Early this morning about 3h30 or so, I woke up to someone pounding on our door and calling out to Taylor and I. I was still a little drowsy, but then I heard them say, “It’s Gay! I really need to talk to you guys!” So I went out there and let her in, and because my mind was in hyper paranoid mode, I locked the door behind her. She told me that she was sorry for waking me, but that she was in a tough situation because she found out that her flight home actually left later today in the afternoon. She started handing me things and telling me to please give them to this or that person, and asking me to tell so-and-so goodbye. Then she asked me if I remembered the woman she’d gone with for the weekend, and I told her I did. On Friday when we were at the clinic two men and a woman from the Sierra Leonean side of the organization that sent her met up with her and took her for the weekend to tour Freetown and Bunce Island. Gay told me that her relationship with this woman was a ‘little strange’ and that she was going to go to the police station early the next morning to speak on her behalf, so she had to go shower, change, pack, and go. I was really surprised, but too tired to really process anything, anything. And when someone wakes you up and seems frantic in the middle of the night, your mind goes into ‘emergency situation’ mode, so when I went back to bed I kept wondering if I’d remembered to lock the door after her and wondering if people were watching me through the windows and trying to get in the house.
In the morning I found out that Gay only told what was going on, she didn’t even tell Dr. ABD or Erdi. The matron asked me if I could wait until tomorrow to present CPR part two because Monday’s are normally very busy. Normally all the wards are supposed to report at Handover, but the nurse from Female ward showed up late and then didn’t come in, she just stood by the door and when the Matron dismissed everyone she ran off and left first out of almost everyone.
I decided to go to wound care and help Kady after Handover. Apparently over the weekend they ‘didn’t have time’ to do dressings for some of the people who have really terrible wounds that require daily dressings, so their wounds looked bad and smelled horrible. I told Kady on one of them that she needed to take over, but I had been doing them myself no that I’ve gotten to know how to do it. I mentioned it to Dr. ABD later, that some patients had gone all weekend without having their wounds cleaned, and he was a little upset by that. He took a quick look at the two patients that he’d done amputations on, one was to foot, and other was the toe, and both looked good. There weren’t any emergency surgeries, so Dr. ABD told us we didn’t have much left to see at the hospital.
After a quick lunch, we went down to the TFC and filmed our video on Family Planning. It was so funny to hear what the Creole translation of some of the information was. When they were talking about the different kinds of birth control that Magbenteh Hospital offers, Musa would end almost every explanation with, “You and you partner just enjoy you selfs, ‘n no worry about the pikin for come!” (Pikin means baby.) And then he would smile this little smile that was just so funny, like he was trying to say, ‘and you know what kind of enjoyment I’m talking about!’
After we finished that video, we made a video about antenatal care, which also went really well and we got Musa and Abi to translate for us. In the late afternoon we played about three rounds of euchre before dinner, which was really good! They have this strange fruit called breadfruit here that you can peal and fry and it turns out like French fries!
After dinner we were hanging out and Dr. Erdi came in and asked if she could get a couple volunteers to scrub in for a C-section, and Taylor and I immediately raised our hands. We all ran over to the theatre and I scrubbed in while Taylor helped the midwife. The baby was laying transverse, or side-to-side. It was very difficult to get the baby out, and they had to resuscitate the baby, but it started breathing fine after three minutes or so. Another successful surgery added to my resume!
This post is dedicated to a patient in male ward who died after severe typhoid. He had a laporotomy but not all repairs could be made, and he passed away shortly after receiving a blood transfusion.
Tuesday, July 26, 2011
Day Forty-seven: A Rainy Day at the Beach 07.24
This morning we got up at 7h30 and packed our backpacks with snacks for the road and the beach and were ready to sit and have breakfast and wait for Dr. ABD, who was undoubtedly going to be late. When we got to the main house, we found Erdi busy in the kitchen making us scrambled eggs with ham and cheese! I was so excited! She had heard me mention the night before that I missed good breakfast food, and said, “Hey! We can do that here!” and made it happen for us! It was so good!
By about 8h30 or 8h45, Dr. ABD arrives and told us that he’d had a flat tire on his car that needed repairing before he arrived. We started discussing what car to take, and realized that we would have five going down but nine coming back, so we needed to take a second car. Dr. ABD called about three different drivers, and none of them answered. Then he asked Marcel or Dr. Abel and his family if they would join us and possibly drive, but it was too short of notice. So Dr. ABD called the friends that Gay had gone to Freetown and Bunce Island with and asked them instead of meeting up with us and dropping Gay off with us if they could take some of us and follow us to Makeni, and since they had borrowed Dr. ABD’s car anyway they said yes. On the way down I interviewed Dr. ABD about HIV and Hep B for my research project, and talked a lot about the state of health care in terms of HIV and Hep B in Sierra Leone, it was very interesting.
When we got to the Freetown area we decided to take the road that sort of goes up and around Freetown to get to the Bay Road and take that to the beach rather than getting on Bay Road in Freetown and following it all the way to River No. 2, our destination. When we got there though, there was a giant traffic jam and we had to turn around and back track all the way to where the Bay Road starts in Freetown, adding two hours to our journey. After being nice and sunny, but not too hot, all day it started raining about 30 minutes before we got to the beach. We sat in the little restaurant hut the entire time and enjoyed the view and ate really amazing shrimp and rice. A meal and two drinks cost me $10.25, and the meal was big. It was ten huge shrimp on skewers that had been seasoned with a little spice and grilled perfectly, with rice that had been fancied up with a little tomato sauce and spices, and a little sauce on the side that was sautéed onions and carrots that was also seasoned really well. I mixed them all together and it was delicious! I was so sad that I couldn’t eat it all, but I got so full after half of it that I knew I would be sick on the ride home if I ate any more. There were guys walking around selling wooden carved stuff, and so I bought a goofy little bracelet off of one of the guys. It appears fine until you really look at the design that he carved into the sides. Little hearts that say, “I love you,” inside them. I figure that this place is a little goofy, so a souvenir that reflects that is perfect.
Gay finally met up with us at about 15h30, and Dr. ABD was very happy because he was antsy to start home. However, Gay and her party explained that they were hoping to stay in Freetown for the night and then head back to Makeni in the morning. Dr. ABD was a little upset but said, “Okay, I guess we all have to fit in the car!” We ended up with two in the far back, which really only fits one, and four in the middle. When we were all trying to fit, John asked if he could sit up front because he’s the only guy and he felt a little awkward about squeezing in with all us girls, so I told him he could since I’d sat up front on the way down. He got in though, and Dr. ABD told him to get out and let someone bigger sit there so that it would be easier to fit four people in the middle seat, and told me to sit up front. I was happy to have the front seat, and I am much taller and unlike John who is very thin I have my big woman hips, but I was a little sad that Dr. ABD thinks ‘da body be fat fat’ as the locals would say here. I made a joke about it, and he said, “No, my dear! You have body!” Which is like telling someone that they have a fit or athletic frame.
On the way back Ashley interviewed Dr. ABD about the hospital for a paper she’s writing. Apparently all she has to do is write a paper about something dealing with her POE, which is international healthcare, and she gets four credits for it! Lucky bum! It was really interesting to hear about all that it took to start the hospital, and all the speed bumps there have been along the way.
When we got back in the evening, I decided to organize my things and figure out what I’m leaving here for the hospital and what I’m taking back, so I started sorting through things and sort of packing things that I know I wont use this week. Taylor told me I was crazy, but ten minutes later they were all doing the same thing. When we were finished we took the stuff over to Erdi, who was happy to have it, and deiced we should watch the rest of “The Sound Of Music” that we started Friday. I can’t believe I’ll be home in four days!
