that she couldn’t lift her hands they were so heavy. Dr. Erdi thought perhaps there was an infection and that the swelling was caused by pus, so she used a needle to drain a small amount from one of the hands to confirm, then we took the child to the OR to make incisions and drain both hands and the foot. The mother was so scared, but when we told her that her baby would get some medicine to make her sleep through it and she wouldn’t feel it, she seemed so relieved. Dr. Erdi also told the mother that the child would sleep much better that night after the draining, and the mother had this look on her face like, “Thank goodness! Maybe I’ll be able to get some sleep, too!”
After that quick procedure, Dr. Erdi decided to go ahead and set the fracture in a young boy who came in with a fractured wrist, back, and hips. Luckily the fracture in his spine is an impression fracture, which is very stable, it just hurts. It also doesn’t normally cause nerve damage. He was hurt falling out of a mango tree, of course. Dr. Erdi had been hoping to get an X-ray of the wrist, but since it’d been all day and the boy was in pain she did it blind, which is not what she wanted to do but she was confident that she’d done a good job.
After a quick look at a child that came in on referral from another hospital, who turned out to have osteomyelitis (bone rot) in her femur and humerus, we went to review patients in the male and children’s wards. It was then that Dr. ABD showed up and kept talking about how tired he was. Dr. Erdi hinted that he had been sitting in a car all day, and that she was hoping to have an hour off to eat lunch and work on her lesson for that night at the same time. He either didn’t take the hint, or missed it. He did join us on our reviews though, and while we were in the children’s ward Marcel came by and was asking why this and that wasn’t done, and Dr. Erdi was like, “I’ve been the only one here today. I’m not ten people.” Then Marcel asked her if she could get around a list of medicine that the hospital needs. She asked him when he wanted her to do that, and he was like, “Oh, tonight will be fine.” And she actually laughed, and told him that when she finished working in an hour, around 17h00, she had been planning on working on her lesson for class that night, then eating, and then had to teach the class, and that she had hoped to sleep tonight. The loner I’m here, the more it’s clear that Dr. Erdi does EVERYTHING around here. Whenever someone doesn’t want to do something, they just leave it for Dr. Erdi. When she was trying to ask Marcel how she was supposed to get around a list of medicine they need when all the pharmacist where gone for the day, and she’s not ever in the pharmacy so she doesn’t know what they need, he just walked away.
I could tell that Dr. Erdi was getting frustrated, and when that happens it’s best for everyone except one to just get out of her way, and the one who stays is basically in charge of running interference. So Callum stayed with her, and when he got back told us that he’d gone with her to the lab to ask when a Lassa fever test that was ordered two days ago hadn’t been done. He lab technician made excuses about being understaffed because one of the lab workers went home sick. Dr. Erdi asked when they hadn’t cleared that with her, because she is the one who okays those kinds of things when Dr. ABD’s not around, and he just shrugged. When she asked what he had been doing all day, he said that he’d been doing X-rays. She got really upset, because she’d been told all day that they didn’t have any film. He just said, “No, we’re just out of the big film.” Then she really got upset. She told him that she’d set a wrist fracture blind because he’d told her that he couldn’t get her an X-ray of it. As she was trying to explain why it’s a problem that she’s practicing medicine without a lab or X-ray department, despite having both, he just sighed a lot and looked at the clock like “when are you going to be done woman?” When she was done, she was near tears, so Callum left before she got too upset. Erdi is the kind of person who would not like to cry in front of anyone.
After dinner, we all went to the class, and Dr. ABD and the CHOs who weren’t at work today weren’t there. We still had a nice time, and I felt like I learned a lot. It was great! Afterward we just hung out and talked about movies and such, and stayed up because a woman was scheduled to give birth around 23h30 or so. We went over at about 22h30 to be safe, but when we got there she’d already given birth! We were so frustrated, especially since she dilated four centimeters in about 45 minutes, which is insane. We made sure they know where our number is, so next time they will definitely call us. After we got back, I was exhausted so I went straight to bed.
This post is dedicated to the woman in female ward who died during the night.
On Wednesday mornings all the CHOs and head nurses join Dr. ABD, Dr. Erdi, and Dr. Abel on Big Rounds, where they review cases that are special in some way. This morning two of the CHOs didn’t show up, and after waiting for Dr. ABD for a couple minutes, Dr. Erdi found out from a nurse that Dr. ABD went to Freetown with Marcel without telling her! She was pretty upset, since that means a lot more work for her.
So we quickly went through big rounds, and didn’t really see anything that incredibly interesting. Then Dr. Erdi did rounds in maternity ward while Hasinatu and Alpha, the two CHOs who bothered to show up for work today, did rounds in the other wards. Dr. Erdi told them to make sure to make lists of patients that she was supposed to review. While Dr. Erdi was doing rounds in the female ward, we basically just cooed at the triplets. They are so cute!!!
Again from 11h00 to 13h00 I worked on my project. I am almost halfway done, and it’s definitely clear that there are more cases of Hepatitis then HIV. Once I have all the lab data, I’m going to go through the patient records to find that patients who tested positive for either HIV or Hep B. Hopefully I finish it before I go, or it may not be very useful.
After working on my project, I went back to the hospital to follow Dr. Erdi some more. We reviewed the patients that needed reviewing, and had to perform and D and C, which is a cleaning of the uterus to remove tissues that shouldn’t be there, whether they are a partially aborted pregnancy or a mola pregnancy. I got to scrub in on that one! It was pretty cool, and Dr. Erdi really let me help, so that was cool.
We were called down to the Maternity ward to check on an infant with an odd mass on his head, which Dr. Erdi thought was a hematoma, which is when blood collects in a tissue due to clotting. When she attempted to drain it, it turned out to be filled with puss, which class for a small incision to be made and the pus drained. Once that was done, Dr. Erdi let us feel the skull. Since baby’s heads grow so quickly and have so much growing to do, the skull bones are not fused and are fairly pliable, and they started to grow in such a way as to make room for the sac of pus. Where the pus had been the skull was slightly indented. Dr. Erdi said that very soon the skull would begin to grow normally, and go back to its normal shape.
After that, we went down to the TFC to check on a couple children there that needed review. One child’s hands and one foot were so swollen that she couldn’t lift her hands they were so heavy. Dr. Erdi thought perhaps there was an infection and that the swelling was caused by pus, so she used a needle to drain a small amount from one of the hands to confirm, then we took the child to the OR to make incisions and drain both hands and the foot. The mother was so scared, but when we told her that her baby would get some medicine to make her sleep through it and she wouldn’t feel it, she seemed so relieved. Dr. Erdi also told the mother that the child would sleep much better that night after the draining, and the mother had this look on her face like, “Thank goodness! Maybe I’ll be able to get some sleep, too!”
After that quick procedure, Dr. Erdi decided to go ahead and set the fracture in a young boy who came in with a fractured wrist, back, and hips. Luckily the fracture in his spine is an impression fracture, which is very stable, it just hurts. It also doesn’t normally cause nerve damage. He was hurt falling out of a mango tree, of course. Dr. Erdi had been hoping to get an X-ray of the wrist, but since it’d been all day and the boy was in pain she did it blind, which is not what she wanted to do but she was confident that she’d done a good job.
After a quick look at a child that came in on referral from another hospital, who turned out to have osteomyelitis (bone rot) in her femur and humerus, we went to review patients in the male and children’s wards. It was then that Dr. ABD showed up and kept talking about how tired he was. Dr. Erdi hinted that he had been sitting in a car all day, and that she was hoping to have an hour off to eat lunch and work on her lesson for that night at the same time. He either didn’t take the hint, or missed it. He did join us on our reviews though, and while we were in the children’s ward Marcel came by and was asking why this and that wasn’t done, and Dr. Erdi was like, “I’ve been the only one here today. I’m not ten people.” Then Marcel asked her if she could get around a list of medicine that the hospital needs. She asked him when he wanted her to do that, and he was like, “Oh, tonight will be fine.” And she actually laughed, and told him that when she finished working in an hour, around 17h00, she had been planning on working on her lesson for class that night, then eating, and then had to teach the class, and that she had hoped to sleep tonight. The loner I’m here, the more it’s clear that Dr. Erdi does EVERYTHING around here. Whenever someone doesn’t want to do something, they just leave it for Dr. Erdi. When she was trying to ask Marcel how she was supposed to get around a list of medicine they need when all the pharmacist where gone for the day, and she’s not ever in the pharmacy so she doesn’t know what they need, he just walked away.
I could tell that Dr. Erdi was getting frustrated, and when that happens it’s best for everyone except one to just get out of her way, and the one who stays is basically in charge of running interference. So Callum stayed with her, and when he got back told us that he’d gone with her to the lab to ask when a Lassa fever test that was ordered two days ago hadn’t been done. He lab technician made excuses about being understaffed because one of the lab workers went home sick. Dr. Erdi asked when they hadn’t cleared that with her, because she is the one who okays those kinds of things when Dr. ABD’s not around, and he just shrugged. When she asked what he had been doing all day, he said that he’d been doing X-rays. She got really upset, because she’d been told all day that they didn’t have any film. He just said, “No, we’re just out of the big film.” Then she really got upset. She told him that she’d set a wrist fracture blind because he’d told her that he couldn’t get her an X-ray of it. As she was trying to explain why it’s a problem that she’s practicing medicine without a lab or X-ray department, despite having both, he just sighed a lot and looked at the clock like “when are you going to be done woman?” When she was done, she was near tears, so Callum left before she got too upset. Erdi is the kind of person who would not like to cry in front of anyone.
After dinner, we all went to the class, and Dr. ABD and the CHOs who weren’t at work today weren’t there. We still had a nice time, and I felt like I learned a lot. It was great! Afterward we just hung out and talked about movies and such, and stayed up because a woman was scheduled to give birth around 23h30 or so. We went over at about 22h30 to be safe, but when we got there she’d already given birth! We were so frustrated, especially since she dilated four centimeters in about 45 minutes, which is insane. We made sure they know where our number is, so next time they will definitely call us. After we got back, I was exhausted so I went straight to bed.
This post is dedicated to the woman in female ward who died during the night.
Tuesday, June 28, 2011
Day Twenty-one: Where are all the cannulas? 06.28
This morning at Morning Handover there was a lot of talk about how supplies are running low. Apparently we’re low on just about everything, from cannulas (which are used to put in IV lines) to antibiotics to give the children. Because if miss-placed or non-existent stock, there were three deaths last night. On top of that, Morning Handover was followed by a length meeting that mostly entailed Dr. Erdi, Dr. ABD, and Marcel arguing about what to do in the children’s ward because there are so many patients and not enough space for them. It was back and forth on what patients we should admit and where we would put them and so on. It’s a very stressful time during rainy season in the children’s ward.
Afterward I followed Dr. Erdi on rounds in the Children’s Ward until about 12h00, and then I took a quick lunch break. When I got back to the theatre, the infant with the huge germ cell tumor was having her dressings cleaned and Dr. Erdi decided it looked infected, and that the infection was spreading, so we couldn’t wait any longer to operate. So I watched a C-section, and then baby-sat the germ cell tumor baby while they performed a hernia repair and an abdomen exploration. We had a terrible time setting an IV for the little baby, because even the smallest size needle we have is much too big. It was only on the sixth try that we were able to set a line. We had to try both arms, both legs, and both sides of the head before we were finally able to get it to work. But when we did, they decided to do that operation last because they wanted to leave the rest of the day to take their time if need be. So, I watched her and made sure she didn’t pull out her IV and cleaned up her poo a couple times.
Eventually we got her into surgery, and it seemed to go well. All the tumor tissue was removed, and the bowel seems to be untouched. We were also able to remove the coccyx, which is where they think the tumor was originating from. Last time they performed a similar surgery the child died within three days. Hopefully this one ends happier.
After some scanning, we had a huge and delicious dinner with some of our expat friends here at the compound. Now we’re just chilling and about to finish a movie we started last night, American Psycho.
This post is dedicated to the two children and one adult patient who died last night, and to the infant who underwent surgery today.
Afterward I followed Dr. Erdi on rounds in the Children’s Ward until about 12h00, and then I took a quick lunch break. When I got back to the theatre, the infant with the huge germ cell tumor was having her dressings cleaned and Dr. Erdi decided it looked infected, and that the infection was spreading, so we couldn’t wait any longer to operate. So I watched a C-section, and then baby-sat the germ cell tumor baby while they performed a hernia repair and an abdomen exploration. We had a terrible time setting an IV for the little baby, because even the smallest size needle we have is much too big. It was only on the sixth try that we were able to set a line. We had to try both arms, both legs, and both sides of the head before we were finally able to get it to work. But when we did, they decided to do that operation last because they wanted to leave the rest of the day to take their time if need be. So, I watched her and made sure she didn’t pull out her IV and cleaned up her poo a couple times.
Eventually we got her into surgery, and it seemed to go well. All the tumor tissue was removed, and the bowel seems to be untouched. We were also able to remove the coccyx, which is where they think the tumor was originating from. Last time they performed a similar surgery the child died within three days. Hopefully this one ends happier.
After some scanning, we had a huge and delicious dinner with some of our expat friends here at the compound. Now we’re just chilling and about to finish a movie we started last night, American Psycho.
This post is dedicated to the two children and one adult patient who died last night, and to the infant who underwent surgery today.
Monday, June 27, 2011
Day Twenty: A Stressful Day 06.27
Today we had spreadable cheese at breakfast for our bread!!! I was so excited, it was delicious. At Handing Over Dr. Erdi got on the late shift nurses, because they failed to properly stock at the end of their shift, and there weren’t any cannulas left for the night shift in the children’s ward. And because the night shift didn’t notice until they needed one, a patient ending up dying. The late shift also didn’t make sure that the emergency phones where properly charged, as they should be at all times, so it was a miracle that they were able to get a hold of the managers and get things stocked properly before they lost any more patients.
So, the day was already stressful, and they person who was supposed to present today wasn’t ready, so Dr. Erdi was pretty frustrated. Callum and I had planned on following her on rounds, so we followed her into Dr. ABD’s office, but she asked us to leave and close the door so that she and Dr. ABD could talk to one of the workers in the financial office alone. I have no idea what they talked about, but Dr. Erdi was even more aggravated afterward. We followed her to children’s ward, but on the way there got ambushed by a sobbing mother who had been told by a passing nurse that he son was dying. The child hadn’t even been admitted yet, and Dr. Erdi yelled at the nurse for being so crass and told the nurse to take the mother and child to the OPD and follow protocol.
When we finally got to children’s ward, it was crazy. There were several children convulsing and nurses not paying attention. After seeing about six out of sixty patients, on of the CHOs came and said, “Dr. Erdi, Dr. Able needs a translator for Timone. It’s very serious.” Dr. Erdi just looked at him and said very sarcastically, “I’ll be right there!” And then asked him why he was telling her about it, because he knows that she doesn’t speak Timone, and he would probably know better which of his colleague speak Timone. She also commented on how Dr. Able is a big boy and should be able to handle himself. The CHO just kept repeating, “It’s very very serious,” until Elizabeth pulled him away and said, “It’s okay, we’ll find someone to translate, we’ll start asking around.”
By this time Dr. Erdi was so frustrated that she said, “I need a break,” and left. She never takes breaks. This was around 9h30 or so, and she still hadn’t come back when I went to help Emmilia down at the TFC at 11h00. She must have been really frustrated. I went down to the TFC and helped them with excel, then had lunch and worked on my research project until about 13h15.
Because the lights were still on, I decided to head to the theatre, and found that they were operating on a young child that had a bowel obstruction. What’s sad is the survival rate is not good, but they had to operate. I hope it turns out okay.
In the afternoon I worked on some more research and just hung out. We had a great dinner and now we’re going to watch American Psycho.
This post is dedicated to the little boy who had surgery today, and I pray he makes it.
So, the day was already stressful, and they person who was supposed to present today wasn’t ready, so Dr. Erdi was pretty frustrated. Callum and I had planned on following her on rounds, so we followed her into Dr. ABD’s office, but she asked us to leave and close the door so that she and Dr. ABD could talk to one of the workers in the financial office alone. I have no idea what they talked about, but Dr. Erdi was even more aggravated afterward. We followed her to children’s ward, but on the way there got ambushed by a sobbing mother who had been told by a passing nurse that he son was dying. The child hadn’t even been admitted yet, and Dr. Erdi yelled at the nurse for being so crass and told the nurse to take the mother and child to the OPD and follow protocol.