By about 8h30 or 8h45, Dr. ABD arrives and told us that he’d had a flat tire on his car that needed repairing before he arrived. We started discussing what car to take, and realized that we would have five going down but nine coming back, so we needed to take a second car. Dr. ABD called about three different drivers, and none of them answered. Then he asked Marcel or Dr. Abel and his family if they would join us and possibly drive, but it was too short of notice. So Dr. ABD called the friends that Gay had gone to Freetown and Bunce Island with and asked them instead of meeting up with us and dropping Gay off with us if they could take some of us and follow us to Makeni, and since they had borrowed Dr. ABD’s car anyway they said yes. On the way down I interviewed Dr. ABD about HIV and Hep B for my research project, and talked a lot about the state of health care in terms of HIV and Hep B in Sierra Leone, it was very interesting.
When we got to the Freetown area we decided to take the road that sort of goes up and around Freetown to get to the Bay Road and take that to the beach rather than getting on Bay Road in Freetown and following it all the way to River No. 2, our destination. When we got there though, there was a giant traffic jam and we had to turn around and back track all the way to where the Bay Road starts in Freetown, adding two hours to our journey. After being nice and sunny, but not too hot, all day it started raining about 30 minutes before we got to the beach. We sat in the little restaurant hut the entire time and enjoyed the view and ate really amazing shrimp and rice. A meal and two drinks cost me $10.25, and the meal was big. It was ten huge shrimp on skewers that had been seasoned with a little spice and grilled perfectly, with rice that had been fancied up with a little tomato sauce and spices, and a little sauce on the side that was sautéed onions and carrots that was also seasoned really well. I mixed them all together and it was delicious! I was so sad that I couldn’t eat it all, but I got so full after half of it that I knew I would be sick on the ride home if I ate any more. There were guys walking around selling wooden carved stuff, and so I bought a goofy little bracelet off of one of the guys. It appears fine until you really look at the design that he carved into the sides. Little hearts that say, “I love you,” inside them. I figure that this place is a little goofy, so a souvenir that reflects that is perfect.
Gay finally met up with us at about 15h30, and Dr. ABD was very happy because he was antsy to start home. However, Gay and her party explained that they were hoping to stay in Freetown for the night and then head back to Makeni in the morning. Dr. ABD was a little upset but said, “Okay, I guess we all have to fit in the car!” We ended up with two in the far back, which really only fits one, and four in the middle. When we were all trying to fit, John asked if he could sit up front because he’s the only guy and he felt a little awkward about squeezing in with all us girls, so I told him he could since I’d sat up front on the way down. He got in though, and Dr. ABD told him to get out and let someone bigger sit there so that it would be easier to fit four people in the middle seat, and told me to sit up front. I was happy to have the front seat, and I am much taller and unlike John who is very thin I have my big woman hips, but I was a little sad that Dr. ABD thinks ‘da body be fat fat’ as the locals would say here. I made a joke about it, and he said, “No, my dear! You have body!” Which is like telling someone that they have a fit or athletic frame.
On the way back Ashley interviewed Dr. ABD about the hospital for a paper she’s writing. Apparently all she has to do is write a paper about something dealing with her POE, which is international healthcare, and she gets four credits for it! Lucky bum! It was really interesting to hear about all that it took to start the hospital, and all the speed bumps there have been along the way.
When we got back in the evening, I decided to organize my things and figure out what I’m leaving here for the hospital and what I’m taking back, so I started sorting through things and sort of packing things that I know I wont use this week. Taylor told me I was crazy, but ten minutes later they were all doing the same thing. When we were finished we took the stuff over to Erdi, who was happy to have it, and deiced we should watch the rest of “The Sound Of Music” that we started Friday. I can’t believe I’ll be home in four days!
Day Forty-six: Cooking with David 07.23
This morning I got up at about 9h00 and had breakfast because David told me to be ready between 9h30 and 10h00 to go to the market with him to buy all the things we need for dinner. I requested the groundnut soup, and John told us he really wanted couscous. We took a motor bike to Makeni and stopped at this little shop that was tucked in behind some other buildings and bought some beef from a guy who had about five or six dead animals hanging around the porch of his shop for sale. I saw David pay, and I didn’t realize that meat here is about the same price is at home, which is why no one can afford it.
After meat man, we walked to the market to buy the vegetables and so on. David showed me this small back alley that I hadn’t noticed before that leads behind the market that I’ve known since arriving here into this HUGE warehouse packed with tables and piled high with food that people were selling. There was barely room for one person to walk between the tables, but people were turning sideways and forcing past each other to get around. Sierra Leone is no a place for fat people, or for tall people. The average Sierra Leonean is about five foot six for men and five foot two for women, so if you’re tall or have hips or any amount of fat on you, as the average Sierra Leonean probably has about 3% body fat, you will have some trouble getting around. The warehouse smelled like fish, probably because there were people selling fish there, and people were selling everything from vegetables and onions and potatoes to couscous and spices and groundnuts and limes. There were also people walking around with trays containing little plastic bags filled with juice that people could buy and drink. As I had no way of knowing where the water came from, or in what state the container they used to mix the drink was, I didn’t try it.
I asked David if he would help me buy some pepper, which in Africa means something far different than at home. There isn’t any pepper like we have, that is a ground peppercorn. What they have is African peppers, which are small, the longest ones are only about an inch long, and fairly thin. You buy them in little handful sizes, and they are either green or red or orange, and all the colors are mixed in together. David uses this fresh kind, and cuts off the little stems and mashes them up with onions before adding them to a stew or sauce. When I told David I wanted to get some African peppers to take home, but that I didn’t want the fresh ones, he told me, “Oh, well just buy pepper!” When they dry out the African peppers and grind them into a powder, they call it pepper. Imagine putting that in a peppershaker and watching people’s faces, because let me tell you these little guys pack a punch! If you were to eat a whole one fresh, you’d better have a glass of milk handy to put out the fire! I figured that I would only get a little of the powder since it doesn’t take much to really spice up a dish. David went to his friend and told me that a little packet containing about two teaspoons by my guestimate was 100 Le, or about $0.02, so I said I’d take 1,000 Le worth. Now I wish I’d have just gotten 2,000 Le worth, but 10 of those little packets should be fine to cook a few things for my family when I get home and figure out how to get either African peppers or something similar back home and use the fresh stuff.
David ended up taking me through all these little alleys and talking to everyone, and they were all so impressed that I knew how to greet them in Timone. They would try to talk to me in Timone, and when I would say, “Uh, I don’t know that much Timone!” They would laugh and just smile at me. David also introduced me to his girlfriend, and when I asked about her he flat out told me that he has a girlfriend and a wife. He seemed surprised that I only had one boyfriend, and that I’m Andrew’s only girlfriend. He told me that, “A man cannot be satisfied by one woman, and women need lots of boyfriends to buy them things and make their friends jealous.” I also found it interesting that when we got to his house because he wanted to introduce me to his wife, he told me not to say anything about the girlfriend. Clearly his wife is not as cool with him having a girlfriend as he tried to tell me.
David also kept telling me that he wants to build a bigger house for his family, and that his family is so poor and they have to rent a house that’s only big enough for them all to stay in one room because he has a big family and it’s expensive and that if I were to see his house or his salary that I was like ‘cry with him’ and ‘sympathize with him.’ But by the time I considered that he’s got a girlfriend that he keeps secret, which is an expensive habit, and that he keeps half or more of the money that Erdi gives him every day to spend on food for us when he’s supposed to spend it all on food for us, I was plum out of sympathy for him. He gets a good salary here, and Dr. Erdi knows he keeps a good portion of the food money but doesn’t say anything, so he makes even more, and he’s got a wife and six kids who work hard farming his land all day and selling the crops. And even so, he wants to beg and make me feel sorry for him and give him money. The mentality that everything should be given, not earned, by the locals here is in my mind one of the biggest reasons Sierra Leone is 180th out of 182 on the development scale. No one is taking responsibility for the situation the country is in, they’re all just standing around and looking to the rest of the world saying, “we need more! Help us more!” I think that the NGOs and charities that are at work here are doing some wonderful things, but it’s time to stop handing out food and clothing and instead start educating people on how to go out, do a job, get paid, and buy their own clothing and food. There is a man who hangs around the hospital who had his leg amputated last year. He still hasn’t paid his whole medical bill for his amputation and care here at the hospital, but he’s telling the hospital and anyone who will listen that they need to sponsor him to get a prosthetic leg. The guy has fourteen children, and none of them are willing to help him pay his medical bills and get a prosthetic? I hope the people in Sierra Leone figure out soon how to take responsibility for their situation, or things are going to be like this for a long time.
After we got back from the market Ashley, Taylor, John, and I played about four or five rounds of euchre. Around 16h30 David called me into the kitchen to show me how to made the groundnut soup, and show me what he’d done with the cucumber and so on. It was a lot of fun cooking with him, but some of the things he thinks about like how malaria works and so on is just so ridiculous it’s almost funny. I guess a lot of Sierra Leoneans believe that eating a lot of spicy food protects you from malaria, that the mosquitoes smell it and don’t want to bite you, and that with all that spice in your body the malaria parasite, once it’s in your body, can fit off the spice enough to survive in your body. I think I’ll keep taking my anti-malaria pill, just in case.
Dinner was early, about 17h30 or so, and then we went into town to trade money, pick up some things at the guest house, and get oil, eggs, and ice cream for the brownie mix that Ashley brought, since we’d decided to make it in celebration of Ashley and Taylor’s birthdays. The money traders did not want to give us the normal rate for the $20 bills we had, which was a problem because John was trading a $100 bill and a $20 bill, I wanted to trade a $20 bill, and Ashley wanted to trade $100 but it was all in 20s. Erdi and I tried to haggle with them, saying that they could either trade all of it at the normal rate with us, or we would go somewhere else. We eventually got them to give us the normal 4400Le per USD for the $100 bill, but had to take 4300Le per USD for the $20 bills. For me it was only a cut of 2000Le, but for Ashley it was a cut of 10,000Le. We figured we wouldn’t get a better rate, so we took it. Erdi wanted to drop by a friend’s house and give them something, but didn’t know if they were home, so she let us out to wonder around the market. It’s always cool to look around, but everything was closing up because it was the end of the day, so it was a little less exciting than usual.
After a quick stop at St. Mary’s, we went back to the guesthouse and mixed up a batch of walnut brownies and headed to Steve’s to use his oven. When we got there he had about four guests over, as well as himself and the other two people who live there with him, so they were also excited for the brownie ice cream sundaes. After a couple beers the brownies were ready, but when we started to serve then and tried to put ice cream on them, we found that the ice cream had all melted from being in the car and in our freezer which wasn’t on too long before we got to Steve’s and were able to put it in a working freezer. It was nice and cold though, so we decided to just spoon it onto the brownies and no one was upset. They were great, and after a beer or two more we were all so full and happy that we almost fell asleep on the couches.
After a quick drive back and a call to Dr. ABD, we set our alarms for 7h30 so we could head for the beach by 8h00.
This post is dedicated to Matt-man, the birthday boy. Happy 19th, Bud!
After meat man, we walked to the market to buy the vegetables and so on. David showed me this small back alley that I hadn’t noticed before that leads behind the market that I’ve known since arriving here into this HUGE warehouse packed with tables and piled high with food that people were selling. There was barely room for one person to walk between the tables, but people were turning sideways and forcing past each other to get around. Sierra Leone is no a place for fat people, or for tall people. The average Sierra Leonean is about five foot six for men and five foot two for women, so if you’re tall or have hips or any amount of fat on you, as the average Sierra Leonean probably has about 3% body fat, you will have some trouble getting around. The warehouse smelled like fish, probably because there were people selling fish there, and people were selling everything from vegetables and onions and potatoes to couscous and spices and groundnuts and limes. There were also people walking around with trays containing little plastic bags filled with juice that people could buy and drink. As I had no way of knowing where the water came from, or in what state the container they used to mix the drink was, I didn’t try it.
I asked David if he would help me buy some pepper, which in Africa means something far different than at home. There isn’t any pepper like we have, that is a ground peppercorn. What they have is African peppers, which are small, the longest ones are only about an inch long, and fairly thin. You buy them in little handful sizes, and they are either green or red or orange, and all the colors are mixed in together. David uses this fresh kind, and cuts off the little stems and mashes them up with onions before adding them to a stew or sauce. When I told David I wanted to get some African peppers to take home, but that I didn’t want the fresh ones, he told me, “Oh, well just buy pepper!” When they dry out the African peppers and grind them into a powder, they call it pepper. Imagine putting that in a peppershaker and watching people’s faces, because let me tell you these little guys pack a punch! If you were to eat a whole one fresh, you’d better have a glass of milk handy to put out the fire! I figured that I would only get a little of the powder since it doesn’t take much to really spice up a dish. David went to his friend and told me that a little packet containing about two teaspoons by my guestimate was 100 Le, or about $0.02, so I said I’d take 1,000 Le worth. Now I wish I’d have just gotten 2,000 Le worth, but 10 of those little packets should be fine to cook a few things for my family when I get home and figure out how to get either African peppers or something similar back home and use the fresh stuff.
David ended up taking me through all these little alleys and talking to everyone, and they were all so impressed that I knew how to greet them in Timone. They would try to talk to me in Timone, and when I would say, “Uh, I don’t know that much Timone!” They would laugh and just smile at me. David also introduced me to his girlfriend, and when I asked about her he flat out told me that he has a girlfriend and a wife. He seemed surprised that I only had one boyfriend, and that I’m Andrew’s only girlfriend. He told me that, “A man cannot be satisfied by one woman, and women need lots of boyfriends to buy them things and make their friends jealous.” I also found it interesting that when we got to his house because he wanted to introduce me to his wife, he told me not to say anything about the girlfriend. Clearly his wife is not as cool with him having a girlfriend as he tried to tell me.
David also kept telling me that he wants to build a bigger house for his family, and that his family is so poor and they have to rent a house that’s only big enough for them all to stay in one room because he has a big family and it’s expensive and that if I were to see his house or his salary that I was like ‘cry with him’ and ‘sympathize with him.’ But by the time I considered that he’s got a girlfriend that he keeps secret, which is an expensive habit, and that he keeps half or more of the money that Erdi gives him every day to spend on food for us when he’s supposed to spend it all on food for us, I was plum out of sympathy for him. He gets a good salary here, and Dr. Erdi knows he keeps a good portion of the food money but doesn’t say anything, so he makes even more, and he’s got a wife and six kids who work hard farming his land all day and selling the crops. And even so, he wants to beg and make me feel sorry for him and give him money. The mentality that everything should be given, not earned, by the locals here is in my mind one of the biggest reasons Sierra Leone is 180th out of 182 on the development scale. No one is taking responsibility for the situation the country is in, they’re all just standing around and looking to the rest of the world saying, “we need more! Help us more!” I think that the NGOs and charities that are at work here are doing some wonderful things, but it’s time to stop handing out food and clothing and instead start educating people on how to go out, do a job, get paid, and buy their own clothing and food. There is a man who hangs around the hospital who had his leg amputated last year. He still hasn’t paid his whole medical bill for his amputation and care here at the hospital, but he’s telling the hospital and anyone who will listen that they need to sponsor him to get a prosthetic leg. The guy has fourteen children, and none of them are willing to help him pay his medical bills and get a prosthetic? I hope the people in Sierra Leone figure out soon how to take responsibility for their situation, or things are going to be like this for a long time.