When we finally got to children’s ward, it was crazy. There were several children convulsing and nurses not paying attention. After seeing about six out of sixty patients, on of the CHOs came and said, “Dr. Erdi, Dr. Able needs a translator for Timone. It’s very serious.” Dr. Erdi just looked at him and said very sarcastically, “I’ll be right there!” And then asked him why he was telling her about it, because he knows that she doesn’t speak Timone, and he would probably know better which of his colleague speak Timone. She also commented on how Dr. Able is a big boy and should be able to handle himself. The CHO just kept repeating, “It’s very very serious,” until Elizabeth pulled him away and said, “It’s okay, we’ll find someone to translate, we’ll start asking around.”
By this time Dr. Erdi was so frustrated that she said, “I need a break,” and left. She never takes breaks. This was around 9h30 or so, and she still hadn’t come back when I went to help Emmilia down at the TFC at 11h00. She must have been really frustrated. I went down to the TFC and helped them with excel, then had lunch and worked on my research project until about 13h15.
Because the lights were still on, I decided to head to the theatre, and found that they were operating on a young child that had a bowel obstruction. What’s sad is the survival rate is not good, but they had to operate. I hope it turns out okay.
In the afternoon I worked on some more research and just hung out. We had a great dinner and now we’re going to watch American Psycho.
This post is dedicated to the little boy who had surgery today, and I pray he makes it.
Sunday, June 26, 2011
Day Nineteen: Up to the Mountain 06.26
This morning we decided to get up at half past six, a time we would never choose to get up in the summer back home if we had the choice, so that we could climb a bit of the small mountain behind the compound. It was beautiful, we followed these tiny paths threw the trees and flowers and beautiful countryside. We only went about halfway, because the path became too steep, but we took some wonderful pictures, then sat and watched the mist clear.
We were back at the compound by nine, and I showered and changed for church. Mr. Hasan came to escort me to the church, which was very large and beautiful. Girls and boys sit on opposite sides, so I couldn’t sit with Mr. Hasan, but he introduced me to some of the sisters at the church, so I sat with them. There were fifteen deacons/priests/bishops there because a newly ordained bishop from Bo was visiting to celebrate with us. The mass was quite long, but very good. Afterward Mr. Hasan showed me the school that the sisters run for the deaf, which really surprised me.
After a short walk to the ClubHouse Bar to see if the rest of my companions had decided to go there for lunch and finding they weren’t there, I took a motorbike back to the compound and mostly just hung out and read in the afternoon.
Dr. Erdi heard from one of her contacts about what they thought about the infant with the tumor. He said he was fairly certain that it’s a germ cell tumor that should be removed, and can very possibly be removed successfully. He gave some pointers on where to cut, and said that the coccyx should be removed because he’s fairly certain that’s where it’s coming from.
For dinner we went to the ClubHouse since we ended up not going last night after all. We had the quickest service yet, I think it was because we came just before all the Peace Corps kids started showing up, which slows things down in the kitchen. I had a cheese pizza, and was glad that it was a fairly large size for an individual pizza, and I ate the whole thing. Now we’re just relaxing and watching a movie.
This post is dedicated to the child that died of typhoid in children’s ward today.
We were back at the compound by nine, and I showered and changed for church. Mr. Hasan came to escort me to the church, which was very large and beautiful. Girls and boys sit on opposite sides, so I couldn’t sit with Mr. Hasan, but he introduced me to some of the sisters at the church, so I sat with them. There were fifteen deacons/priests/bishops there because a newly ordained bishop from Bo was visiting to celebrate with us. The mass was quite long, but very good. Afterward Mr. Hasan showed me the school that the sisters run for the deaf, which really surprised me.
After a short walk to the ClubHouse Bar to see if the rest of my companions had decided to go there for lunch and finding they weren’t there, I took a motorbike back to the compound and mostly just hung out and read in the afternoon.
Dr. Erdi heard from one of her contacts about what they thought about the infant with the tumor. He said he was fairly certain that it’s a germ cell tumor that should be removed, and can very possibly be removed successfully. He gave some pointers on where to cut, and said that the coccyx should be removed because he’s fairly certain that’s where it’s coming from.
For dinner we went to the ClubHouse since we ended up not going last night after all. We had the quickest service yet, I think it was because we came just before all the Peace Corps kids started showing up, which slows things down in the kitchen. I had a cheese pizza, and was glad that it was a fairly large size for an individual pizza, and I ate the whole thing. Now we’re just relaxing and watching a movie.
This post is dedicated to the child that died of typhoid in children’s ward today.
Saturday, June 25, 2011
Day Eighteen: A Lazy Sunday 06.25
Last night after dinner, we decided to watch Despicable Me, which was a total hit, until the power went out. We were going to try to finish it just on a computer, but we decided to watch the rest of it tonight when we have the projector. Since there wasn’t much to do here, Steve invited us to his place to get in his little wading pool and have a couple beers. It was a great time, however I was struck by how Steve treats the locals they employ and how the company he works for encourages them to live. Most people don’t have electricity, and the hospital is constantly struggling to make ends meet in terms of affording fuel for the generators, while Adex provides a huge home for it’s European employees, with cars and drivers as well as a huge stone wall and a guard, and a huge generator located in another building to keep the sound minimal. Almost every light in the house was on when we got there, even though no one was there. They were also running the AC with the front door open and had the TV on. It just seemed so wasteful and sad. Steve also surprised all of us but giving his smokes and lighter to the gatekeeper, and every time he wanted another cig he would whistle, the guard would come over and offer the pack to Steve. Steve would take one, and the guard would hold up the lighter so Steve could light them. Then he would say, “Thank you Johnny” and Johnny would say, “Yes, sir.” And walk away. It made me really uneasy that he was so okay with the arrangement.
So today I slept in and then we all spent most of the morning just reading and hangout out. It was nice day too, fairly cool and pleasant.
In the afternoon we decided to walk around town and take pictures and shop. No problems changing money this time. Last time they tried to tell that because my bill had a crease from folding it that it was counterfeit. I really wanted to explain how counterfeiting actually works, but I figured that would just worsen the situation. I found a couple cool finds in town, and then we walked to the tailor to pick up our stuff. My skirt is great, a little wide in the hips but it fits well, and my dress just needs to be taken in. When I first tried it on, I was like, “Whoa!!! Have I lost that much weight already!?!” because it needs to be taken in about six to eight inches in the waist area. I think they made it a little big because they tend to do so to make things modest, but it’s just huge. I also want it a little shorter, but that will be an easy fix. I think I’ll go back before I leave and get a couple more skirts made now that I know they are nice.
The most common footwear for the locals is nothing or flip-flops. It’s rare to see people with closed toed shoes because they’re so expensive, and because if they’re too small you can’t continue to wear them anyway like you can with flip-flops. Women most commonly wear t-shirts that are obvious misprints in some way, like miss spelled words or backwards, like American Egale. As bottoms, jeans are a rarity, and most women just have a lapa (a measurement of fabric that is two square yards) of fabric just wrapped around their waste and tucked in like you might wear a towel. Many women do have actual skirts made, but many pregnant women prefer the wrap-and-tuck because it fits no matter how big they are. Most men wear polo tops, many times with semi-obvious manufacturing defects, like one I saw had the logo printed on the front and back when it was supposed to be a front breast pocked design. Most of the men wear surprisingly nice jeans, although a common outfit for older Islamic men is baggy long pants and a long and flowing tunic-like top that reaches to floor. Most children wear clothes that are completely random and miss-matched, and either way too big or much too small.
After the market, I was quite tired and not feeling great, so I decided to shower while the others went into Magbenteh to shoot some clips for an informational video they’re making. Then I fell asleep, I don’t know why I’ve been so tired today! Today was also the first day I’ve gotten sunburned, but I hardly got any color.
Dinner was good as always, and now we’re going to finish watching Despicable Me before we head to the Club House.
This post is dedicated to a young man who died in a traffic accident working with our friends Steve today.
So today I slept in and then we all spent most of the morning just reading and hangout out. It was nice day too, fairly cool and pleasant.
In the afternoon we decided to walk around town and take pictures and shop. No problems changing money this time. Last time they tried to tell that because my bill had a crease from folding it that it was counterfeit. I really wanted to explain how counterfeiting actually works, but I figured that would just worsen the situation. I found a couple cool finds in town, and then we walked to the tailor to pick up our stuff. My skirt is great, a little wide in the hips but it fits well, and my dress just needs to be taken in. When I first tried it on, I was like, “Whoa!!! Have I lost that much weight already!?!” because it needs to be taken in about six to eight inches in the waist area. I think they made it a little big because they tend to do so to make things modest, but it’s just huge. I also want it a little shorter, but that will be an easy fix. I think I’ll go back before I leave and get a couple more skirts made now that I know they are nice.
The most common footwear for the locals is nothing or flip-flops. It’s rare to see people with closed toed shoes because they’re so expensive, and because if they’re too small you can’t continue to wear them anyway like you can with flip-flops. Women most commonly wear t-shirts that are obvious misprints in some way, like miss spelled words or backwards, like American Egale. As bottoms, jeans are a rarity, and most women just have a lapa (a measurement of fabric that is two square yards) of fabric just wrapped around their waste and tucked in like you might wear a towel. Many women do have actual skirts made, but many pregnant women prefer the wrap-and-tuck because it fits no matter how big they are. Most men wear polo tops, many times with semi-obvious manufacturing defects, like one I saw had the logo printed on the front and back when it was supposed to be a front breast pocked design. Most of the men wear surprisingly nice jeans, although a common outfit for older Islamic men is baggy long pants and a long and flowing tunic-like top that reaches to floor. Most children wear clothes that are completely random and miss-matched, and either way too big or much too small.
After the market, I was quite tired and not feeling great, so I decided to shower while the others went into Magbenteh to shoot some clips for an informational video they’re making. Then I fell asleep, I don’t know why I’ve been so tired today! Today was also the first day I’ve gotten sunburned, but I hardly got any color.
Dinner was good as always, and now we’re going to finish watching Despicable Me before we head to the Club House.
This post is dedicated to a young man who died in a traffic accident working with our friends Steve today.
Friday, June 24, 2011
Day Seventeen: Preparation for Motherhood??? 06.24
Today I decided that I wanted a bit of change in pace, and since Dr. ABD was nowhere to be found, I decided to go down to the Under Fives Clinic. There weren’t many patients to be seen there, but it was only Musa and Sally (how isn’t much help) trying to check kids in, so I stepped in to help and Sally went to help the doctor. Without her there things actually went much faster, and we were able to get through kids pretty quickly. I was in charge of taking their temperature and weighing them. If their temperature was considered a fever, I also had to get them to swallow about a teaspoon amount of water with half a fever-reducing pill dissolved in it. Most of the kids where horribly scared of me, because I’m a scary white ghost. Because I weigh them before giving them the fever reducer if they need it, a lot of them are already kicking and screaming and scared that I’m putting them in this little fabric swing and attaching them to a scale so I can weigh them. Then trying to get them to drink a really gross concoction of water and fever reducer? Not a chance. By the end I was getting pretty good at it, until one of them threw up in my hand. Talk about preparing for parenthood. I was oddly okay with it though, because the child was clearly very sick. She was semi-conscious the entire time I was weighing her, which is very unusual, and only woke up long enough to throw up when I fed her the fever reducer. I was surprised that Musa hadn’t already recommended that she see the doctor immediately, but I took her to the doctor and told him that I thought she should be sent to the children’s ward fairly quickly.
After we’d checked in all the students, Musa kept asking me questions about life in the U.S. He was amazed by the number of high schools and colleges/universities in Michigan, and was even more surprised that there are lots of high schools and universities in all the states. He was also very surprised that Michigan is known for isn’t agriculture, and even more impressed that I knew how to drive. When I told him that we have lots of driving rules, he laughed and said it was the same here but people don’t follow them. When I told him that people pretty much follow them, because you can get massive ticket fines, and you can’t pay off the police, he was completely astonished. He kept saying, “So, you don’t bribe the police? Ever?” And didn’t seem to understand the honesty factor there. It’s sad that there’s so much corruption here.
After a while, I decided to go work on my research since it was a pretty chill day. They did to surgeries, but I wasn’t feeling like standing there watching the cleanings so I basically did my research all afternoon. I haven’t really analyzed the information in any way, but so far I can see just by going through the data that Hepatitis B is much more prevalent here than HIV for certain. My plan is to record the outcome of every HIV, Hepatitis B, and Hepatitis C test for the year of 2010, then look up those patients and see what happened to them. I’m hoping that I can turn it into an Honors Day presentation, or at least present the information to some charities, starting with Footprints Missions to try and get the word about Hepatitis, and hopefully start getting vaccines and any possible treatment here.
In the late afternoon Callum showed me some pictures he took today, and they’re pretty impressive. Come to find out he’s really into photography and filmography. He showed me a video he made from clips he took on a surfing trip to Morocco. He also snowboards, so even though he’s ‘one of them’ we talked cool places to ski/board and cool trips. He reminds me a lot of Andy, tall, lanky, and into all the camping, granola crunching, backwoods extreme sports. He’s also into mountain biking and apparently got an offer to follow a whole bunch of professional rides around for a year and get paid big bucks to make one of those videos like Andy’s always watching for them, but didn’t think he could take a year off of school. Man, if I had that chance, I’d risk it!
Tonight at dinner I learned that mangos are going out of season, and I’m very sad. But pineapple is reaching its peak, so I’ll have tons of super fresh pineapple now, so I guess it’s all good. Now we’re waiting for Dr. Erdi to check on a patient before we start a little movie night. Hopefully the woman pregnant with triplets has them tonight! Mary, the midwife who’s really with it, has promised to call us so we can see! I’m so excited!!!
This post is dedicated to the small child that lost the battle with malaria today.
After we’d checked in all the students, Musa kept asking me questions about life in the U.S. He was amazed by the number of high schools and colleges/universities in Michigan, and was even more surprised that there are lots of high schools and universities in all the states. He was also very surprised that Michigan is known for isn’t agriculture, and even more impressed that I knew how to drive. When I told him that we have lots of driving rules, he laughed and said it was the same here but people don’t follow them. When I told him that people pretty much follow them, because you can get massive ticket fines, and you can’t pay off the police, he was completely astonished. He kept saying, “So, you don’t bribe the police? Ever?” And didn’t seem to understand the honesty factor there. It’s sad that there’s so much corruption here.
After a while, I decided to go work on my research since it was a pretty chill day. They did to surgeries, but I wasn’t feeling like standing there watching the cleanings so I basically did my research all afternoon. I haven’t really analyzed the information in any way, but so far I can see just by going through the data that Hepatitis B is much more prevalent here than HIV for certain. My plan is to record the outcome of every HIV, Hepatitis B, and Hepatitis C test for the year of 2010, then look up those patients and see what happened to them. I’m hoping that I can turn it into an Honors Day presentation, or at least present the information to some charities, starting with Footprints Missions to try and get the word about Hepatitis, and hopefully start getting vaccines and any possible treatment here.
In the late afternoon Callum showed me some pictures he took today, and they’re pretty impressive. Come to find out he’s really into photography and filmography. He showed me a video he made from clips he took on a surfing trip to Morocco. He also snowboards, so even though he’s ‘one of them’ we talked cool places to ski/board and cool trips. He reminds me a lot of Andy, tall, lanky, and into all the camping, granola crunching, backwoods extreme sports. He’s also into mountain biking and apparently got an offer to follow a whole bunch of professional rides around for a year and get paid big bucks to make one of those videos like Andy’s always watching for them, but didn’t think he could take a year off of school. Man, if I had that chance, I’d risk it!
Tonight at dinner I learned that mangos are going out of season, and I’m very sad. But pineapple is reaching its peak, so I’ll have tons of super fresh pineapple now, so I guess it’s all good. Now we’re waiting for Dr. Erdi to check on a patient before we start a little movie night. Hopefully the woman pregnant with triplets has them tonight! Mary, the midwife who’s really with it, has promised to call us so we can see! I’m so excited!!!