After we got back from the market Ashley, Taylor, John, and I played about four or five rounds of euchre. Around 16h30 David called me into the kitchen to show me how to made the groundnut soup, and show me what he’d done with the cucumber and so on. It was a lot of fun cooking with him, but some of the things he thinks about like how malaria works and so on is just so ridiculous it’s almost funny. I guess a lot of Sierra Leoneans believe that eating a lot of spicy food protects you from malaria, that the mosquitoes smell it and don’t want to bite you, and that with all that spice in your body the malaria parasite, once it’s in your body, can fit off the spice enough to survive in your body. I think I’ll keep taking my anti-malaria pill, just in case.
Dinner was early, about 17h30 or so, and then we went into town to trade money, pick up some things at the guest house, and get oil, eggs, and ice cream for the brownie mix that Ashley brought, since we’d decided to make it in celebration of Ashley and Taylor’s birthdays. The money traders did not want to give us the normal rate for the $20 bills we had, which was a problem because John was trading a $100 bill and a $20 bill, I wanted to trade a $20 bill, and Ashley wanted to trade $100 but it was all in 20s. Erdi and I tried to haggle with them, saying that they could either trade all of it at the normal rate with us, or we would go somewhere else. We eventually got them to give us the normal 4400Le per USD for the $100 bill, but had to take 4300Le per USD for the $20 bills. For me it was only a cut of 2000Le, but for Ashley it was a cut of 10,000Le. We figured we wouldn’t get a better rate, so we took it. Erdi wanted to drop by a friend’s house and give them something, but didn’t know if they were home, so she let us out to wonder around the market. It’s always cool to look around, but everything was closing up because it was the end of the day, so it was a little less exciting than usual.
After a quick stop at St. Mary’s, we went back to the guesthouse and mixed up a batch of walnut brownies and headed to Steve’s to use his oven. When we got there he had about four guests over, as well as himself and the other two people who live there with him, so they were also excited for the brownie ice cream sundaes. After a couple beers the brownies were ready, but when we started to serve then and tried to put ice cream on them, we found that the ice cream had all melted from being in the car and in our freezer which wasn’t on too long before we got to Steve’s and were able to put it in a working freezer. It was nice and cold though, so we decided to just spoon it onto the brownies and no one was upset. They were great, and after a beer or two more we were all so full and happy that we almost fell asleep on the couches.
After a quick drive back and a call to Dr. ABD, we set our alarms for 7h30 so we could head for the beach by 8h00.
This post is dedicated to Matt-man, the birthday boy. Happy 19th, Bud!
Saturday, July 23, 2011
Day Forty-five: Another Amputation 07.22
This morning at Handover, Taylor and I presented a lesson about cannulas and IV lines that went really well. All day long nurses were telling us how they liked the lesson, and Gay was telling me how nurses were correcting each other and encouraging them to do it the right way. I think on Monday when I present CPR part 2 that I’ll commend everyone on a job well done, and encourage them to keep helping each other. Gay also told me that she tried to show a nurse how she does it back home, as she is a hospice nurse back in Oklahoma, and the nurse said, “No, I can’t do it that way, because it’s not one of the ways that Taylor and Ali showed us in their presentation,” so I think I’ll also mention that there are more right ways to tape a cannula than we showed in our short presentation, and that we just gave two ways that are easy to remember and work well, but that they should still be open to other staff members and visitors who are nurses back home showing them new things, because that’s how we learn and get better.
After Handover Taylor, Danielle, and I decided we were going to follow Dr. ABD on rounds, which is always interesting but I think I had become a little desensitized to some of the gore and the crazy injuries and stories that come with them. Danielle was in awe at almost every patient, and filled an entire page front and back of regular notebook paper with little notes about what she was seeing and hearing. One woman who came in a little over a week ago with lesions all over her body, in her eyes, mouth, nose, ears, hands, feet, buttocks, and everywhere in between is improving a lot. She told the doctor that she had taken about six different medications but didn’t know what she’d taken, so Dr. ABD was pretty certain she had a skin reaction that he called Johnson’s Syndrome where the skin reactions badly to an overdose or reaction between medications. Most of the lesions on her face and ears are gone, and now she’s just got GV paint on her hands and feet. GV paint is a purple paste that is common here that is very strange, I’ve never seen something similar back home. It helps kill bacteria, and creates a seal against new bacteria getting into the wound. It also helps heal the area.
A woman who came in with a large sore on her foot that was diagnosed as a tropical ulcer is doing much better with daily wound cleanings and antibiotics. The area that is open is large, and Dr. ABD would like to do a skin graft, and thinks she’ll be ready for it soon. The woman who had her foot amputated looks fine, but she seems very confused and disoriented even though the anesthesia should have worn off by now, which concerns Dr. ABD. After a quick check through male ward on patients that CHO Alpha wanted him to review, Dr. ABD told us to go get ourselves some lunch and to meet back for surgery at 11h00 or 11h30.
After lunch they started surgery with a hernia repair on a young boy who had a strangulated hernia. Gay was very excited to get pictures of that particular surgery because one of her financial sponsors supplied the hospital with surgical mesh for hernia repairs, and asked her to take photos of hernia related surgery in hopes that they could use the photos to get even more funding for the hospital, which Dr. ABD and Dr. Erdi are very excited about.
After the hernia repair, they brought in a man who fell and broke his femur. The way they were treating him was appalling. Yelling at him for crying, moving him very roughly without caring if it hurt him, yelling at him when he asked if he could move himself because it hurt when they moved him, and all the time ridiculing him for not coming in sooner. It really upset me, and I ended up telling them that it is mean and unfair to yell at a patient for crying, especially when they have a broken femur and no care is being taken to move them carefully. The nurses just laughed at me and told me that he wouldn’t be in this situation if he had not waited two months to come in. That really made me mad, and I told them that if I knew that I would be treated like they were treating this man if I came in for treatment, I’d go to the traditional healer instead too. At least he’s here now, at least he’s trusting us now, and you’re yelling him and telling him he’s weak. What is he going to tell his family and friends when he goes back to his village? ‘Don’t go to Magbenteh Hospital, they’re mean and yell at you and they don’t care if they hurt you when they move you.’ If instead we told him, ‘Thank you for coming in, thank you for trusting us with your care, we’re glad you finally made it here, we can help you!’ He’d go back and tell his village, ‘I went to the hospital and had a great experience! You should all go there when you’re sick or hurt!” But even when I told them this, they either laughed or shook their heads like, ‘Stupid Apoto doesn’t understand.’ They kept making excuses about how much trouble he’s causing them by waiting, and Abi kept saying that he knows her and she’s upset because he didn’t ask her for help. It was so frustrating. That is one thing I’ll be happy to leave here when I come home.
They suspected that the fracture to the femur had become infected, so they made an incision and were going to inspect for pus and infection. When they got to the bone, Dr. ABD stated scraping at the bone, and pulling out shards of infected bone. It was so gross, I hate that sound of scraping on bone, it makes my teeth hurt, and every time he pulled out a piece of bone I just thought, “AH! That’s not supposed to happen!” I don’t know why bone injuries freak me out way more than soft tissue injuries, but it’s good to know that I would not do well as a doctor who sets bones or does surgery on bones. It just creeps me out and I’m going to leave it to someone else.
The last surgery of the day was an amputation of a necrotic big toe. Dr. ABD was a little anxious that he might be prematurely amputating the toe and that he might find that he needs to amputate the foot all together, but he also was hoping to save the foot and thought that getting the infected toe off would help keep the infection from spreading the woman would be able to keep her foot.
After surgery Dr. ABD took us to his clinic, which is right in front of his house and still under construction. He works all day at the hospital and then comes home to see patients in his clinic all night. Right now only the first floor is function, and when he gave us the tour he would say about almost every room, “This will be the_____, but right now I have to put patients in here because they are already showing up, and I can’t just turn them away.” It was very impressive, and the second floor is really starting to look like it could be a hospital someday. He hopes to have four floors when it’s finished, but he doesn’t know when that will happen because it depends on when the money is available.
Now that there are so many of us here in the guesthouse, it’s hard to get time on the modem since we’re all sharing it. I ended up missing my skype date with my Mamma, so I’ll try again tomorrow but I’ll be home in just six days, so it wont be long before I get to see everyone in person! I’m excited to go home, but I will definitely miss this place. I go through phases where I’m sad to be going home because this place is so cool, and then being anxious to get home sooner because I miss home so much! I have a few last things on my Sierra Leone bucket list to complete, and then I will definitely be ready to go home and be back with the people I love.
This post is dedicated to two children who passed in the night, one of malaria and pneumonia, one of malaria and typhoid.
After Handover Taylor, Danielle, and I decided we were going to follow Dr. ABD on rounds, which is always interesting but I think I had become a little desensitized to some of the gore and the crazy injuries and stories that come with them. Danielle was in awe at almost every patient, and filled an entire page front and back of regular notebook paper with little notes about what she was seeing and hearing. One woman who came in a little over a week ago with lesions all over her body, in her eyes, mouth, nose, ears, hands, feet, buttocks, and everywhere in between is improving a lot. She told the doctor that she had taken about six different medications but didn’t know what she’d taken, so Dr. ABD was pretty certain she had a skin reaction that he called Johnson’s Syndrome where the skin reactions badly to an overdose or reaction between medications. Most of the lesions on her face and ears are gone, and now she’s just got GV paint on her hands and feet. GV paint is a purple paste that is common here that is very strange, I’ve never seen something similar back home. It helps kill bacteria, and creates a seal against new bacteria getting into the wound. It also helps heal the area.
A woman who came in with a large sore on her foot that was diagnosed as a tropical ulcer is doing much better with daily wound cleanings and antibiotics. The area that is open is large, and Dr. ABD would like to do a skin graft, and thinks she’ll be ready for it soon. The woman who had her foot amputated looks fine, but she seems very confused and disoriented even though the anesthesia should have worn off by now, which concerns Dr. ABD. After a quick check through male ward on patients that CHO Alpha wanted him to review, Dr. ABD told us to go get ourselves some lunch and to meet back for surgery at 11h00 or 11h30.
After lunch they started surgery with a hernia repair on a young boy who had a strangulated hernia. Gay was very excited to get pictures of that particular surgery because one of her financial sponsors supplied the hospital with surgical mesh for hernia repairs, and asked her to take photos of hernia related surgery in hopes that they could use the photos to get even more funding for the hospital, which Dr. ABD and Dr. Erdi are very excited about.
After the hernia repair, they brought in a man who fell and broke his femur. The way they were treating him was appalling. Yelling at him for crying, moving him very roughly without caring if it hurt him, yelling at him when he asked if he could move himself because it hurt when they moved him, and all the time ridiculing him for not coming in sooner. It really upset me, and I ended up telling them that it is mean and unfair to yell at a patient for crying, especially when they have a broken femur and no care is being taken to move them carefully. The nurses just laughed at me and told me that he wouldn’t be in this situation if he had not waited two months to come in. That really made me mad, and I told them that if I knew that I would be treated like they were treating this man if I came in for treatment, I’d go to the traditional healer instead too. At least he’s here now, at least he’s trusting us now, and you’re yelling him and telling him he’s weak. What is he going to tell his family and friends when he goes back to his village? ‘Don’t go to Magbenteh Hospital, they’re mean and yell at you and they don’t care if they hurt you when they move you.’ If instead we told him, ‘Thank you for coming in, thank you for trusting us with your care, we’re glad you finally made it here, we can help you!’ He’d go back and tell his village, ‘I went to the hospital and had a great experience! You should all go there when you’re sick or hurt!” But even when I told them this, they either laughed or shook their heads like, ‘Stupid Apoto doesn’t understand.’ They kept making excuses about how much trouble he’s causing them by waiting, and Abi kept saying that he knows her and she’s upset because he didn’t ask her for help. It was so frustrating. That is one thing I’ll be happy to leave here when I come home.
They suspected that the fracture to the femur had become infected, so they made an incision and were going to inspect for pus and infection. When they got to the bone, Dr. ABD stated scraping at the bone, and pulling out shards of infected bone. It was so gross, I hate that sound of scraping on bone, it makes my teeth hurt, and every time he pulled out a piece of bone I just thought, “AH! That’s not supposed to happen!” I don’t know why bone injuries freak me out way more than soft tissue injuries, but it’s good to know that I would not do well as a doctor who sets bones or does surgery on bones. It just creeps me out and I’m going to leave it to someone else.
The last surgery of the day was an amputation of a necrotic big toe. Dr. ABD was a little anxious that he might be prematurely amputating the toe and that he might find that he needs to amputate the foot all together, but he also was hoping to save the foot and thought that getting the infected toe off would help keep the infection from spreading the woman would be able to keep her foot.
After surgery Dr. ABD took us to his clinic, which is right in front of his house and still under construction. He works all day at the hospital and then comes home to see patients in his clinic all night. Right now only the first floor is function, and when he gave us the tour he would say about almost every room, “This will be the_____, but right now I have to put patients in here because they are already showing up, and I can’t just turn them away.” It was very impressive, and the second floor is really starting to look like it could be a hospital someday. He hopes to have four floors when it’s finished, but he doesn’t know when that will happen because it depends on when the money is available.
Now that there are so many of us here in the guesthouse, it’s hard to get time on the modem since we’re all sharing it. I ended up missing my skype date with my Mamma, so I’ll try again tomorrow but I’ll be home in just six days, so it wont be long before I get to see everyone in person! I’m excited to go home, but I will definitely miss this place. I go through phases where I’m sad to be going home because this place is so cool, and then being anxious to get home sooner because I miss home so much! I have a few last things on my Sierra Leone bucket list to complete, and then I will definitely be ready to go home and be back with the people I love.
This post is dedicated to two children who passed in the night, one of malaria and pneumonia, one of malaria and typhoid.