This post is dedicated to the small child that lost the battle with malaria today.
Thursday, June 23, 2011
Day Sixteen: Big Tumors 06.23
This morning it seemed like everyone was pretty tired; we were all slow to get our start to the day. At Morning Handover, we found out that the woman pregnant with triplets was in labor! I spent my morning in the OPD (Out Patient Department) with Dr. Abel, diagnosing and then following the proper plan of action for patients visiting with ailments. It is pretty monotonous work, the patient comes in, and we review their history. Luckily, the nurse takes a patient history before they get to us, or it would take even longer. Then we start asking questions about why they’re here and what symptoms they have. It can be very difficult at times, because the nurses tend to ask closed ended questions when they translate for Dr. Abel, even when he asks open-ended questions. People here don’t have the same concept of time as we do, and they don’t really think in a stepwise fashion. It’s very strange. If you ask a patient if they’ve been sick for four days, they most of the time say yes. If you follow that question asking if they’ve been sick for three days, they will say yes. If you ask how long they’ve been sick, they look at you blankly. They also need a little lesson in cause and effect. One woman couldn’t tell us how her ribs were injured, but when asked if she’s fallen recently she said, “well, I did fall off a bridge…” Um, OF COURSE your ribs hurt! You fell off a bridge!
Another woman didn’t want a pregnancy test because she knew she was pregnant and that the baby wasn’t her husband’s, and another family refused to even be tested for blood type matches to their sick family member who needed a blood transfusion to live! Luckily there was blood in the blood bank for him, so he got treatment, but it’s amazing that people find blood testing and donating blood so scary that they wont even do it to save a family member.
At around 11h00, I went to have my lunch because I knew the day was packed full of surgeries and wanted to eat before they started so I didn’t miss anything. After lunch, I went to the theatre and found that they’d already started, which is unusual. They don’t normally start on time. They were performing a full hysterectomy on a forty-year-old woman who had a mola pregnancy. A mola pregnancy occurs when an unfertilized egg becomes cancerous and starts dividing. It can be very serious, and it’s less risk to do a hysterectomy hand try and clean it if the woman is older and already has children. After the uterus was removed, Dr. Erdi cut it open for us! I have some really cool pictures. Well, cool for me…
After that surgery, Dr. Erdi wanted to see if we, meaning Tanis, Elizabeth, her and I, could do a couple minor surgeries on our own. Yikes! We ended up doing just fine though, I was the anesthetist all by myself!! For TWO procedures! I had to keep track of vitals and write them down every five minutes, and even administer drugs! Tanis scrubbed in on one, and Elizabeth on the other, and I got to do all the drug stuff, so it worked out great!
Between the two procedures, Marcel asked Dr. Erdi to come out and see a child that was a rare case. An infant that was born yesterday at home was delivered with a massive tumor of some kind that seems to come from the base of the spine. The pictures are unbelievable. Dr. Erdi has seen one case like this before, and when she operated on that patient he died. Dr. Erdi made sure to explain to the family that the child is sick, and isn’t possessed by the devil or a witch, which is commonly thought of people with strange illnesses. She told the mother that neither she nor the child did anything wrong, and that it’s a good baby, it just got sick. She is going to consult with a doctor in Freetown, and if he can’t do it, we will try to remove the tumor. The baby is so cute, I hope she makes it!
After a quick break, I went back to watch a bowel resection. We were going to have two more surgeries today, by Dr. ABD and Dr. Erdi where beat, and there were still a lot of patients waiting to be seen in the OPD by Dr. ABD or to be scanned by Dr. Erdi, so we decided to do them tomorrow.
After some reading, we had a great dinner. More fruit, which is very good here. Now it’s pouring rain, which will be nice for sleeping tonight!
This post is dedicated to the little baby girl with the tumor. Pray that she makes it.
Another woman didn’t want a pregnancy test because she knew she was pregnant and that the baby wasn’t her husband’s, and another family refused to even be tested for blood type matches to their sick family member who needed a blood transfusion to live! Luckily there was blood in the blood bank for him, so he got treatment, but it’s amazing that people find blood testing and donating blood so scary that they wont even do it to save a family member.
At around 11h00, I went to have my lunch because I knew the day was packed full of surgeries and wanted to eat before they started so I didn’t miss anything. After lunch, I went to the theatre and found that they’d already started, which is unusual. They don’t normally start on time. They were performing a full hysterectomy on a forty-year-old woman who had a mola pregnancy. A mola pregnancy occurs when an unfertilized egg becomes cancerous and starts dividing. It can be very serious, and it’s less risk to do a hysterectomy hand try and clean it if the woman is older and already has children. After the uterus was removed, Dr. Erdi cut it open for us! I have some really cool pictures. Well, cool for me…
After that surgery, Dr. Erdi wanted to see if we, meaning Tanis, Elizabeth, her and I, could do a couple minor surgeries on our own. Yikes! We ended up doing just fine though, I was the anesthetist all by myself!! For TWO procedures! I had to keep track of vitals and write them down every five minutes, and even administer drugs! Tanis scrubbed in on one, and Elizabeth on the other, and I got to do all the drug stuff, so it worked out great!
Between the two procedures, Marcel asked Dr. Erdi to come out and see a child that was a rare case. An infant that was born yesterday at home was delivered with a massive tumor of some kind that seems to come from the base of the spine. The pictures are unbelievable. Dr. Erdi has seen one case like this before, and when she operated on that patient he died. Dr. Erdi made sure to explain to the family that the child is sick, and isn’t possessed by the devil or a witch, which is commonly thought of people with strange illnesses. She told the mother that neither she nor the child did anything wrong, and that it’s a good baby, it just got sick. She is going to consult with a doctor in Freetown, and if he can’t do it, we will try to remove the tumor. The baby is so cute, I hope she makes it!
After a quick break, I went back to watch a bowel resection. We were going to have two more surgeries today, by Dr. ABD and Dr. Erdi where beat, and there were still a lot of patients waiting to be seen in the OPD by Dr. ABD or to be scanned by Dr. Erdi, so we decided to do them tomorrow.
After some reading, we had a great dinner. More fruit, which is very good here. Now it’s pouring rain, which will be nice for sleeping tonight!
This post is dedicated to the little baby girl with the tumor. Pray that she makes it.
Wednesday, June 22, 2011
Day Fifteen: Journey to find a modem 06.22
I hope this hasn’t been tangible through my blogs thus far, but I have been quite homesick so far. I don’t like feeling like I don’t even have the option to talk to anyone back home. I’ve learned so much about the world and myself on this trip, and one thing that has become very obvious about myself is that one thing that really makes me happy, and I think will make me much happier on this trip (although I am already fairly happy) is a way to contact my family and friends fairly easily. So when I heard late last night that Marcel was traveling to Freetown today, I asked if I could go along and take care of this modem business once and for all. I appreciate that I’m supposed to be on an “African” time schedule, but I decided enough was enough.
I got up nice and early and jumped in a car with Marcel, with Clem’s debit card in hand. Clearly she feels I’m trustworthy, and I very much appreciate that, because she wanted me to withdraw quite a large amount of money for her, and felt secure that I would bring her all her money and her card back safely. We almost left without a driver, which is technically against policy, because the driver was late. Marcel ended up calling a different driver, and soon we were on our way.
On the way down to Freetown, I fell asleep almost immediately, but about halfway through the ride was up and ready to see the sights. There is such a stark contrast here between things; it is truly a place where opposites live together. There are shops with no sides, just a roof of palm branches held up by sticks, next to great big offices with AC and all the works. There are beautiful countrysides, and horribly dirty streets. I was told a while back that because the market fluctuates so much, people invest in land or building their house when they have money rather than putting money in the back. So you end up seeing large, beautiful plots of land with a shack on it. Then you see a beautiful plot of land and a GIANT half-built house, with a shack next to it.
Once in Freetown, we stopped at a clinic so Janet, one of the lab employees here, could pick up more supplies for the lab. After that we took a trip to the ATM and the bakery for something to nibble on. And finally, the moment of truth: we went to Sierratel for the modem. It took a bit longer than we wanted, but I walked out with a modem that works on PCs and Macs, that is charged with two months of unlimited internet access! It was a tad more expensive than I planned, but if I need to give up a souvenir or two so that I can talk to my family and friends, so be it!
The rest of the day was spent driving back and forth all over Freetown finding different people Marcel needed to meet with. We almost got in an accident twice and the driver actually ended up letting the car roll back too much and hitting another car. And we got pulled over, and the police wanted to take the driver to the station, or cash to let us go. We ended up convincing them that we needed to get medical supplies back to the hospital, so we were allowed to go, but Marcel got very upset and told our driver that he would have to take a driving course.
Once I got back to the compound, I found out that a man who arrived yesterday and told us that he was from France and hoping to work in our lab for two weeks had some issues with his story. First of all, he said he studied in the Ukraine for seven years, but couldn’t speak a word of Ukrainian with Clem who is fluent in it. He also didn’t know how to do anything in the lab, even though he had said he was a lab technician. And this morning he told all sorts of people that he wanted to stay for two months, not two weeks, and stay in the guest house and be provided food and so on. He kept asking Clem where he was going to be put up for the night.
Normally that sort of thing is Marcel’s business. He interviews them, reviews their paperwork, and decides which room they get, where they work, what they have to pay for and what is part of their salary, and so on. Because Marcel was in Freetown all day, Dr. ABD and Dr. Erdi didn’t quite know what to do with him, and didn’t want him to move in his things to the guest house without knowing if he was trustworthy. So they asked him for an interview, and because he only speaks French Clem was going to help translate. When Clem informed him of the interview, and told him that he would need to show Dr. Erdi and Dr. ABD his passport and some sort of documentation of his degree and so on, he told them her that he didn’t have his paper that said he’s a cardiologist (when he said he was a lab technician) and that he was staving and couldn’t wait another five minutes before running out for a bite. We haven’t seen him since.
When Marcel and I got back, Marcel called Hasan, who our mystery man said he knew, to see what Hasan had to say about all this. Apparently he sort of screwed Hasan’s hospital out of some money, and Hasan doesn’t think he’s very trust worthy, so our assessment of him was correct.
Today was the first of weekly meetings for the CHOs (like registered nurses) for MCH, and Tanis, Elizabeth, Callum, and I all attended. It was very informative, and I think I’ll go to all of them because it was very helpful. But for now, it’s time for bed.
Today Marcel told me a story about how he noticed that when you walk past the children’s ward early in the morning, it smells like urine. He asked around, and found that the women who are there with their children relieve themselves right outside the building at nighttime. Marcel insisted that the bathrooms be kept open at night so that they could be used and the place would not smell. However, after one night the bathroom was a total and complete mess. Feces and urine and toilet paper all over the floor. Marcel asked around again, and was told that most of the people who visit don’t know how to even use a toilet. That day he taught twenty-eight women how to use a toilet, then went home and wept at how sad it was.
I got up nice and early and jumped in a car with Marcel, with Clem’s debit card in hand. Clearly she feels I’m trustworthy, and I very much appreciate that, because she wanted me to withdraw quite a large amount of money for her, and felt secure that I would bring her all her money and her card back safely. We almost left without a driver, which is technically against policy, because the driver was late. Marcel ended up calling a different driver, and soon we were on our way.
On the way down to Freetown, I fell asleep almost immediately, but about halfway through the ride was up and ready to see the sights. There is such a stark contrast here between things; it is truly a place where opposites live together. There are shops with no sides, just a roof of palm branches held up by sticks, next to great big offices with AC and all the works. There are beautiful countrysides, and horribly dirty streets. I was told a while back that because the market fluctuates so much, people invest in land or building their house when they have money rather than putting money in the back. So you end up seeing large, beautiful plots of land with a shack on it. Then you see a beautiful plot of land and a GIANT half-built house, with a shack next to it.
Once in Freetown, we stopped at a clinic so Janet, one of the lab employees here, could pick up more supplies for the lab. After that we took a trip to the ATM and the bakery for something to nibble on. And finally, the moment of truth: we went to Sierratel for the modem. It took a bit longer than we wanted, but I walked out with a modem that works on PCs and Macs, that is charged with two months of unlimited internet access! It was a tad more expensive than I planned, but if I need to give up a souvenir or two so that I can talk to my family and friends, so be it!
The rest of the day was spent driving back and forth all over Freetown finding different people Marcel needed to meet with. We almost got in an accident twice and the driver actually ended up letting the car roll back too much and hitting another car. And we got pulled over, and the police wanted to take the driver to the station, or cash to let us go. We ended up convincing them that we needed to get medical supplies back to the hospital, so we were allowed to go, but Marcel got very upset and told our driver that he would have to take a driving course.
Once I got back to the compound, I found out that a man who arrived yesterday and told us that he was from France and hoping to work in our lab for two weeks had some issues with his story. First of all, he said he studied in the Ukraine for seven years, but couldn’t speak a word of Ukrainian with Clem who is fluent in it. He also didn’t know how to do anything in the lab, even though he had said he was a lab technician. And this morning he told all sorts of people that he wanted to stay for two months, not two weeks, and stay in the guest house and be provided food and so on. He kept asking Clem where he was going to be put up for the night.
Normally that sort of thing is Marcel’s business. He interviews them, reviews their paperwork, and decides which room they get, where they work, what they have to pay for and what is part of their salary, and so on. Because Marcel was in Freetown all day, Dr. ABD and Dr. Erdi didn’t quite know what to do with him, and didn’t want him to move in his things to the guest house without knowing if he was trustworthy. So they asked him for an interview, and because he only speaks French Clem was going to help translate. When Clem informed him of the interview, and told him that he would need to show Dr. Erdi and Dr. ABD his passport and some sort of documentation of his degree and so on, he told them her that he didn’t have his paper that said he’s a cardiologist (when he said he was a lab technician) and that he was staving and couldn’t wait another five minutes before running out for a bite. We haven’t seen him since.
When Marcel and I got back, Marcel called Hasan, who our mystery man said he knew, to see what Hasan had to say about all this. Apparently he sort of screwed Hasan’s hospital out of some money, and Hasan doesn’t think he’s very trust worthy, so our assessment of him was correct.
Today was the first of weekly meetings for the CHOs (like registered nurses) for MCH, and Tanis, Elizabeth, Callum, and I all attended. It was very informative, and I think I’ll go to all of them because it was very helpful. But for now, it’s time for bed.
Today Marcel told me a story about how he noticed that when you walk past the children’s ward early in the morning, it smells like urine. He asked around, and found that the women who are there with their children relieve themselves right outside the building at nighttime. Marcel insisted that the bathrooms be kept open at night so that they could be used and the place would not smell. However, after one night the bathroom was a total and complete mess. Feces and urine and toilet paper all over the floor. Marcel asked around again, and was told that most of the people who visit don’t know how to even use a toilet. That day he taught twenty-eight women how to use a toilet, then went home and wept at how sad it was.
Day Fourteen: Journey in Magbenteh 06.21
The morning started out very normal until we went to the Morning Handover meeting, and found that the goat had gotten locked in the room where the meeting normally is all night long and had pooped and peed all over the floor. It was actually quite hilarious to watch the matron’s face when he opened the door and this goat walks out like it’s normal. We ended having the shortest Handover meeting yet in the physical therapy room, but afterward I couldn’t find Dr. ABD for follow on his rounds.
While I was looking for him, Marcel came by and told me that the ‘new guy’ had arrived. Callum (pronounced like Collin but with a british accent and an m at the end instead of an n) from Ireland had just gotten in. He is between his third and forth year out of five of medical school in Ireland and will be here for about five weeks. Because I couldn’t find Dr. ABD I gave him a quick tour. Once I found Dr. ABD, I followed him on the quickest rounds yet. About halfway through rounds, a helicopter landed in our lawn, which is a first. Apparently a guy who works for African Minerals, a German based company, got in a big accident. African Minerals pays for all their employees to get med-evacuated when they are sick or need surgery, so they were only landing there because it was convenient to load the guy there, but it’s a step toward a relationship with the company, which is good.