Day Forty-four: Donating blood 07.21
This morning after Handover Taylor and I decided that today was the day to give blood. So after Handover we went to the lab and told John that we wanted to give blood and he told us to come back at 10h00. Taylor followed Dr. Erdi on rounds, and I sat with Dr. Abel in his office. Dr. Abel has some sweet videos of a chameleon catching and eating a praying mantis. He didn’t have any patients to see, so he decided to go to the bank and it was almost 10h00 so Taylor and I went to the lab to save lives. John tested our blood type, as well as our hemoglobin, and our HIV, Hep B, and Hep C status. We were able to help John sort out his blood typing and prove that one of his testing serums was not working properly since we both know our blood types. It was good that we were able to help him see that the new serum was right, but scary that he’s been testing people’s blood type incorrectly. I have 14.0 hemoglobin protein, which is really high even for people in the States, so I think his test is off. The way the test the hemoglobin is based on hemoglobin concentration in the blood, and so doesn’t take into account if someone is dehydrated, which everyone here is basically chronically dehydrated, so the test tends to show high protein levels that you really have because it’s just more concentrated. And good news! I’m negative for HIV, Hep B, and Hep C! I would certainly hope so, but it’s nice to confirm it I guess.
We then went to the blood bank room where they keep all the blood in a big refrigerator. All the bags and needles and so on come out of sterilized bags, and John wore gloves of course and made sure to clean the area with alcohol before inserting the needle. I’m definitely glad I gave blood since when I get home I wont be able to donate for a year, and they need the blood so much more here than they do in the States. Now Taylor and I or the only two bags of blood on the AB shelf in the blood bank. John told us that only 4% of the population is AB, but I’m not sure if he’s talking the worlds population, or Africa’s population, which I’ve hear is dominated by B+. I’ll have to look that up.
After we gave blood we went back to the house for a snack and to get drinks. Then it was off to the theatre to watch some surgeries. There was a hysterectomy, and then we were able to watch Dr. ABD amputate a woman’s leg just above the ankle because of a severely infected foot. It smelled so bad in that room! And the bone-cutting portion of the surgery was pretty tough to take, but it was okay.
Taylor and I had really wanted to see the amputation, but we were drained (haha, punny) from giving blood, so afterward we went back to the house and took a nap. It felt really good, and afterward we worked on our presentation for tomorrow Morning Handover, “IV lines and Cannulas.” We got dressed to go to Dr. ABD’s for dinner (I wore my African dress that I had made here), but because they were still in surgery we decided to go over to the wards and get pictures of cannulas that weren’t taped down properly or had a problem with them. When we got back Alie was back to show us more of his things. He told me that he would see about making some small things for me, so I hope I can get the prices very low and afford them.
At about 19h00 we went over to Dr. ABD’s house and had a wonderful meal. Kumba made all sorts of good food, and we got to talk to all the kids again. After dinner we all went and sat out on the porch and enjoyed the nice cool rain and talked. Most of us were tired and went home, but a couple people went to the bar with Callum to help him celebrate his last night in Sierra Leone.
This post is dedicated to Abi’s nephew, who was born in the hospital yesterday but died of complications this morning, and to the child who came in with second and third degree burns of 50% of his body yesterday who passed of infection.
We then went to the blood bank room where they keep all the blood in a big refrigerator. All the bags and needles and so on come out of sterilized bags, and John wore gloves of course and made sure to clean the area with alcohol before inserting the needle. I’m definitely glad I gave blood since when I get home I wont be able to donate for a year, and they need the blood so much more here than they do in the States. Now Taylor and I or the only two bags of blood on the AB shelf in the blood bank. John told us that only 4% of the population is AB, but I’m not sure if he’s talking the worlds population, or Africa’s population, which I’ve hear is dominated by B+. I’ll have to look that up.
After we gave blood we went back to the house for a snack and to get drinks. Then it was off to the theatre to watch some surgeries. There was a hysterectomy, and then we were able to watch Dr. ABD amputate a woman’s leg just above the ankle because of a severely infected foot. It smelled so bad in that room! And the bone-cutting portion of the surgery was pretty tough to take, but it was okay.
Taylor and I had really wanted to see the amputation, but we were drained (haha, punny) from giving blood, so afterward we went back to the house and took a nap. It felt really good, and afterward we worked on our presentation for tomorrow Morning Handover, “IV lines and Cannulas.” We got dressed to go to Dr. ABD’s for dinner (I wore my African dress that I had made here), but because they were still in surgery we decided to go over to the wards and get pictures of cannulas that weren’t taped down properly or had a problem with them. When we got back Alie was back to show us more of his things. He told me that he would see about making some small things for me, so I hope I can get the prices very low and afford them.
At about 19h00 we went over to Dr. ABD’s house and had a wonderful meal. Kumba made all sorts of good food, and we got to talk to all the kids again. After dinner we all went and sat out on the porch and enjoyed the nice cool rain and talked. Most of us were tired and went home, but a couple people went to the bar with Callum to help him celebrate his last night in Sierra Leone.
This post is dedicated to Abi’s nephew, who was born in the hospital yesterday but died of complications this morning, and to the child who came in with second and third degree burns of 50% of his body yesterday who passed of infection.
Day Forty-three: Filming 07.20
Today I woke up with a headache, but wanted to be able to go on Big Rounds, so I got up and went to Morning Handover anyway. At Morning Handover, Marcel announced that he wanted to meet with the upper level staffers after the meeting to discuss some things. Dr. Erdi also announced that at 10h00 all the expat staff needed to go to a meeting in Makeni with a government official. By 9h30 when they still had not started Big Rounds, my headache was bad enough that I decided to come back to the house, take a pain killer, and have a nap.
It was extra hot today, and so it was hard to rest but eventually I was able to fall asleep for a short bit and woke up feeling much better. Abi has a friend who’s a tailor and asked her to come to the hospital to show us what she can make, take some measurements, and make some cloths for us. Gay, Danielle, Ashley, and Taylor all got pieces made. While the tailor was here, one of the shopkeepers that Gay bought fabric from yesterday showed up to tell her that she’s made a mistake in paying for the fabric, that she had charged her for one lappa when she bought two. She wanted Gay to either give back one lappa, or pay for the second one. Gay seemed about to say, ‘It was your mistake, it’s not my fault, the transaction is done,” but I could tell by Abi’s body language and what she was saying that it’s common practice to be very honest and make the transaction fair. Gay decided to just give one lappa back, but the shopkeeper got upset and said that she should pay for the second lappa instead, AND give her money for her transport because she came all the way out to find her. Gay told her no, and that she would be back to her shop to buy more so the shopkeeper would make more money from her later, and she seemed to accept that.
In the afternoon Taylor, Danielle, Ashley and I went down to the TFC to start filming clips for our videos we’re making for the hospital. We got some great clips of the woman who teaches family planning classes on Wednesdays, and we got some clips of them all singing and dancing.
After getting some good clips of that, we decided to film our Dental Hygiene video. Musa helped us out a lot, he was our interpreter, and would say the lines in Creole and Timone after we said them in English. It sounds so cool when he says the lines! We all couldn’t stop smiling and giggling. A few of the boys who follow me around we following us and watching us, so we decided to have a scene with them holding different posters of dental hygiene we have and pretending to brush their teeth. We also got Mary, one of our friends who is a patient here, to brush her teeth while we said lines, and then we let her keep the toothbrush and mini-toothpaste, so we also got a clip of her putting it in a “clean, dry place” while not using it.
In the late afternoon we just relaxed and read, and Alie, the wood carver I know, came over to show us his things. I was very happy to see him, because I was about to call him and tell him to come later this week and what he should bring. I told him I’m leaving next week, and he told me he would make me something special. I told him I didn’t have any money for it, and he said, “No, no! I make for you no charge!” I’m very excited to see it what it is! After dinner we played some cards and relaxed together.
This post is dedicated to a child who died of malaria in the night.