After rounds, it was into the theatre for surgery day! We were going to remove a lump from a woman’s breast today, but Dr. ABD determined that the problem was worse than just a lump and decided to reschedule so that they could determine if the whole breast needed removing, and to perhaps recommend someone more capable to do it. Then there was a hernia repair, which had been strangulated. It didn’t look like there had been any real damage to the bowel, but we will continue to watch and make sure everything flows normally through there in the next couple days. After that we opened up a woman to explore when she had severe pain in her abdomen, and it turned out to be a GIANT hole in her liver that was also infected. They couldn’t really close her up because of the infection, and because they don’t really know what to do about the hole, so they cleaned her up as best they could and packed her full of gauze, then closed her partially. In a couple of days they’re going back in to clean it and hopefully fix the whole and close.
After surgery it started pouring again, but we decided to go to town anyway, and as soon as Dr. ABD dropped us of in town it stopped raining, which was perfect. We walked around and got fabric for Elizabeth and found extensions for me, not for the price I wanted but I didn’t want to risk asking Abie’s friend to bring extensions when she does my hair tomorrow and totally get the color wrong. Hopefully she doesn’t charge an arm and a leg because I don’t have much money left other than the money I’ve set aside for the modem.
John says he’s going to Freetown tomorrow and will buy the modem for us!!! I really hope he gets the one we want, and that it works. I’m a little scared that either it wont be right or that he wont get it at all and I’ll be out that money. I don’t know how much to trust him, so we’ll see.
After a visit to the tailors, we went to St. Mary’s and grabbed some water, and then Elizabeth and I jumped on a motorbike to get back. Halfway there, it broke down. We were fine, we just coasted to a stop, but we weren’t back yet, so he had to find us a new bike. He told us that we wouldn’t have to pay any extra, but our replacement guy told us that we were supposed to pay him 1000 Le each, rather than 1000 Le total, which was the original agreement. Oh well, it’s only 25¢ or so. After we got back we had dinner with a whole bunch of our fellow expats here at the house and now it’s chill time.
While I was looking for him, Marcel came by and told me that the ‘new guy’ had arrived. Callum (pronounced like Collin but with a british accent and an m at the end instead of an n) from Ireland had just gotten in. He is between his third and forth year out of five of medical school in Ireland and will be here for about five weeks. Because I couldn’t find Dr. ABD I gave him a quick tour. Once I found Dr. ABD, I followed him on the quickest rounds yet. About halfway through rounds, a helicopter landed in our lawn, which is a first. Apparently a guy who works for African Minerals, a German based company, got in a big accident. African Minerals pays for all their employees to get med-evacuated when they are sick or need surgery, so they were only landing there because it was convenient to load the guy there, but it’s a step toward a relationship with the company, which is good.
After rounds, it was into the theatre for surgery day! We were going to remove a lump from a woman’s breast today, but Dr. ABD determined that the problem was worse than just a lump and decided to reschedule so that they could determine if the whole breast needed removing, and to perhaps recommend someone more capable to do it. Then there was a hernia repair, which had been strangulated. It didn’t look like there had been any real damage to the bowel, but we will continue to watch and make sure everything flows normally through there in the next couple days. After that we opened up a woman to explore when she had severe pain in her abdomen, and it turned out to be a GIANT hole in her liver that was also infected. They couldn’t really close her up because of the infection, and because they don’t really know what to do about the hole, so they cleaned her up as best they could and packed her full of gauze, then closed her partially. In a couple of days they’re going back in to clean it and hopefully fix the whole and close.
After surgery it started pouring again, but we decided to go to town anyway, and as soon as Dr. ABD dropped us of in town it stopped raining, which was perfect. We walked around and got fabric for Elizabeth and found extensions for me, not for the price I wanted but I didn’t want to risk asking Abie’s friend to bring extensions when she does my hair tomorrow and totally get the color wrong. Hopefully she doesn’t charge an arm and a leg because I don’t have much money left other than the money I’ve set aside for the modem.
John says he’s going to Freetown tomorrow and will buy the modem for us!!! I really hope he gets the one we want, and that it works. I’m a little scared that either it wont be right or that he wont get it at all and I’ll be out that money. I don’t know how much to trust him, so we’ll see.
After a visit to the tailors, we went to St. Mary’s and grabbed some water, and then Elizabeth and I jumped on a motorbike to get back. Halfway there, it broke down. We were fine, we just coasted to a stop, but we weren’t back yet, so he had to find us a new bike. He told us that we wouldn’t have to pay any extra, but our replacement guy told us that we were supposed to pay him 1000 Le each, rather than 1000 Le total, which was the original agreement. Oh well, it’s only 25¢ or so. After we got back we had dinner with a whole bunch of our fellow expats here at the house and now it’s chill time.
Day Thirteen: Journey of the Upset Stomach 06.20
For the first time in Sierra Leone, I have food sickness. And it’s definitely from the food at the Club House last night. Funny how all sorts of native food made by our native cook and I’m fine, but one night of attempted U.S. cuisine and I wake up with an upset stomach and even feel bad enough that I go back to bed.
Nicole and Charlotte hoped to leave at 9h00 for Freetown to be sure and make the 14h00 fairy across to Lungi and therefore not miss their flight. They ended up not leaving until 10h20, and they were getting really anxious about it. When they finally left they looked relieved and Marcel told us when he got back that they made their flight alright, so I hope they get home safe!
After sleeping for an extra half hour or so, I got up and worked on my HIV vs. Hepatitis project until my computer died around noon. Then I had a quick lunch and went to the hospital to continue helping out. Dr. ABD was STILL doing rounds, sometimes they take forever. Dr. ABD normally does rounds in the male ward, which has 28 beds, and the female ward with 25 beds, and the last couple days there have been maybe three beds empty in each.
Just as per usual, there were a couple emergency theatre patients, one cleaning of an infection and one acutely infected appendix that was removed. It was really cool! The mentality towards cell phones is totally different here though. It’s totally okay for everyone to have their cell phone with them and the ring on high volume all the time, even in the middle of meetings and surgeries. As soon as the power goes on, everyone rushes to the outlets to charge their phones, and people even unplug things like oxygen compressors that are keeping patients alive to charge their phones. Even the surgical staff does it, and today there was a little spat over who would be the one phone left without an outlet and therefore not charged.
It rained in the evening, so we didn’t go to town like we had hoped to look at fabric and by extensions (guess who’s getting their hair braided!?!) But after dinner we went to the Club House to see Audrey off, as it was her last night in Sierra Leone. I was SOOOO tired, and it didn’t help that I was full and Steve got me a beer. One thing I noticed today is that a lot of the houses have rocks on the roofs, so I asked Dr. ABD why they were there, and he said that people use them to hold down the roof. I just never imagined that people can’t even afford nails to hold their roof on, it’s no wonder they can’t pay for healthcare.
A woman who was admitted early this morning was concerned for her baby that she was two months pregnant for. Dr. Erdi had to inform her that the child was no longer living, and that if she didn’t miscarry it soon they would have to remove it surgically. This post is dedicated to her and her child.
Nicole and Charlotte hoped to leave at 9h00 for Freetown to be sure and make the 14h00 fairy across to Lungi and therefore not miss their flight. They ended up not leaving until 10h20, and they were getting really anxious about it. When they finally left they looked relieved and Marcel told us when he got back that they made their flight alright, so I hope they get home safe!
After sleeping for an extra half hour or so, I got up and worked on my HIV vs. Hepatitis project until my computer died around noon. Then I had a quick lunch and went to the hospital to continue helping out. Dr. ABD was STILL doing rounds, sometimes they take forever. Dr. ABD normally does rounds in the male ward, which has 28 beds, and the female ward with 25 beds, and the last couple days there have been maybe three beds empty in each.
Just as per usual, there were a couple emergency theatre patients, one cleaning of an infection and one acutely infected appendix that was removed. It was really cool! The mentality towards cell phones is totally different here though. It’s totally okay for everyone to have their cell phone with them and the ring on high volume all the time, even in the middle of meetings and surgeries. As soon as the power goes on, everyone rushes to the outlets to charge their phones, and people even unplug things like oxygen compressors that are keeping patients alive to charge their phones. Even the surgical staff does it, and today there was a little spat over who would be the one phone left without an outlet and therefore not charged.
It rained in the evening, so we didn’t go to town like we had hoped to look at fabric and by extensions (guess who’s getting their hair braided!?!) But after dinner we went to the Club House to see Audrey off, as it was her last night in Sierra Leone. I was SOOOO tired, and it didn’t help that I was full and Steve got me a beer. One thing I noticed today is that a lot of the houses have rocks on the roofs, so I asked Dr. ABD why they were there, and he said that people use them to hold down the roof. I just never imagined that people can’t even afford nails to hold their roof on, it’s no wonder they can’t pay for healthcare.
A woman who was admitted early this morning was concerned for her baby that she was two months pregnant for. Dr. Erdi had to inform her that the child was no longer living, and that if she didn’t miscarry it soon they would have to remove it surgically. This post is dedicated to her and her child.
Monday, June 20, 2011
Day Twelve: Journey on a Motorbike 06.19
Today I slept in quite a bit and got up around 11h00. It was really great to just rest a lot. After I got up, I got around and Clem, Tanis, and I decided to go the market in Makeni. We were going to take motorbikes, but Tanis was too afraid so we ended up walking, and it’s about an hour and a half walk. The entire time people were yelling, “Apoto! Apoto!” (white person) and asking us for money and food. It got old very fast, and people kept hissing and making kissy noises to get our attention. When we got to town, we walked around to try and find the Sierratel office, which is where people told me I could buy a modem. After getting like four different directions, I finally figured out that there isn’t a Sierratel office in Makeni, so when John goes to Freetown this week I’ll have him get it for us.
While we were at the market, all we really did was get fabric to make some clothing and things, and then went to the tailor. I got four different fabric patterns, but only got things made out of two of them, a dress and a skirt. The fabric is very African, so I got things made that are in more of western style, so that I can wear them in the U.S. and not feel too out of place. On the way back I took a motorbike while Clem and Tanis walked because I had to use the bathroom. I found a guy who was very good, drove nice and slowly and had a very new looking bike. I got back just fine, and showered because I was so sweaty.
We all read and hung out a bit until dinnertime when we left for The Club House, which is a restaurant run by expats for expats, and has western food like pizza and burgers. We took Dr. ABD there to say Happy Father’s Day, and to say goodbye to Charlotte and Nicole, who are leaving tomorrow.
All in all, a very restful day. Night all!
While we were at the market, all we really did was get fabric to make some clothing and things, and then went to the tailor. I got four different fabric patterns, but only got things made out of two of them, a dress and a skirt. The fabric is very African, so I got things made that are in more of western style, so that I can wear them in the U.S. and not feel too out of place. On the way back I took a motorbike while Clem and Tanis walked because I had to use the bathroom. I found a guy who was very good, drove nice and slowly and had a very new looking bike. I got back just fine, and showered because I was so sweaty.
We all read and hung out a bit until dinnertime when we left for The Club House, which is a restaurant run by expats for expats, and has western food like pizza and burgers. We took Dr. ABD there to say Happy Father’s Day, and to say goodbye to Charlotte and Nicole, who are leaving tomorrow.
All in all, a very restful day. Night all!
Day Eleven: Journey to Freetown 06.18
Last night I decided to read before falling asleep, and since I was almost done with my book I decided to try and finish it. Unfortunately, there was more left than I thought so I ended up staying up pretty late trying to finish it. At about midnight I was still up reading when I read voices getting closer and saw a flash from a flashlight. I looked out the window, and three men with lights were walking toward the house, but they were whispering and had their hands over their lights to hid them a little. They walked up to our house and one of them stayed while the other two left, and I could hear the one try to open the front door. When he couldn’t get that open, he went around to the kitchen door and came in. It was really freaking me out, and I didn’t know who it was or what they were doing, and I didn’t know what I should do. I ended up just laying stiff as a board in my bed trying to listen for any noise. I thought maybe it was a worker who left their phone here in the house, and that they would go soon. And I figured that even if it wasn’t a worker, that the screen door from the kitchen to the rest of the house was closed and locked with one of those metal sliding locks, so they wouldn’t be able to get into the house anyway. But then I heard that door creak open really slowly. After about ten minutes of silence, I started to calm down. I finally decided that they were either gone or hiding somewhere and sleeping. I slept horribly though.
In the morning I found out that it was John, from Nigeria, who has been living here for some time, but has been away in Freetown since I got here because he’s been having trouble with his passport and they sort of locked him up for a little while before it was verified that his passport was okay. He finally got back late last night and didn’t want to wake anyone, so he tried to come in quietly. Turns out I was scared because one of my housemates was trying to be polite.
We got up early and left early for Freetown and the beach. Elizabeth decided not to go, so the rest of us pilled into the car for the three-hour ride down. The countryside is so beautiful here, it’s amazing. And yet people pollute the land with trash, just tossing it wherever. They seem to take no responsibility for what happens to them. Charlotte said that she believes some of that stems from the religious beliefs. Every service is all about God’s will being all powerful, and that you just need to hang in there. So if they get thrown from a motorbike, it’s God’s will. If they paint a prayer on the side of their car, God’s Will will protect them, rather than doing maintenance and taking care of your vehicle.
Anyway, in Freetown we went to the market, which was all wood carvings and fabric, and all the traders were really pushy, telling us we had to buy from them, and even taking our hands and pulling us to their booth when we were already looking at another booth. They also kept saying “I give you good price, because it’s your first time, cheap cheap price.” I just kept thinking “yeah, right!” After the market, we went to the Crown Bakery, which is the hang out place for breakfast and lunch for all the NGOs and Expats, basically all the foreigners. We had a quick bite, then found an ATM for Clem and drove by the cotton tree on the way to NRC, which is a place where they make prostatic legs and arms for amputees. Charlotte had decided to sponsor the purchase and therapy for a boy who had his arm amputated at MCH. The total cost was $150.00 U.S. When we got there and paid for Abdulai, we also talked to Issa, who had been sponsored by some other girls who had stayed here earlier this year and has received his prostatic leg and can now walk fairly well with it. It was great to see.
After that we drove a long way out to a resort that Erdi loves called Francos, which is a hotel and diving school and a restaurant. We drove in and it was just beautiful, like stepping into another world. Here at the hospital, it’s so sad and the people seem miserable so much of the time, but here their were beautiful rooms to stay in and a wonderful view of the beach and ocean, and the restaurant was right on the water, you could even site out in the sand under the palm trees and eat. It was so wonderful, we went out and played in the sand a big, and some friends of Erdi happened to be sitting near us and kept sending us bottles of wine with our dinner. Everything was so good, and it was like we were on vacation for the afternoon.
On the way home, we took the mountain road with it’s wonderful views and huge bumps. We saw the U.S. embassy, which was actually kind of disappointing in that it was a large parcel of land just separated from the rest of Sierra Leone by a gigantic and unnecessary white brick wall, and looked large and overdone it was kind of sad. We also saw the Sierra Leone military base, which was dwarfed by the U.S. embassy.
When we got back, we dropped by the house to get Elizabeth and drop off Nicole and Charlotte before heading back out again to a party that Steve, Erdi’s friend, invited us to. It was on the Apex compound, which is a company that grows sugar cane for bio-fuels. It was so much fun, just hanging out with people who speak English in air conditioning and drinking beer while Marty, an older guy, hit on us all night long! I know I will sleep well tonight!
In the morning I found out that it was John, from Nigeria, who has been living here for some time, but has been away in Freetown since I got here because he’s been having trouble with his passport and they sort of locked him up for a little while before it was verified that his passport was okay. He finally got back late last night and didn’t want to wake anyone, so he tried to come in quietly. Turns out I was scared because one of my housemates was trying to be polite.
We got up early and left early for Freetown and the beach. Elizabeth decided not to go, so the rest of us pilled into the car for the three-hour ride down. The countryside is so beautiful here, it’s amazing. And yet people pollute the land with trash, just tossing it wherever. They seem to take no responsibility for what happens to them. Charlotte said that she believes some of that stems from the religious beliefs. Every service is all about God’s will being all powerful, and that you just need to hang in there. So if they get thrown from a motorbike, it’s God’s will. If they paint a prayer on the side of their car, God’s Will will protect them, rather than doing maintenance and taking care of your vehicle.
Anyway, in Freetown we went to the market, which was all wood carvings and fabric, and all the traders were really pushy, telling us we had to buy from them, and even taking our hands and pulling us to their booth when we were already looking at another booth. They also kept saying “I give you good price, because it’s your first time, cheap cheap price.” I just kept thinking “yeah, right!” After the market, we went to the Crown Bakery, which is the hang out place for breakfast and lunch for all the NGOs and Expats, basically all the foreigners. We had a quick bite, then found an ATM for Clem and drove by the cotton tree on the way to NRC, which is a place where they make prostatic legs and arms for amputees. Charlotte had decided to sponsor the purchase and therapy for a boy who had his arm amputated at MCH. The total cost was $150.00 U.S. When we got there and paid for Abdulai, we also talked to Issa, who had been sponsored by some other girls who had stayed here earlier this year and has received his prostatic leg and can now walk fairly well with it. It was great to see.
After that we drove a long way out to a resort that Erdi loves called Francos, which is a hotel and diving school and a restaurant. We drove in and it was just beautiful, like stepping into another world. Here at the hospital, it’s so sad and the people seem miserable so much of the time, but here their were beautiful rooms to stay in and a wonderful view of the beach and ocean, and the restaurant was right on the water, you could even site out in the sand under the palm trees and eat. It was so wonderful, we went out and played in the sand a big, and some friends of Erdi happened to be sitting near us and kept sending us bottles of wine with our dinner. Everything was so good, and it was like we were on vacation for the afternoon.
On the way home, we took the mountain road with it’s wonderful views and huge bumps. We saw the U.S. embassy, which was actually kind of disappointing in that it was a large parcel of land just separated from the rest of Sierra Leone by a gigantic and unnecessary white brick wall, and looked large and overdone it was kind of sad. We also saw the Sierra Leone military base, which was dwarfed by the U.S. embassy.
When we got back, we dropped by the house to get Elizabeth and drop off Nicole and Charlotte before heading back out again to a party that Steve, Erdi’s friend, invited us to. It was on the Apex compound, which is a company that grows sugar cane for bio-fuels. It was so much fun, just hanging out with people who speak English in air conditioning and drinking beer while Marty, an older guy, hit on us all night long! I know I will sleep well tonight!
Sunday, June 19, 2011
Day Ten: Journey in the Heat 06.17
Today I got up at the normal time and had Sierra Leonean oatmeal for breakfast, which looks a lot different from our oatmeal but is very good. We all went to Morning Handover, normally only Tanis, Elizabeth and I go, but today Nicole and Charlotte wanted to say goodbye because it was their last day working on the compound. Charlotte left before the end, but Nicole gave a presentation on the stages of development in children. Marcel, the business manager, also came in and announced that he had been informed of some dishonest behavior on the part of the staff occurring, especially in the children’s ward. Staff has apparently been telling patients that they must pay for certain things, and that they must pay the nurse immediately, which is untrue. All payment is handled through the secretary, who writes receipts for everything. He also started talking about the ‘crisis in the children’s ward,’ and everyone started looking around like “What? What crisis?” He is upset because about ten of the thirty-eight beds in the children’s ward have two patients in them, which sounds bad but that’s how it is this time of year. All the kids are getting malaria because it’s the rainy season, and they don’t want to turn anyone away, so that ask mothers if they would be okay doubling up and as long as they’re okay with it they get as many children as they can admitted. Marcel was appalled by this, but then again he just started there about three months ago and he formally was working as a teacher in the States. He kept talking about pulling staff from other wards, especially the operating theatre, to pull extra shifts without pay in a wing another building that’s not being used right now, because he wants to move children down there. The problem is, no one wants to work extra shifts, and people are already begging for raises, so no one wants to take shifts without pay. The hospital is also already understaffed, so you’d be taking a one of the nurses away from the regular children’s ward, when we already have children who are pulling out IVs because the nurses need to help other patients and the parents can’t be bothered to watch their children. Another problem is that there aren’t any beds down there, which Marcel has completely overlooked, and he keeps saying that we are going to put the ‘less sick’ children in that wing, but the less sick children are the children who need a blood transfusion and had a temperate of 40 ºC (104 ºF) last night, but are less feverish today. There aren’t any ‘less sick’ children.
After such an eventful morning, I went on rounds with Dr. ABD. Today he wanted to see if the new CHO (sort of like a RA) named Alpha (the one who purposed to me) could do rounds on his own, and they spoke mostly in Creole, which can be hard to follow sometimes, so I felt a little left out. After we finished rounds, I went to the lab where they do blood work to ask if I could see some other their old records. They gave me the book of all the blood work they did in 2010, which has the name, age, sex, and the test results all organized in it. I think it will help a lot in determining if there is something to be found out about HIV versus Hepatitis in terms of which is more prominent and which one causes more deaths in Sierra Leone.
I went back to the house with my book, and worked on my little project for a bit, when Nicole came and told me that after doing such an awesome job with Excel the other day when I worked with Mr. Swaray, that my services where being requested by Amelia for computer help. Amelia just wanted the same for that I made for Mr. Swaray, and a lesson on how to use it, which would have been really easy if Mr. Swaray’s computer was working. I told her that as soon as it’s working I will get if from his computer, load it on hers, and show her how to use it.
At about 13h45, I noticed that the lights were still on, which meant surgery! I hurried over and got to watch Dr. ABD open up a man he’d already operated on, as infection had set in and he wanted to know the source and to clean it out. The source in the first man turned out to be the testis. [It’s incredible that an infection in the testis can cause the whole abdomen to full completely with pus.] The second surgery was much the same, but the infection was worse and located in the gull bladder if I remember correctly. After about 45 minutes of trying to clean out this mans abdomen and remove all the infection, Dr. ABD finally decided that he was have to just start regular cleanings for a couple days in order to get out all the infection and to make sure it didn’t get more infected.
After Dr. ABD was finished and the OR cleaned, Dr. Erdi came in and I got to watch the delivery of twins! Two baby girls, both healthy, where delivered by C-section. It all happened very quickly, much quicker than most of the surgeries I’ve seen, and I actually caught most of it on tap. After that, I went back to the house and did some more work on my project until dinner. Jack, the cook who has been here for most of the time that Nicole and Charlotte have been here, was just a replacement cook for David, who came back today. I’d heard good things about him from Mallory, but he hasn’t made a very good impression with us so far. He yelled at our little kitten that we’ve adopted, and in general has a very unhappy disposition. He also prepared fewer dishes than Jack normally does, which means if you don’t like fish you had fries for dinner tonight. He also cut up the fruit for dinner at noon-ish, and left it sitting out uncovered all day. When dinner rolled around and he brought it to the table, fruit flies where into it like crazy. I hope things improve, or I will be losing weight even faster than I am now. I have already lost a kilogram at least (about 2 & ¼ pounds) between eating less for breakfast and lunch and the fact that we’re active and sweating out all our extra calories all day long.
After dinner, a friend of Dr. Erdi named Steve came over. Steve is English, and has lived in Sierra Leone for a couple years now. He’s a very funny guy, and very fond of beer. When we were talking on the porch tonight, I put on long sleeves and long pants because it was a little chilly and because of the bugs, and everyone thought I was crazy, so I must be getting used to the heat. Tomorrow we are getting up early to go to the beach in Freetown, so it’s off to bed for me.
After such an eventful morning, I went on rounds with Dr. ABD. Today he wanted to see if the new CHO (sort of like a RA) named Alpha (the one who purposed to me) could do rounds on his own, and they spoke mostly in Creole, which can be hard to follow sometimes, so I felt a little left out. After we finished rounds, I went to the lab where they do blood work to ask if I could see some other their old records. They gave me the book of all the blood work they did in 2010, which has the name, age, sex, and the test results all organized in it. I think it will help a lot in determining if there is something to be found out about HIV versus Hepatitis in terms of which is more prominent and which one causes more deaths in Sierra Leone.
I went back to the house with my book, and worked on my little project for a bit, when Nicole came and told me that after doing such an awesome job with Excel the other day when I worked with Mr. Swaray, that my services where being requested by Amelia for computer help. Amelia just wanted the same for that I made for Mr. Swaray, and a lesson on how to use it, which would have been really easy if Mr. Swaray’s computer was working. I told her that as soon as it’s working I will get if from his computer, load it on hers, and show her how to use it.
At about 13h45, I noticed that the lights were still on, which meant surgery! I hurried over and got to watch Dr. ABD open up a man he’d already operated on, as infection had set in and he wanted to know the source and to clean it out. The source in the first man turned out to be the testis. [It’s incredible that an infection in the testis can cause the whole abdomen to full completely with pus.] The second surgery was much the same, but the infection was worse and located in the gull bladder if I remember correctly. After about 45 minutes of trying to clean out this mans abdomen and remove all the infection, Dr. ABD finally decided that he was have to just start regular cleanings for a couple days in order to get out all the infection and to make sure it didn’t get more infected.
After Dr. ABD was finished and the OR cleaned, Dr. Erdi came in and I got to watch the delivery of twins! Two baby girls, both healthy, where delivered by C-section. It all happened very quickly, much quicker than most of the surgeries I’ve seen, and I actually caught most of it on tap. After that, I went back to the house and did some more work on my project until dinner. Jack, the cook who has been here for most of the time that Nicole and Charlotte have been here, was just a replacement cook for David, who came back today. I’d heard good things about him from Mallory, but he hasn’t made a very good impression with us so far. He yelled at our little kitten that we’ve adopted, and in general has a very unhappy disposition. He also prepared fewer dishes than Jack normally does, which means if you don’t like fish you had fries for dinner tonight. He also cut up the fruit for dinner at noon-ish, and left it sitting out uncovered all day. When dinner rolled around and he brought it to the table, fruit flies where into it like crazy. I hope things improve, or I will be losing weight even faster than I am now. I have already lost a kilogram at least (about 2 & ¼ pounds) between eating less for breakfast and lunch and the fact that we’re active and sweating out all our extra calories all day long.
After dinner, a friend of Dr. Erdi named Steve came over. Steve is English, and has lived in Sierra Leone for a couple years now. He’s a very funny guy, and very fond of beer. When we were talking on the porch tonight, I put on long sleeves and long pants because it was a little chilly and because of the bugs, and everyone thought I was crazy, so I must be getting used to the heat. Tomorrow we are getting up early to go to the beach in Freetown, so it’s off to bed for me.
Day Nine: Journey in the OR 06.16
Today I woke up extra happy because in the past two days not only did I get to talk to my parents, but I also got to talk to that boy I like. ☺ It rained all night, but it didn’t cool things down much, so I didn’t sleep that well. I had bread and cheese for breakfast, and saw that our little kitten that we still haven’t named had pooped again in the corner and had peed on the chair. I put some sun screen on quickly and went down to Morning Handover, which started late because it rained last night… When it rains all night and into the morning, people are late to start their day. Another one of those cultural things.
After Morning Handover I went to the lab and I was going to see if I could help or watch or anything, but they weren’t really doing anything even though they were pretty backed up. I then went and introduced myself to the woman who keeps all the records so that eventually I can ask her if I can borrow the records a bit at a time so that Tanis and I can do an analysis of the statistics of HIV versus Hepatitis. She was very busy and couldn’t really take the time to show me what she does, so I went to find Dr. ABD in the male ward. It was locked, which they do sometimes if it’s not visiting hours but people keep trying to come in and visit, but they let me in. Dr. ABD wasn’t feeling well today, he said he was sneezing and coughing and so he really was hurrying people through rounds, which was fine with me. He kept saying, “I don’t need to see them in the ward, I’m already going to see them in the theatre!” Yesterday while I was on rounds with Dr. Erdi, Dr. ABD discharged a lot of women in the female ward so that they can admit some of the people who have been waiting to be admitted.
They started surgeries on time today! It was crazy! And when we were in the male ward I asked Dr. ABD as a joke when he was going to let me assist him in surgery, and he said, “Today if you’d like!” and he was totally serious! So I thought he was just going to let me be just a little bit closer to the action, but when we went into the theatre, he told Becky, the scrub nurse, to help me scrub in! So got my OR scrubs on and my hair net and mask on and went to the official sink and she told me how to scrub up, and then I got to put on the long gown and the gloves. They told me to put my hands together like I was praying and to wait like that so I didn’t touch anything. Then I got to take the position of the assistant, and the legit assistant stood next to me and told me what to do. My name is even in the book now!
I assisted on a RIH, which is a hernia repair. It was a minor repair, and I got to hold skin and hold the clamps and the nylon thread that he uses for secures and it was SO COOL!!! I got some pictures of it, so there’s proof! I’m a natural at it, and I like surgery so much! That’s what I want to do.
Halfway through the surgery I assisted on, Elizabeth came in and her eyes got really big with surprise, and Dr. ABD said, “Are you going to scrub in next?” and Elizabeth said, “Heck yes!” [The surgery she got to scrub in on was a bowel resection where they removed a four-inch section of the large intestine and sewed the two cut ends back together. I was a little jealous at first, but the incision Dr. ABD made for the operation was HUGE and most of the guys intestines where in her hands. I think that would have been an intense procedure to be your first one.]
Afterward, I had to eat but they were still doing more surgeries so I hurried to the house to eat quickly, and when I was talking to Clem I completely fell asleep! I took an unintended forty-five minute nap. I went back though, and was able to see the most interesting one, which was a woman they admitted today with a back leg. She had initially tried traditional African medicine, and so it became infected. It also looked like they had gone to someone who knew western medicine, who must have took one look, bandaged it as best they could, and told them to come to MCH, because it was nicely bandaged and had a cleaning agent that the locals use to clean wounds that’s actually good, just not effective on injuries so severe.
]You can tell when infection has set in by the smell, it’s very distinct, and the moment this woman was wheeled into the OR I knew she had a terrible infection. When they unwrapped it, you could see one big hole and a small hole where puss was seeping out, and an ulcer looking soar as well. They decided to bring in their big bucket and soap and a scrub brush to clean in like crazy. It helped so that Dr. Erdi could actually see what she was working with, but it also exposed how bad it was. Dr. Erdi started by cutting away the skin near the large soar to see if the skin could be saved, but ended up throwing the chuck of skin and the half inch layer of pus and infection into the waste basin. She ended up cutting off quite a bit of skin around the soar and the large hole, and well as turning the small hole into an inch and a half slit so that she could clean it out. Then they just started squeezing pus out of the leg, from about the knee down. And the smell! I thought the smell had been bad when she first came in, but when the smell reached Tanis, Elizabeth and I we all immediately started fanning our faces (even though we had masks on) and moving to the other side of the room when the AC blows so that we could get the fresh air. Dr. Erdi said afterward that this job has taught her to breath through her mouth whenever she’s in the OR. They ended up just cleaning up the hole they had made, and they were going to bandage her back up, pump her with antibiotics, and do another cleaning tomorrow. When Dr. Erdi is satisfied with how clean the wound is, then she will operate and see what she can save of the muscle/skin and do the official operation then.]
After the OR, Tanis and I went down to the admissions office and asked if we could take some of the files to start our little research projects. Tanis wants to look at infant mortality rate and uterine ruptures during pregnancy, and I want to study the death rate of HIV versus Hepatitis. The secretary there gave us all the records from today, and so far we’re just trying to decide how to even get started.
The afternoon was pretty quiet, and dinner was as usual. All in all a very calm evening. One cool thing about the beds here is we all get mosquito nets, which makes me feel like I have one of those princess canopy beds. The nets are actually very functions, and when you tuck them in at the edges. Unless you press up against the edge of the net, you sleep virtually mosquito free, and the hospital has been trying very hard to get mothers and fathers to understand that they need to put the mosquito nets down on their children’s beds and make them understand that it’s the mosquitoes that have malaria and make them sick. Even though I don’t have to worry about the mosquitoes in Michigan having malaria, I’m almost considering getting one for my bed at home. The mosquitoes here are also very different. They don’t really swarm you like Michigan mosquitoes do, and they are much smaller and quicker than Michigan mosquitoes. They are also red, which is kind of scary but they are only out at about 7pm and they wont come near you if you’re wearing spray. Tanis and I also keep our nets down during the day, so they don’t really ever have a chance to get under them and attack up.
Today, a patient’s family drove from a neighboring country to MCH because it was the nearest hospital to get care for them. The patient died just as they arrived. This post is dedicated to them.