It was extra hot today, and so it was hard to rest but eventually I was able to fall asleep for a short bit and woke up feeling much better. Abi has a friend who’s a tailor and asked her to come to the hospital to show us what she can make, take some measurements, and make some cloths for us. Gay, Danielle, Ashley, and Taylor all got pieces made. While the tailor was here, one of the shopkeepers that Gay bought fabric from yesterday showed up to tell her that she’s made a mistake in paying for the fabric, that she had charged her for one lappa when she bought two. She wanted Gay to either give back one lappa, or pay for the second one. Gay seemed about to say, ‘It was your mistake, it’s not my fault, the transaction is done,” but I could tell by Abi’s body language and what she was saying that it’s common practice to be very honest and make the transaction fair. Gay decided to just give one lappa back, but the shopkeeper got upset and said that she should pay for the second lappa instead, AND give her money for her transport because she came all the way out to find her. Gay told her no, and that she would be back to her shop to buy more so the shopkeeper would make more money from her later, and she seemed to accept that.
In the afternoon Taylor, Danielle, Ashley and I went down to the TFC to start filming clips for our videos we’re making for the hospital. We got some great clips of the woman who teaches family planning classes on Wednesdays, and we got some clips of them all singing and dancing.
After getting some good clips of that, we decided to film our Dental Hygiene video. Musa helped us out a lot, he was our interpreter, and would say the lines in Creole and Timone after we said them in English. It sounds so cool when he says the lines! We all couldn’t stop smiling and giggling. A few of the boys who follow me around we following us and watching us, so we decided to have a scene with them holding different posters of dental hygiene we have and pretending to brush their teeth. We also got Mary, one of our friends who is a patient here, to brush her teeth while we said lines, and then we let her keep the toothbrush and mini-toothpaste, so we also got a clip of her putting it in a “clean, dry place” while not using it.
In the late afternoon we just relaxed and read, and Alie, the wood carver I know, came over to show us his things. I was very happy to see him, because I was about to call him and tell him to come later this week and what he should bring. I told him I’m leaving next week, and he told me he would make me something special. I told him I didn’t have any money for it, and he said, “No, no! I make for you no charge!” I’m very excited to see it what it is! After dinner we played some cards and relaxed together.
This post is dedicated to a child who died of malaria in the night.
Wednesday, July 20, 2011
Day Forty-two: Trying to pack it all in 07.19
Today at Morning Handover, I presented part one of CPR. I explained what CPR is, why it can be helpful in some situations but very harmful in others, talked about some of those different situations, and then demonstrated the most important part of CPR, which is how to check if the individual needs CPR. It was fun, and I used Taylor as my demonstration dummy, but I was a little sad that people didn’t participate more. I figured that they were bored or didn’t like it, but afterward for the rest of the day people were telling me how good it was, so I guess I’ll just prepare part two knowing that I wont get a lot from them during the presentation.
After Morning Handover, I went to the main office where patients are checked and the patient files are kept. My plan was to go back through the lab book that I had gotten my data from, and try to find the patient files for the patients who had tested positive for either HIV or Hep B. I had readied myself for a tough project, thinking that it might not be easy to fined everyone, and that I may not see the results I want, but I had no idea how incredibly impossible it would prove. The first ten patient names I looked up couldn’t be found, and when I finally found one of the patients, I had planned on writing tallies for dead, alive, or false positive, and also record the number of patients referred elsewhere for treatment. I was hoping that I could say that of this number of people who tested positive for HIV, this many were false positives. Of the rest, this many are alive, this many are dead. Of those who tested positive and are alive, this many were referred elsewhere for long term treatment. The very first patient wasn’t even a false positive, it was a different lab test that had been recorded in the wrong column. After looking some more, I decided to go ask why so many of the patient records I was looking for were missing. Dr. ABD told me that the patient records for those who die are taking to the storage building and kept there. At that point I had to concede that I would never have enough time to find everyone, and I had also already realized that the information in the files themselves are almost always incomplete, so it’s hard to even determine what happened to the patients who’s files you do find. It was very frustrating.
After that, I decided to follow Dr. ABD on rounds, and found that I was not alone. Taylor, Gay, and Callum all had the same idea. We followed him in the Female ward, then to review patients in the Male ward. We finished shortly before 11h00, and Dr. ABD told us to go get a drink and a bite, then meet him in theatre. When we got to the theatre after a quick lunch, they were preparing the first patient for the removal of his testis. He was having very slight problems with urinating, and Dr. ABD examined him to determine that his prostrate was slightly enlarged, but not so much that Dr. ABD wanted to risk removing it. He said that removing the testis was a better option for this patient, as he’s older and doesn’t want more children, and the operation is simpler. Removing the testis helps the problem because the testis is where most of the male sex hormones are secreted, and in older men those hormones can cause the prostrate to enlarge. If you remove the hormones, the prostrate stops growing and sometimes even shrinks. You can control these hormones with hormone therapy in the U.S., but here it is not available. However, removing the testis works just as well and is not a very risky operation.
The second surgery was a prostectomy, or removal of the prostate. This man’s prostate was much to large to hope that removing the testis would help, so removal was the only option. I’d never seen a prostate before, and it was HUGE!!! I didn’t realize that the prostate, even when it’s normal, is wrapped completely around the urethra, so any enlargement can easily restrict the flow. Clearly there’s good reason to get your prostate check, men.
The third surgery was an examination of a woman who was said to have scar tissue build up in the vaginal area due to female circumcision. Dr. ABD could find nothing much the matter though, besides a very small scar that would not have caused her much pain.
The final patient of the day was a woman who has Hep B. It has metastasized, and most of her care at this point is simply maintenance of her condition in hopes of giving her a little more time. Her abdomen was enormously enlarged due to fluid build up, so Dr. ABD inserted a small drain to remove the liquid. After inserting it, he attached a bag that had measurements on it, and told us that in cases like this it can cause the patient to go into hypoglycemic shock if you remove too much liquid too quickly, so we should not remove more than 6 liters of fluid. At the time I was sure that she didn’t have six liters to drain, but they drained all six and her abdomen was still huge. They will continue to drain six liters a day until she has no more fluid to drain, then they will send her home with instructions to come back if she gets worse, which is all they can do. I had noticed on rounds that she was wearing a shirt that said “Grand Valley State University,” which I thought was pretty cool so I took a picture and then explained to her why I wanted a picture of the shirt. At first she thought I wanted the shirt, but once Henry, one of the workers here, helped interpret for me, she was so excited to have a shirt that was from where the “Apoto” was from. I hope she stays well for a long time.
After surgery was finished, the girls plus Abi went to the market to help Gay buy fabric and so on. It was a lot of fun but tiring. I’m definitely starting to feel ready to go home, it’s been a long haul here.
Dinner was excellent as usual, and our friends visited as per the Tuesday night ritual. Catherine came, so I was able to say goodbye to her as she leaves on Friday. After dinner we watched ‘Up’ and were all able to shower in our newly fixed shower.
This post is dedicated to the woman who’s baby was left in fetal distress at the government hospital before she was referred here for so long that the baby died, as well as the child who died of malaria early this morning.
After Morning Handover, I went to the main office where patients are checked and the patient files are kept. My plan was to go back through the lab book that I had gotten my data from, and try to find the patient files for the patients who had tested positive for either HIV or Hep B. I had readied myself for a tough project, thinking that it might not be easy to fined everyone, and that I may not see the results I want, but I had no idea how incredibly impossible it would prove. The first ten patient names I looked up couldn’t be found, and when I finally found one of the patients, I had planned on writing tallies for dead, alive, or false positive, and also record the number of patients referred elsewhere for treatment. I was hoping that I could say that of this number of people who tested positive for HIV, this many were false positives. Of the rest, this many are alive, this many are dead. Of those who tested positive and are alive, this many were referred elsewhere for long term treatment. The very first patient wasn’t even a false positive, it was a different lab test that had been recorded in the wrong column. After looking some more, I decided to go ask why so many of the patient records I was looking for were missing. Dr. ABD told me that the patient records for those who die are taking to the storage building and kept there. At that point I had to concede that I would never have enough time to find everyone, and I had also already realized that the information in the files themselves are almost always incomplete, so it’s hard to even determine what happened to the patients who’s files you do find. It was very frustrating.