After Morning Handover I went to the lab and I was going to see if I could help or watch or anything, but they weren’t really doing anything even though they were pretty backed up. I then went and introduced myself to the woman who keeps all the records so that eventually I can ask her if I can borrow the records a bit at a time so that Tanis and I can do an analysis of the statistics of HIV versus Hepatitis. She was very busy and couldn’t really take the time to show me what she does, so I went to find Dr. ABD in the male ward. It was locked, which they do sometimes if it’s not visiting hours but people keep trying to come in and visit, but they let me in. Dr. ABD wasn’t feeling well today, he said he was sneezing and coughing and so he really was hurrying people through rounds, which was fine with me. He kept saying, “I don’t need to see them in the ward, I’m already going to see them in the theatre!” Yesterday while I was on rounds with Dr. Erdi, Dr. ABD discharged a lot of women in the female ward so that they can admit some of the people who have been waiting to be admitted.
They started surgeries on time today! It was crazy! And when we were in the male ward I asked Dr. ABD as a joke when he was going to let me assist him in surgery, and he said, “Today if you’d like!” and he was totally serious! So I thought he was just going to let me be just a little bit closer to the action, but when we went into the theatre, he told Becky, the scrub nurse, to help me scrub in! So got my OR scrubs on and my hair net and mask on and went to the official sink and she told me how to scrub up, and then I got to put on the long gown and the gloves. They told me to put my hands together like I was praying and to wait like that so I didn’t touch anything. Then I got to take the position of the assistant, and the legit assistant stood next to me and told me what to do. My name is even in the book now!
I assisted on a RIH, which is a hernia repair. It was a minor repair, and I got to hold skin and hold the clamps and the nylon thread that he uses for secures and it was SO COOL!!! I got some pictures of it, so there’s proof! I’m a natural at it, and I like surgery so much! That’s what I want to do.
Halfway through the surgery I assisted on, Elizabeth came in and her eyes got really big with surprise, and Dr. ABD said, “Are you going to scrub in next?” and Elizabeth said, “Heck yes!” [The surgery she got to scrub in on was a bowel resection where they removed a four-inch section of the large intestine and sewed the two cut ends back together. I was a little jealous at first, but the incision Dr. ABD made for the operation was HUGE and most of the guys intestines where in her hands. I think that would have been an intense procedure to be your first one.]
Afterward, I had to eat but they were still doing more surgeries so I hurried to the house to eat quickly, and when I was talking to Clem I completely fell asleep! I took an unintended forty-five minute nap. I went back though, and was able to see the most interesting one, which was a woman they admitted today with a back leg. She had initially tried traditional African medicine, and so it became infected. It also looked like they had gone to someone who knew western medicine, who must have took one look, bandaged it as best they could, and told them to come to MCH, because it was nicely bandaged and had a cleaning agent that the locals use to clean wounds that’s actually good, just not effective on injuries so severe.
]You can tell when infection has set in by the smell, it’s very distinct, and the moment this woman was wheeled into the OR I knew she had a terrible infection. When they unwrapped it, you could see one big hole and a small hole where puss was seeping out, and an ulcer looking soar as well. They decided to bring in their big bucket and soap and a scrub brush to clean in like crazy. It helped so that Dr. Erdi could actually see what she was working with, but it also exposed how bad it was. Dr. Erdi started by cutting away the skin near the large soar to see if the skin could be saved, but ended up throwing the chuck of skin and the half inch layer of pus and infection into the waste basin. She ended up cutting off quite a bit of skin around the soar and the large hole, and well as turning the small hole into an inch and a half slit so that she could clean it out. Then they just started squeezing pus out of the leg, from about the knee down. And the smell! I thought the smell had been bad when she first came in, but when the smell reached Tanis, Elizabeth and I we all immediately started fanning our faces (even though we had masks on) and moving to the other side of the room when the AC blows so that we could get the fresh air. Dr. Erdi said afterward that this job has taught her to breath through her mouth whenever she’s in the OR. They ended up just cleaning up the hole they had made, and they were going to bandage her back up, pump her with antibiotics, and do another cleaning tomorrow. When Dr. Erdi is satisfied with how clean the wound is, then she will operate and see what she can save of the muscle/skin and do the official operation then.]
After the OR, Tanis and I went down to the admissions office and asked if we could take some of the files to start our little research projects. Tanis wants to look at infant mortality rate and uterine ruptures during pregnancy, and I want to study the death rate of HIV versus Hepatitis. The secretary there gave us all the records from today, and so far we’re just trying to decide how to even get started.
The afternoon was pretty quiet, and dinner was as usual. All in all a very calm evening. One cool thing about the beds here is we all get mosquito nets, which makes me feel like I have one of those princess canopy beds. The nets are actually very functions, and when you tuck them in at the edges. Unless you press up against the edge of the net, you sleep virtually mosquito free, and the hospital has been trying very hard to get mothers and fathers to understand that they need to put the mosquito nets down on their children’s beds and make them understand that it’s the mosquitoes that have malaria and make them sick. Even though I don’t have to worry about the mosquitoes in Michigan having malaria, I’m almost considering getting one for my bed at home. The mosquitoes here are also very different. They don’t really swarm you like Michigan mosquitoes do, and they are much smaller and quicker than Michigan mosquitoes. They are also red, which is kind of scary but they are only out at about 7pm and they wont come near you if you’re wearing spray. Tanis and I also keep our nets down during the day, so they don’t really ever have a chance to get under them and attack up.
Today, a patient’s family drove from a neighboring country to MCH because it was the nearest hospital to get care for them. The patient died just as they arrived. This post is dedicated to them.
Day Eight: Journey in the Scanning Room 06.15
Please note: If you’re squeamish, don’t read anything in [brackets.]
I didn’t really get a chance to talk in depth about the surgeries I saw yesterday because I had the internet and wanted to get it posted while I had the interent. To elaborate, I finished helping Mr. Swaray and had a quick lunch, and then joined the OR. Dr. ABD was about halfway through a hernia repair. It looked quite large to me, but he said it was a small one according to his standards. The repair went quickly and without complication. The next procedure Dr. ABD performed was for a woman who had a miscarriage at home, and then started to bleed. [When she came in, they determined that much of the afterbirth remained in her uterus. They decided to go in and remove it before it made her sick. I’ve never experienced anything like it, they used clamps the hold this woman’s vaginal canal open, and used metal rods of increasing width to widen her cervix enough to fit his tools in it. Then he used a thin metal rod with a loop on the end of it to basically scrap all the afterbirth out of her uterus. There was a LOT more than I expected, with lots of blood clots but also clear liquid.]
The next procedure was a quick cleaning of the man who had his testicle removed. They didn’t even put him under, which really surprised me. They pulled the gauze that they left inside the wound out, pushed on the incision a bit and prodded around to makes sure there was no puss or any infection starting, re-packed it, and sent him on his way. The final case was a young boy who came in with to severely injured arms. [One arm had a minor fracture near the wrist, which had originally been treated at home with traditional African medicine. They had poured boiling hot water with herbs in it on his arm, which melted away some of the skin and left the muscle exposed over the fracture. They had already reset the bone properly and cleaned the wound, so they were just checking on it and putting a new bandage on it. The other arm had been injured in the same accident, but his wrist was broken so badly that it was no longer attached to his arm, and his radius and ulna were showing. They had also tried traditional African medicine on that too, but because his bone was exposed when they treated it with their concoction, it melted away a lot of his skin and infected the skin and the bones had become necrotic. His hand was still sort of okay when they brought him in, but the lower are couldn’t be saved and they had amputated. Today they were supposed to do a routine cleaning, but while Dr. Erdi was removing some of the blood clots from the surface (“Bacteria love old blood, they eat it up, if you want infection just add some old blood and you’ll be all set” ~Dr. Erdi) they accidently cut a suture that was keeping a bleeder closed, which started a lot of bleeding. So they had to quick open up a kit and clean it out and sew it up, all while Dr. Erdi got covered in blood.]
After Dr. Erdi changed, she did one final cleaning of the man’s knee that had a cleaning yesterday. No infection today, and on Thursday if all is well Wednesday when they change his bandage and on Thursday when they open then they will put in some pins and start to close him up! I will definitely sit in on that one!
Anyway, this morning I got up at the normal time and had my regular breakfast, then went to Morning Handover. On Wednesday mornings, Dr. ABD, Dr. Erdi, and all the head nurses go on rounds together, but only see the patients that are extra interesting or were miss-diagnosed when they first arrived. It was very interesting, because all the patients you see on this round are the really really exceptional conditions. After Big Rounds, I followed Dr. Erdi on her rounds in the maternity and children’s wards, and by that time it was 14h00 (2:00pm) and time for a late lunch. After lunch, I noticed the lights where on, so I went to see if there was a surgery going on. Normally, the big generator for the whole compound is on from 11h00 to 13h00, and the small generator just for the houses in the back is on from 19h00 to 22h00, but you can always tell when they do a surgery or procedure because they turn on the big generator to power the OR, so all the lights come on. Despite having limited power, I haven’t once felt like I’m without electricity.
Anyway, so I zipped over to the OR, but they had just finished with the procedure, which was just a wound cleaning. So I went to find Dr. Erdi, who was doing ultrasounds in the maternity ward. One of the Creole words I’ve learned is Peecin, which means baby. During the scanning, the conversation goes something like this:
Dr. Erdi: Ha-low, how dee body? (Hello, how are you?)
Patient: Dee body fine, fine. (I’m doing well.)
Dr. Erdi: How long dee belly? (How far along in your pregnancy are you?)
Patient: ___ mont. (___ months.)
Dr. Erdi: How dee peecin? (How’s the baby doing?)
Patient: Dah peecin be fine, fine. (The baby is doing well.)
After a few, Dr. Erdi showed me how to do a physical examination of the fetus by feeling the abdomen, which can tell you about how far along the pregnancy is, and where the head is. Once the head is found, she normally starts by looking at it and using her ultrasound instrument to calculate how far along the pregnancy is based on how big the head and sometimes the femur is. She also looks at the heart, and if it’s beating fine she tells the mother, “Dah peecin be blow fine, fine,” which means that the fetal heartbeat is strong.
Some other Creole that I’ve learned:
“How dee sleep?” How did you sleep?
“How dee morning?” Good morning, how are you?
“Dah peecin be warm?” Does the baby/child have a fever?
“Small, small” A little. They use this a lot to mean a little or small or not much.
“Hum dee dee deedah.” I’m doing much better.
“Light head.” Headache.
“Dah peecin be eat?” Has the baby/child been eating?
“Dah peecin be toilet?” Has the baby/child had a BM today?
“Dah peecin be eatin dee fruit, for make dee toilet soft.” Feed the baby lots of fruits and soft foods to make their stool soft.
It’s just amazing what people just doing understand here as far as hygiene and child care that we find very important in the U.S. Mothers who bring their children into the Hospital are given classes daily about health and hygiene, and one thing that they stress every day is cleaning all eating utensils, bowls, and plants “fine, fine” (very well) before feeding the child out of them. They also pick children up here like they are sacks of rice. They grab them around the upper arm, near the arm pit, and with only one hand swing them onto their backs and secure them there with scarves. I’ll have to take some pictures. They also whip out their breast whenever they whimper just the littlest bit. And most nursing women don’t wear tops, because it’s too much of a hassle to take off their clothes to breast-feed.
Bo, one of the cats who live here with Dr. Erdi, had kittens about three weeks ago, but they never found the kittens. Today we found the only survivor living in one of the spare rooms here in the guesthouse. Unfortunately, Bo seems to have rejected it and will hiss at it if it is near. We don’t know what to do with it, so we might ask Dr. Abel, one of the other doctors who lives on the compound with his family, if his son Elliot would like to have it.
Other than that, it was a pretty quite day. It can be very frustrating being here, because you can see that you’re needed, but they don’t really know how to use you, so at times you can sit doing nothing because no one has anything for you to do.
Here is Sierra Leone, the female coming of age ritual is still widely practiced and includes anywhere between partial to full female castration. Many of the women working here have gone through the process. This post is dedicated to them.
I didn’t really get a chance to talk in depth about the surgeries I saw yesterday because I had the internet and wanted to get it posted while I had the interent. To elaborate, I finished helping Mr. Swaray and had a quick lunch, and then joined the OR. Dr. ABD was about halfway through a hernia repair. It looked quite large to me, but he said it was a small one according to his standards. The repair went quickly and without complication. The next procedure Dr. ABD performed was for a woman who had a miscarriage at home, and then started to bleed. [When she came in, they determined that much of the afterbirth remained in her uterus. They decided to go in and remove it before it made her sick. I’ve never experienced anything like it, they used clamps the hold this woman’s vaginal canal open, and used metal rods of increasing width to widen her cervix enough to fit his tools in it. Then he used a thin metal rod with a loop on the end of it to basically scrap all the afterbirth out of her uterus. There was a LOT more than I expected, with lots of blood clots but also clear liquid.]
The next procedure was a quick cleaning of the man who had his testicle removed. They didn’t even put him under, which really surprised me. They pulled the gauze that they left inside the wound out, pushed on the incision a bit and prodded around to makes sure there was no puss or any infection starting, re-packed it, and sent him on his way. The final case was a young boy who came in with to severely injured arms. [One arm had a minor fracture near the wrist, which had originally been treated at home with traditional African medicine. They had poured boiling hot water with herbs in it on his arm, which melted away some of the skin and left the muscle exposed over the fracture. They had already reset the bone properly and cleaned the wound, so they were just checking on it and putting a new bandage on it. The other arm had been injured in the same accident, but his wrist was broken so badly that it was no longer attached to his arm, and his radius and ulna were showing. They had also tried traditional African medicine on that too, but because his bone was exposed when they treated it with their concoction, it melted away a lot of his skin and infected the skin and the bones had become necrotic. His hand was still sort of okay when they brought him in, but the lower are couldn’t be saved and they had amputated. Today they were supposed to do a routine cleaning, but while Dr. Erdi was removing some of the blood clots from the surface (“Bacteria love old blood, they eat it up, if you want infection just add some old blood and you’ll be all set” ~Dr. Erdi) they accidently cut a suture that was keeping a bleeder closed, which started a lot of bleeding. So they had to quick open up a kit and clean it out and sew it up, all while Dr. Erdi got covered in blood.]
After Dr. Erdi changed, she did one final cleaning of the man’s knee that had a cleaning yesterday. No infection today, and on Thursday if all is well Wednesday when they change his bandage and on Thursday when they open then they will put in some pins and start to close him up! I will definitely sit in on that one!
Anyway, this morning I got up at the normal time and had my regular breakfast, then went to Morning Handover. On Wednesday mornings, Dr. ABD, Dr. Erdi, and all the head nurses go on rounds together, but only see the patients that are extra interesting or were miss-diagnosed when they first arrived. It was very interesting, because all the patients you see on this round are the really really exceptional conditions. After Big Rounds, I followed Dr. Erdi on her rounds in the maternity and children’s wards, and by that time it was 14h00 (2:00pm) and time for a late lunch. After lunch, I noticed the lights where on, so I went to see if there was a surgery going on. Normally, the big generator for the whole compound is on from 11h00 to 13h00, and the small generator just for the houses in the back is on from 19h00 to 22h00, but you can always tell when they do a surgery or procedure because they turn on the big generator to power the OR, so all the lights come on. Despite having limited power, I haven’t once felt like I’m without electricity.
Anyway, so I zipped over to the OR, but they had just finished with the procedure, which was just a wound cleaning. So I went to find Dr. Erdi, who was doing ultrasounds in the maternity ward. One of the Creole words I’ve learned is Peecin, which means baby. During the scanning, the conversation goes something like this:
Dr. Erdi: Ha-low, how dee body? (Hello, how are you?)
Patient: Dee body fine, fine. (I’m doing well.)
Dr. Erdi: How long dee belly? (How far along in your pregnancy are you?)
Patient: ___ mont. (___ months.)
Dr. Erdi: How dee peecin? (How’s the baby doing?)
Patient: Dah peecin be fine, fine. (The baby is doing well.)
After a few, Dr. Erdi showed me how to do a physical examination of the fetus by feeling the abdomen, which can tell you about how far along the pregnancy is, and where the head is. Once the head is found, she normally starts by looking at it and using her ultrasound instrument to calculate how far along the pregnancy is based on how big the head and sometimes the femur is. She also looks at the heart, and if it’s beating fine she tells the mother, “Dah peecin be blow fine, fine,” which means that the fetal heartbeat is strong.
Some other Creole that I’ve learned:
“How dee sleep?” How did you sleep?
“How dee morning?” Good morning, how are you?
“Dah peecin be warm?” Does the baby/child have a fever?
“Small, small” A little. They use this a lot to mean a little or small or not much.
“Hum dee dee deedah.” I’m doing much better.
“Light head.” Headache.
“Dah peecin be eat?” Has the baby/child been eating?
“Dah peecin be toilet?” Has the baby/child had a BM today?
“Dah peecin be eatin dee fruit, for make dee toilet soft.” Feed the baby lots of fruits and soft foods to make their stool soft.
It’s just amazing what people just doing understand here as far as hygiene and child care that we find very important in the U.S. Mothers who bring their children into the Hospital are given classes daily about health and hygiene, and one thing that they stress every day is cleaning all eating utensils, bowls, and plants “fine, fine” (very well) before feeding the child out of them. They also pick children up here like they are sacks of rice. They grab them around the upper arm, near the arm pit, and with only one hand swing them onto their backs and secure them there with scarves. I’ll have to take some pictures. They also whip out their breast whenever they whimper just the littlest bit. And most nursing women don’t wear tops, because it’s too much of a hassle to take off their clothes to breast-feed.
Bo, one of the cats who live here with Dr. Erdi, had kittens about three weeks ago, but they never found the kittens. Today we found the only survivor living in one of the spare rooms here in the guesthouse. Unfortunately, Bo seems to have rejected it and will hiss at it if it is near. We don’t know what to do with it, so we might ask Dr. Abel, one of the other doctors who lives on the compound with his family, if his son Elliot would like to have it.
Other than that, it was a pretty quite day. It can be very frustrating being here, because you can see that you’re needed, but they don’t really know how to use you, so at times you can sit doing nothing because no one has anything for you to do.
Here is Sierra Leone, the female coming of age ritual is still widely practiced and includes anywhere between partial to full female castration. Many of the women working here have gone through the process. This post is dedicated to them.
Tuesday, June 14, 2011
Day Seven: Journey in Under Fives 06.14
One way to get used to the heat and surprisingly makes you sweat less is if you drink massive amounts of water. I’ve been pounding water since I got here, not only because I’ve been super thirsty but because the more I drink the better I feel and because I was loosing so much water sweating. But the more water I drink, the less I sweat, or maybe I just don’t notice it any more. Anyway I’m much more used to the heat, and I can tell it’s hot but I don’t feel obsessed by it any more. The water here is from the tap in our house, which comes unfiltered up from a well, and then we fill up our fancy filter thing and the water it filters is safe to drink. Or at least I have been believing it is because Charlotte and Nicole haven’t gotten sick off of it, and neither have I as of yet. The filter is made up of two large metal pail shaped containers that fit one on top of each other. The top on has two of the filters screwed in, so that the water is pulled down to the bottom container through them. I don’t know what the filters are made of (they look like some sort of calcified salt) or how they work, but I guess they work fine because I feel good.
Even though I slept well last night I didn’t want to get up. Yesterday was a big day and I was very tired. Finally I got myself out of bed and had breakfast. Today Jack made oatmeal and cut up pineapple to go with breakfast. I decided to go down with Nicole to the “Under Fives” clinic, where they see all children under five. The Sierra Leone government offers free vaccinations as long as they are all give to the child by the time they are nine months old, and discount health care to every child under five if they have the right card. At the Under Fives clinic here, we treat all children at the discounted rate, because otherwise parents might not bring their child in. Children are not of the same importance here as they are in the U.S. Here, the man of the household and all the other adults are fed first, and the younger you are the less likely you are to be fed if you have a big family, which is why they have a lot of malnutrition. Most of the children who come through for treatment are diagnosed basically on the spot with malaria since it’s so common, are given a bag with medication, and sent out the door. The more severe cases get admitted to the hospital.
To give you an idea of what happens at Under Fives, here’s the process. First, all the women with their children line up to wait to be seen. And the head nurse, Sally, makes us wait until there’s a nice long line before we actually start checking kids in. After there’s a like of about thirty, we can start. To check a child in, the mother steps up to the desk and Sally asks them to pay. She then asks for their Under Five card, and starts recording their information. About halfway through recording their information, she strikes up a conversation with someone nearby. It doesn’t matter whom, just anyone in the vicinity. About ten minutes later, she’s recorded info that should have taken a minute or so to record and passes the paper she’s filled out on to the next person and the Under Five card back to the mom. The next person copies down the name of the patient, the address and sex of the patient, and the tribe of the father. They normally do so very slowly, because normally it’s not someone literate, so they copy each letter as they see it very slowly. Then the sheet would be passed to me, so that I could record the patients name, sex, age, and whether or not they paid in another book, as well as get their temperature from Charlotte who takes temperatures before the kids get to the front of the line, and the weight from Nicole. Only after I’ve finished does Sally start on the next patient, so each one takes 15 minutes or so. It’s so frustrating, because it could go so much faster, but if you try to push them to go faster, they get confused and mess up, so you can’t go any faster.
At about 10h45 (10:45am) I got so annoyed with it that I had to go find something else to do. Tuesdays are surgery days, so I went to check if surgeries were going to start on time, which is 11h00 (11:00am). When I went up to check, they weren’t anywhere near ready to start, so I went to find Mr. Swaray, who works in the Under Fives and the TFC. He has a document that he has on paper, but wanted on his computer so that he could type it up rather than make a copy and hand write it every month. The problem is, it’s a document that was made in Excel with blanks that he wanted to fill in. He told me he has no idea how to get it on his computer, so I told him I would try. His computer is actually pretty up to date, and I was able to make the document in Excel for him, and showed him how he now has a blank, template version, so at the end of the month when he fills it out, he just needs to rename it for that month, and he’ll always have a blank one to work with. He was so happy, he kept telling me how happy he was, and telling me he’ll bring me something tomorrow, and that he’s just amazed at how it all works. I’m happy I got to do something that makes me feel like I accomplished something.
I also watched a hernia repair today, which was fairly standard, and the cleaning of an amputated arm, the same leg from yesterday, and watch the uterine scraping of a woman who miscarried at home. I have pictures of some of it, and will post some soon.
After surgery I took a nap because I was so tired, and for dinner a huge group joined us. Katherine, who’s from a school in Indian, who stays in Makeni and does research, Rudy, the German repair man, a French woman named Audrey who is here in Makeni for another month volunteering, and an English couple who work at another hospital north of here. So far, a very laid-back day.
Charlotte has been doing research about the civil war here, and has found that most people lost family members during the fighting. This post is dedicated today.
Even though I slept well last night I didn’t want to get up. Yesterday was a big day and I was very tired. Finally I got myself out of bed and had breakfast. Today Jack made oatmeal and cut up pineapple to go with breakfast. I decided to go down with Nicole to the “Under Fives” clinic, where they see all children under five. The Sierra Leone government offers free vaccinations as long as they are all give to the child by the time they are nine months old, and discount health care to every child under five if they have the right card. At the Under Fives clinic here, we treat all children at the discounted rate, because otherwise parents might not bring their child in. Children are not of the same importance here as they are in the U.S. Here, the man of the household and all the other adults are fed first, and the younger you are the less likely you are to be fed if you have a big family, which is why they have a lot of malnutrition. Most of the children who come through for treatment are diagnosed basically on the spot with malaria since it’s so common, are given a bag with medication, and sent out the door. The more severe cases get admitted to the hospital.
To give you an idea of what happens at Under Fives, here’s the process. First, all the women with their children line up to wait to be seen. And the head nurse, Sally, makes us wait until there’s a nice long line before we actually start checking kids in. After there’s a like of about thirty, we can start. To check a child in, the mother steps up to the desk and Sally asks them to pay. She then asks for their Under Five card, and starts recording their information. About halfway through recording their information, she strikes up a conversation with someone nearby. It doesn’t matter whom, just anyone in the vicinity. About ten minutes later, she’s recorded info that should have taken a minute or so to record and passes the paper she’s filled out on to the next person and the Under Five card back to the mom. The next person copies down the name of the patient, the address and sex of the patient, and the tribe of the father. They normally do so very slowly, because normally it’s not someone literate, so they copy each letter as they see it very slowly. Then the sheet would be passed to me, so that I could record the patients name, sex, age, and whether or not they paid in another book, as well as get their temperature from Charlotte who takes temperatures before the kids get to the front of the line, and the weight from Nicole. Only after I’ve finished does Sally start on the next patient, so each one takes 15 minutes or so. It’s so frustrating, because it could go so much faster, but if you try to push them to go faster, they get confused and mess up, so you can’t go any faster.
At about 10h45 (10:45am) I got so annoyed with it that I had to go find something else to do. Tuesdays are surgery days, so I went to check if surgeries were going to start on time, which is 11h00 (11:00am). When I went up to check, they weren’t anywhere near ready to start, so I went to find Mr. Swaray, who works in the Under Fives and the TFC. He has a document that he has on paper, but wanted on his computer so that he could type it up rather than make a copy and hand write it every month. The problem is, it’s a document that was made in Excel with blanks that he wanted to fill in. He told me he has no idea how to get it on his computer, so I told him I would try. His computer is actually pretty up to date, and I was able to make the document in Excel for him, and showed him how he now has a blank, template version, so at the end of the month when he fills it out, he just needs to rename it for that month, and he’ll always have a blank one to work with. He was so happy, he kept telling me how happy he was, and telling me he’ll bring me something tomorrow, and that he’s just amazed at how it all works. I’m happy I got to do something that makes me feel like I accomplished something.
I also watched a hernia repair today, which was fairly standard, and the cleaning of an amputated arm, the same leg from yesterday, and watch the uterine scraping of a woman who miscarried at home. I have pictures of some of it, and will post some soon.
After surgery I took a nap because I was so tired, and for dinner a huge group joined us. Katherine, who’s from a school in Indian, who stays in Makeni and does research, Rudy, the German repair man, a French woman named Audrey who is here in Makeni for another month volunteering, and an English couple who work at another hospital north of here. So far, a very laid-back day.
Charlotte has been doing research about the civil war here, and has found that most people lost family members during the fighting. This post is dedicated today.
Day Six: Journey in Magbenteh Community Hospital 06.13
Today was a landmark day for Alison Hemenway in Sierra Leone. Not only was it my first day in the hospital, but this morning, while I was sleeping, I felt cold. Not like I’m-shivering-it’s-so-cold-right-now kind of cold, but I felt chilled. Enough to pull my sheet over me while I was sleeping. So before I even woke up, I knew it was going to be a big day.
This morning I woke up at about 7h00 (7:00am) and had a breakfast of half a loaf of bread with peanut butter. The loafs of bread here look a bit like a short baguette, about ten or twelve inches long with a crisp outside and very soft inside. They aren’t very thick, but having half a loaf of bread is about the equivalent of a medium to large bagel. They are very delicious actually. What people normally have to drink is hot coco…even though it’s hotter here than the warmest day in Michigan. But everyone thinks it’s cold so they have hot coco, and because I was chilled (Yay for being used to the heat!) I tried it. It’s very different from U.S. hot coco, but still very good.
Each morning at 8h00 (8:00am) they have a meeting with all the head night shift nurses and the new nursing staff that’s coming in for the day shit called Morning Handover. They basically review what has happened over the night as far as beds full, beds empty, number of patients, if anyone was discharged or passed away during the night, and so on. Then they have nurse presentations. Each nurse takes a turn researching a topic and presenting what he or she find to the rest of the nurses. Today a nurse presented on the different parts of the abdomen and what organs are there. It is really helpful to know because you can diagnose why people have abdominal pain if you know what organs are in the area where the pain is. After he finished his presentation, Dr. Erdi introduced Tanis, Elizabeth, and I to the nurses.
We decided after Morning Handover that I would follow Dr. ABD, Elizabeth would follow Dr. Erdi, and Tanis would hang out with Nicole in the Therapeutic Feeding Center (TFC). I started to follow Dr. ABD but he kept getting distracted by people asking for help, so he told me and his nurses aid, Alpha, to go to the Male Ward and start rounds and that he would catch up. Before we barely started Alpha asked me if I wanted to do the writing in the charts. I told him I might try it tomorrow. About ten minutes later her asked if I would marry him, and I told him that I didn’t think that would work out. Then he asked if I would be his friend, and I told him that I would, and he seemed pleased.
We went around, and I saw so many things that I have never seen before, and would never see in the U.S. There were two men who had sections of their intestines removed because typhoid had absolutely destroyed it. One man was diagnosed (by me, whoa!) with tuberculosis and I got to listen to his lung sounds. There were two men who had strokes, one man who they had no idea what was wrong with him, and one man that they thought might have diabetes. Lots of men recovering from severe malaria and typhoid. Another couple had recently had operations to repair hernias. One man came in with leg pain, and an X-ray relieved server osteomyelitis, or bone rot, in the upper section of his tibia. Dr. ABD decided to remove it and operated to do so three months ago. Most doctors in the US would have just amputated the leg, on the rare possibility that a doctor in the U.S. were to see any injury the progressed for the first time.
There was also a man in the male ward that had cardiomyopathy, who’s heart was severely enlarged and so was his liver and spleen. I believe Dr. ABD told me that there was fluid building in his lungs and abdomen, and you could see the ripple of the heart beat down into the chest cavity. Dr. ABD let me feel the enlarged liver and spleen. The man also had conjunctivitis, and I think malaria too. He will be treated for malaria and conjunctivitis, and given medication for his heart, but odds are he wont last long because they can’t really do anything about it here.
In the female ward, Dr. ABD saw a woman who’s spleen was severely enlarged, so much so that you didn’t even have to touch her stomach and feel for the spleen to know, it was so large it was protruding and could be seen through the wall of her abdomen. She also had very swollen legs. In the States, a specialist would be called in for an emergency spleen-ectomy (spleen removal surgery), but here it is a very tricky operation that they wont do until they have no other choice. They will treat her for malaria (which she also has) and see if that improves things.
Almost everyone who comes into the hospital, even if they come in because their leg is hurting, has malaria. And odds are if a male patient comes in for leg pain, he hurt himself falling out of a mango tree. And odds are they tried traditional African medicine first before coming to MCH, which consists of pouring a solution of boiling hot water and herbs onto it, which melts the skin away and causes infection, making the situation much worse than it needs to be.
So after I followed Dr. ABD on his rounds, he had a meeting with Marcel so I went to have lunch. Lunch consists of the same bread from breakfast, the topping of your choice, and whatever you brought from home. So after bread, a cheese stick, and a piece of beef jerky, I went to find Dr. ABD, but he wasn’t back in his office yet so I found Dr. Erdi about to start giving ultrasounds to pregnant women. Sierra Leone has a government operation that has been attempting to encourage family planning, good fetal care, and HIV testing during pregnancy. After about three, Marcel came in to ask Dr. Erdi for help and told me that Dr. ABD was back in his office, so I went to find him. When he finally emerged from his office, I asked if I could keep following him and his said of course and took off. I followed him and before I knew it I was being told to put on scrubs and get ready to go into the OR.
The first procedure was just supposed to be a dressing change for the patient I mentioned earlier that had part of his bone taken out. When they started to remove his dressings, they found maggots, but Dr. ABD wasn’t concerned because they were just on the surface, and maggots only eat dead flesh anyway. They removed all the old dressing, or so I’d thought, when they started pulling a tremendous amount of gauze out of the wound. I had no idea that must gauze could fit in a knee! The man had a large incision on the right side of his left knee starting about mid knee and extending down about four inches, an incision below his knee on the left side about one inch long, and another incision above his knee on the left about two inches long. Dr. ABD let me get really close and see where they’d removed a section of bone, and it was very cool. Part of the remaining bone still didn’t look so good, and he said they might have to remove more later. When they began to clean the incision above his knew on the left side, they found an infection above the incision inside the leg, because when they pushed on the leg above the incision pus came out. I’ve never seen any procedure so invasive. Dr. ABD stuck his finger in any hole he could find, and fished around like crazy. In attempt to get the infection out of the incision that had the pus, he stuck his finger up in the patient’s leg as far as it would go and made another incision at the end of his finger so that he could flush the area out with iodine. After the procedure he told me that while most doctors in developed countries would have just amputated, he sees value in saving as much of the leg as he can. To me it seems like they could avoid a lot of potential infection by amputating, but he’s in charge so I didn’t say anything.
The second procedure was actually an emergency operation on a man who originally came in for a hernia, which was prepared, and then some bleeding complications that required emergency surgery. And after all that, Dr. ABD found out that one of his testis was necrotic (dead or infected) and should be removed. And can you believe he could tell that by how it smelled!?! So the patient was re-opened where his original incision was, which was a two or three inch vertical incision across the middle of the abdomen about four inches below the belly button. Dr. ABD also made another incision downward from the middle of the original incision about four or five inches, and had his assistant use metal tong like things to hold the incision wide open while got like both hands inside this guy. After a while, he pulled out the necrotic testi and removed it. One of the nurses, Abby, had trained herself in her spare time in some of the elementary anesthesiology involved in surgery, and she started giving me things to do, which was awesome!
One things I was totally not prepared for was the amount of surgeries that they keep the patient open afterward. Both with the man’s leg and with the testi-ectomy (testi removal surgery) Dr. ABD packed the wound with gauze and intends to go back in on Wednesday if everything looks good during rounds tomorrow morning and clean it again. Later in the day Dr. Erdi told me that this is common with patients who have an infection, but not so for patients who have regularly scheduled surgeries.
Once the two procedures where over, Dr. ABD had another meeting to go to so I went in to observe as Dr. Abel saw patients in the OPD (out patient department). All patients start in the OPD and if they are severe enough are admitted but most of the time are sent home with medications. One woman was found to be pregnant, with malaria and typhoid. She was pleased because she only has one other child. The malaria medication is not a problem to take when pregnant, but most typhoid drugs are not recommended for pregnant women. Luckily there happened to be some typhoid drugs on hand that doesn’t have any warnings for pregnant women. Another patient, male, was found to have syphilis and severe typhoid, but his main concern was his sex drive. He kept asking if the drugs were going to help him get is libido back, and I’m pretty sure that the nurse eventually lied and told him the typhoid drugs where to get it back.
Thinking that exciting part of the day was over, we sat down to dinner and swapped the stories for that day over a wonderful meal of very spicy pasta with sausage, some sort of beef that had been fried with onions, fried plantains with sugar on them, fruit salad, and salad. We were all sort of chillaxing, doing our own thing, and I was in my room when a bat flew in. While Tanis was in the shower. And it flew around all menacing and I barely got away. We finally got it out into the common room, and we’re pretty sure it’s out of the house, but we’re keeping our bedroom door closed tonight just in case. And now it’s time to fall asleep to rain on a tin roof.
When I first arrived here, I met a little boy named Abulay. His mother brought him here to the TFC a year and half ago, and left him here while he was getting treatment to pick something up at the market and never came back. He has been living here as an orphan since, and always has a smile on his face even though the workers yell at him and treat him poorly. Today I found out that he’s very sick, they think he has malaria. This post is dedicated to him.
This morning I woke up at about 7h00 (7:00am) and had a breakfast of half a loaf of bread with peanut butter. The loafs of bread here look a bit like a short baguette, about ten or twelve inches long with a crisp outside and very soft inside. They aren’t very thick, but having half a loaf of bread is about the equivalent of a medium to large bagel. They are very delicious actually. What people normally have to drink is hot coco…even though it’s hotter here than the warmest day in Michigan. But everyone thinks it’s cold so they have hot coco, and because I was chilled (Yay for being used to the heat!) I tried it. It’s very different from U.S. hot coco, but still very good.
Each morning at 8h00 (8:00am) they have a meeting with all the head night shift nurses and the new nursing staff that’s coming in for the day shit called Morning Handover. They basically review what has happened over the night as far as beds full, beds empty, number of patients, if anyone was discharged or passed away during the night, and so on. Then they have nurse presentations. Each nurse takes a turn researching a topic and presenting what he or she find to the rest of the nurses. Today a nurse presented on the different parts of the abdomen and what organs are there. It is really helpful to know because you can diagnose why people have abdominal pain if you know what organs are in the area where the pain is. After he finished his presentation, Dr. Erdi introduced Tanis, Elizabeth, and I to the nurses.
We decided after Morning Handover that I would follow Dr. ABD, Elizabeth would follow Dr. Erdi, and Tanis would hang out with Nicole in the Therapeutic Feeding Center (TFC). I started to follow Dr. ABD but he kept getting distracted by people asking for help, so he told me and his nurses aid, Alpha, to go to the Male Ward and start rounds and that he would catch up. Before we barely started Alpha asked me if I wanted to do the writing in the charts. I told him I might try it tomorrow. About ten minutes later her asked if I would marry him, and I told him that I didn’t think that would work out. Then he asked if I would be his friend, and I told him that I would, and he seemed pleased.
We went around, and I saw so many things that I have never seen before, and would never see in the U.S. There were two men who had sections of their intestines removed because typhoid had absolutely destroyed it. One man was diagnosed (by me, whoa!) with tuberculosis and I got to listen to his lung sounds. There were two men who had strokes, one man who they had no idea what was wrong with him, and one man that they thought might have diabetes. Lots of men recovering from severe malaria and typhoid. Another couple had recently had operations to repair hernias. One man came in with leg pain, and an X-ray relieved server osteomyelitis, or bone rot, in the upper section of his tibia. Dr. ABD decided to remove it and operated to do so three months ago. Most doctors in the US would have just amputated the leg, on the rare possibility that a doctor in the U.S. were to see any injury the progressed for the first time.
There was also a man in the male ward that had cardiomyopathy, who’s heart was severely enlarged and so was his liver and spleen. I believe Dr. ABD told me that there was fluid building in his lungs and abdomen, and you could see the ripple of the heart beat down into the chest cavity. Dr. ABD let me feel the enlarged liver and spleen. The man also had conjunctivitis, and I think malaria too. He will be treated for malaria and conjunctivitis, and given medication for his heart, but odds are he wont last long because they can’t really do anything about it here.
In the female ward, Dr. ABD saw a woman who’s spleen was severely enlarged, so much so that you didn’t even have to touch her stomach and feel for the spleen to know, it was so large it was protruding and could be seen through the wall of her abdomen. She also had very swollen legs. In the States, a specialist would be called in for an emergency spleen-ectomy (spleen removal surgery), but here it is a very tricky operation that they wont do until they have no other choice. They will treat her for malaria (which she also has) and see if that improves things.
Almost everyone who comes into the hospital, even if they come in because their leg is hurting, has malaria. And odds are if a male patient comes in for leg pain, he hurt himself falling out of a mango tree. And odds are they tried traditional African medicine first before coming to MCH, which consists of pouring a solution of boiling hot water and herbs onto it, which melts the skin away and causes infection, making the situation much worse than it needs to be.
So after I followed Dr. ABD on his rounds, he had a meeting with Marcel so I went to have lunch. Lunch consists of the same bread from breakfast, the topping of your choice, and whatever you brought from home. So after bread, a cheese stick, and a piece of beef jerky, I went to find Dr. ABD, but he wasn’t back in his office yet so I found Dr. Erdi about to start giving ultrasounds to pregnant women. Sierra Leone has a government operation that has been attempting to encourage family planning, good fetal care, and HIV testing during pregnancy. After about three, Marcel came in to ask Dr. Erdi for help and told me that Dr. ABD was back in his office, so I went to find him. When he finally emerged from his office, I asked if I could keep following him and his said of course and took off. I followed him and before I knew it I was being told to put on scrubs and get ready to go into the OR.
The first procedure was just supposed to be a dressing change for the patient I mentioned earlier that had part of his bone taken out. When they started to remove his dressings, they found maggots, but Dr. ABD wasn’t concerned because they were just on the surface, and maggots only eat dead flesh anyway. They removed all the old dressing, or so I’d thought, when they started pulling a tremendous amount of gauze out of the wound. I had no idea that must gauze could fit in a knee! The man had a large incision on the right side of his left knee starting about mid knee and extending down about four inches, an incision below his knee on the left side about one inch long, and another incision above his knee on the left about two inches long. Dr. ABD let me get really close and see where they’d removed a section of bone, and it was very cool. Part of the remaining bone still didn’t look so good, and he said they might have to remove more later. When they began to clean the incision above his knew on the left side, they found an infection above the incision inside the leg, because when they pushed on the leg above the incision pus came out. I’ve never seen any procedure so invasive. Dr. ABD stuck his finger in any hole he could find, and fished around like crazy. In attempt to get the infection out of the incision that had the pus, he stuck his finger up in the patient’s leg as far as it would go and made another incision at the end of his finger so that he could flush the area out with iodine. After the procedure he told me that while most doctors in developed countries would have just amputated, he sees value in saving as much of the leg as he can. To me it seems like they could avoid a lot of potential infection by amputating, but he’s in charge so I didn’t say anything.
The second procedure was actually an emergency operation on a man who originally came in for a hernia, which was prepared, and then some bleeding complications that required emergency surgery. And after all that, Dr. ABD found out that one of his testis was necrotic (dead or infected) and should be removed. And can you believe he could tell that by how it smelled!?! So the patient was re-opened where his original incision was, which was a two or three inch vertical incision across the middle of the abdomen about four inches below the belly button. Dr. ABD also made another incision downward from the middle of the original incision about four or five inches, and had his assistant use metal tong like things to hold the incision wide open while got like both hands inside this guy. After a while, he pulled out the necrotic testi and removed it. One of the nurses, Abby, had trained herself in her spare time in some of the elementary anesthesiology involved in surgery, and she started giving me things to do, which was awesome!
One things I was totally not prepared for was the amount of surgeries that they keep the patient open afterward. Both with the man’s leg and with the testi-ectomy (testi removal surgery) Dr. ABD packed the wound with gauze and intends to go back in on Wednesday if everything looks good during rounds tomorrow morning and clean it again. Later in the day Dr. Erdi told me that this is common with patients who have an infection, but not so for patients who have regularly scheduled surgeries.
Once the two procedures where over, Dr. ABD had another meeting to go to so I went in to observe as Dr. Abel saw patients in the OPD (out patient department). All patients start in the OPD and if they are severe enough are admitted but most of the time are sent home with medications. One woman was found to be pregnant, with malaria and typhoid. She was pleased because she only has one other child. The malaria medication is not a problem to take when pregnant, but most typhoid drugs are not recommended for pregnant women. Luckily there happened to be some typhoid drugs on hand that doesn’t have any warnings for pregnant women. Another patient, male, was found to have syphilis and severe typhoid, but his main concern was his sex drive. He kept asking if the drugs were going to help him get is libido back, and I’m pretty sure that the nurse eventually lied and told him the typhoid drugs where to get it back.
Thinking that exciting part of the day was over, we sat down to dinner and swapped the stories for that day over a wonderful meal of very spicy pasta with sausage, some sort of beef that had been fried with onions, fried plantains with sugar on them, fruit salad, and salad. We were all sort of chillaxing, doing our own thing, and I was in my room when a bat flew in. While Tanis was in the shower. And it flew around all menacing and I barely got away. We finally got it out into the common room, and we’re pretty sure it’s out of the house, but we’re keeping our bedroom door closed tonight just in case. And now it’s time to fall asleep to rain on a tin roof.
When I first arrived here, I met a little boy named Abulay. His mother brought him here to the TFC a year and half ago, and left him here while he was getting treatment to pick something up at the market and never came back. He has been living here as an orphan since, and always has a smile on his face even though the workers yell at him and treat him poorly. Today I found out that he’s very sick, they think he has malaria. This post is dedicated to him.
Day Five: Journey in Magbenteh 06.12
In Sierra Leone, as soon as the sun starts rising the birds go crazy. Not like they do in the U.S. in the mornings, they are loud and they live in very dense populations in the mango trees, and they are quite colorful. It’s almost impossible to sleep after about 8, since the sun is fully risen and the birds are so loud, but it doesn’t matter much because the power goes out at 22h00 (10:00pm) and there’s really nothing to do since it’s SO dark, everyone goes to bed. Without a flashlight, you wouldn’t have any hope of finding your way from your bed to the attached bathroom in the night. Dark in Africa is a different kind of dark.
So we got up about 7:30 and I read for a bit outside before Dr. Erdi walked by and said she was going into town to find bread and asked who wanted to go with her, so of course I went along. Many “traders” (the families who sell things on the street) set up stands alone the main road where the car traffic is, so you can pull over a bit and ask for things through the window. It’s like the African version of a drive-thru, only with much better bread, and I wouldn’t trust any of the meat…
Once we got back to the compound, I wondered into the kitchen where Charlotte was making our fruit salad for our “special breakfast” that Dr. Erdi wanted to have with us and asked what I could do to help. Come to find out, no one had ever eaten a pineapple still in the rind before, so I jumped up and started cutting it. We also decided to make pancakes, but no one knew how to make pancakes from scratch. Except for the girl who’s dad has made pancakes from scratch all her life. Thanks dad!!! Haha, so I guessed at the ratio of egg to flour, and told them to mix in and start adding milk until it was thinner than they would think it should be. While they were doing that, I started frying the beacon. Once we decided the pancake mixture was good, I started frying them up. Once we had breakfast ready, we had our first “African” breakfast, and I was deemed the “domestic” one, and in charge of breakfast on Sundays henceforth.
Every day except for Sunday we have a cook to make us breakfast and dinner, and lunch is on our own (basically bread with the topping of your choice). On Sundays all meals are on our own. So after a breakfast of fruit salad, pancakes, and bacon, we mostly hung out and read. There are two cats that live with Dr. Erdi but spend quite a bit of time here at the guesthouse. Their names are Bo and Freetown, and they are full-grown but look like kittens! Every animal, even humans, seems not to get as big here, and I’m not just referring to the American epidemic of obesity. All the dogs are on the small to medium side, and none of them are what I would call big by any means. Most of the men are shorter than I am, and the women even shorter.
At about 11h00 (11:00am) we heard screaming and wailing from the Children’s ward. Later we found out that a young boy that Dr. Erdi had operated on Thursday of last week passed away. When he arrived, he had severe Typhoid, and had so many bowel perforations that Dr. Erdi didn’t think he would make it, but she operated anyway. It seems that it didn’t make a difference, since his kidneys ended up shutting down.
In between the unpacking, reading, playing card games, and napping the wind started to pick up, which is very unusual for Magbenteh and Sierra Leone as a whole. Then it poured hard for about thirty or forty minutes and everything cooled down and it was so nice!
At about 17h30 (5:30pm) we went over to Dr. ABD’s house, who had invited us over for a special meal and to spend time with him and his wife, Koomba. They have a nice big house, but it is crowded because all his extended family assumes that he has lots of money and so they come to stay with him and think they will live off of him. They had a beautiful table set for us, and his wife made lots of good food like fried and spicy chicken and fried rice. His wife is beautiful and so nice, as is his whole family. After we all ate, we were rested and we noticed that some of the people living with Dr. ABD, especially the smaller children, were crowding near the doorways to peek at us. Tanis started playing hand games with them, and before we knew it the room was full of children and teenagers asking us to “snap” them, which meant take a picture of them, or asking our names and teaching us their rhymes and such. Clem started just doing really goofy things with a group of kids, and they started imitating everything she did and it was a RIOT!!! I got a video of it, it was great.
After a while, Dr. ABD came back in the room to find us having a party without him, and only then did we realize that he wasn’t there any more. One of our friends, Marcel, had gotten stuck trying to get his car out of Dr. ABD’s driveway and Dr. ABD had been helping him out. After a little bit, we decided it was time to head back home. When we drove near the market area, I thought it would be dead. On the contrary, it was even busier than it had been when we’d gone during the day! Everyone seemed to be hanging out there, and everyone was just walking down the middle of the road, and the motorcycles were driving just as reckless as they do during the day, it was insane!
Once we got back to the compound, we only had a little while before the lights went off, so we counted up all the medicine that Tanis had to donate to MCH, I showered, and now it is time for bed. Tomorrow I plan on following Dr. Erdi on her rounds to see what she does here at the hospital.
This post is dedicated to the young boy who died today of kidney failure.
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