After that, I decided to follow Dr. ABD on rounds, and found that I was not alone. Taylor, Gay, and Callum all had the same idea. We followed him in the Female ward, then to review patients in the Male ward. We finished shortly before 11h00, and Dr. ABD told us to go get a drink and a bite, then meet him in theatre. When we got to the theatre after a quick lunch, they were preparing the first patient for the removal of his testis. He was having very slight problems with urinating, and Dr. ABD examined him to determine that his prostrate was slightly enlarged, but not so much that Dr. ABD wanted to risk removing it. He said that removing the testis was a better option for this patient, as he’s older and doesn’t want more children, and the operation is simpler. Removing the testis helps the problem because the testis is where most of the male sex hormones are secreted, and in older men those hormones can cause the prostrate to enlarge. If you remove the hormones, the prostrate stops growing and sometimes even shrinks. You can control these hormones with hormone therapy in the U.S., but here it is not available. However, removing the testis works just as well and is not a very risky operation.
The second surgery was a prostectomy, or removal of the prostate. This man’s prostate was much to large to hope that removing the testis would help, so removal was the only option. I’d never seen a prostate before, and it was HUGE!!! I didn’t realize that the prostate, even when it’s normal, is wrapped completely around the urethra, so any enlargement can easily restrict the flow. Clearly there’s good reason to get your prostate check, men.
The third surgery was an examination of a woman who was said to have scar tissue build up in the vaginal area due to female circumcision. Dr. ABD could find nothing much the matter though, besides a very small scar that would not have caused her much pain.
The final patient of the day was a woman who has Hep B. It has metastasized, and most of her care at this point is simply maintenance of her condition in hopes of giving her a little more time. Her abdomen was enormously enlarged due to fluid build up, so Dr. ABD inserted a small drain to remove the liquid. After inserting it, he attached a bag that had measurements on it, and told us that in cases like this it can cause the patient to go into hypoglycemic shock if you remove too much liquid too quickly, so we should not remove more than 6 liters of fluid. At the time I was sure that she didn’t have six liters to drain, but they drained all six and her abdomen was still huge. They will continue to drain six liters a day until she has no more fluid to drain, then they will send her home with instructions to come back if she gets worse, which is all they can do. I had noticed on rounds that she was wearing a shirt that said “Grand Valley State University,” which I thought was pretty cool so I took a picture and then explained to her why I wanted a picture of the shirt. At first she thought I wanted the shirt, but once Henry, one of the workers here, helped interpret for me, she was so excited to have a shirt that was from where the “Apoto” was from. I hope she stays well for a long time.
After surgery was finished, the girls plus Abi went to the market to help Gay buy fabric and so on. It was a lot of fun but tiring. I’m definitely starting to feel ready to go home, it’s been a long haul here.
Dinner was excellent as usual, and our friends visited as per the Tuesday night ritual. Catherine came, so I was able to say goodbye to her as she leaves on Friday. After dinner we watched ‘Up’ and were all able to shower in our newly fixed shower.
This post is dedicated to the woman who’s baby was left in fetal distress at the government hospital before she was referred here for so long that the baby died, as well as the child who died of malaria early this morning.
Day Forty-one: Planning for the end 07.18
Today I realized that I have a lot of things I want to get done, but not much more time to do them! I have the second part of my research project to finish, which consists of going through the lab book again, but this time looking up in the patient record all the patients who tested positive for HIV or Hep B. I also want us to make sure we film some videos for the hospital before we leave, because I know those will be very helpful.
This morning was sort of slow to start, so I went to the Theatre to see if they had started wound care, and while I was there a man wondered up and started asking us questions in a language I don’t speak. Dr. Erdi happened to be there, and kicked him out of the theatre and starting telling him to go to the OPD where all patients are check in. He just kept asking where we were going to put him and his family for the night, because he came from Guinea and his family is not going to sleep on the floor or outside. Dr. Erdi had to tell him that she’s a doctor with a hospital, not a manager with a hotel. He did not want understand her, but eventually they got him to head in the direction of OPD. Dr. Erdi left and not five minutes later he was back trying to get inside the theatre to know where he was staying that night, and I just shooed him out and kept telling him no, because I didn’t understand a word he was saying.
I decided to work for an extra long time on my research project today because I really wanted to finish it and start on the second part of it, since I think that part might actually take quite a long time. Since there wasn’t really anything going on, we were all just sort of hanging around at the guesthouse. I ended up finishing my data collection portion of my research project, and decided to figure out what videos we’re going to film and who’s going to do what and write the scripts. I also researched CPR to make sure I had all the correct information because the Matron wanted me to give part one of my CPR talk soon, possibly tomorrow at Morning Handover. I finished my CPR part one lesson, and wrote the script for my antenatal care video and started on my malaria script. By four I was exhausted. It was really hot and the heat can just zap your energy. I had also convinced myself that I had all the symptoms of stage one malaria, and thought it wise to stop researching the topic and continue when I was less tired and therefore more able to defeat my silly brain for trying to be a hypochondriac.
After dinner our newest resident, Gay, came over to chat and see what we’ve bought so far while we’ve been here. Gay is a woman from Oklahoma who is African American and about four years ago decided to research into her heritage, and specifically wanted to know what African country her ancestors came from. She already knew that her ancestors had been taken as slaves to the U.S. during the slave trade, but through DNA testing and through asking her family members and so on, she was able to determine that she is Sierra Leonean. Since then she has worked hard to save enough money to come and visit. She is here for two weeks, and so far is enjoying herself. At first I was just giving her advice like I was the other AC girls when they got here, but after a bit realized that because she looks like a Sierra Leonean, and looks like a local, that a lot of my advice might not be of value. It’s very interesting to see how the locals react to her, both in the market and at the hospital. One of her main sponsors helping her with the costs of this visit is a company that provided surgical equipment for the hospital as well. When other companies got wind of what this company was doing, they sent funds and equipment as well. Gay is a photographer in her spare time, so the companies that donated asked her if she would be willing to take photos in surgery and the wards that they could use to potentially get more funding and more sponsorship, so she will also be taking a ton of photos.
Anyway, we showed Gay our fabric and wooden carvings and so on, and she really loved it all. She kept asking how the money worked, and she seemed anxious about some of the things that many first time travelers worry about. We told her we would take her into town tomorrow, and show her the market, help her buy some things, and get it to the tailor to be made into dresses and so on.
In the evening some of the guests watched a movie about the Sierra Leonean Civil War, and Steve came over. Since our shower is still not functioning properly, Gay offered us her shower and I took her up on it because I was gross. It’s crazy how much you sweat here in just a day because of the heat!
This post is dedicated to the mother who gave birth to a still born child early this morning, and to the child who died of severe malaria and anemia during the night.
This morning was sort of slow to start, so I went to the Theatre to see if they had started wound care, and while I was there a man wondered up and started asking us questions in a language I don’t speak. Dr. Erdi happened to be there, and kicked him out of the theatre and starting telling him to go to the OPD where all patients are check in. He just kept asking where we were going to put him and his family for the night, because he came from Guinea and his family is not going to sleep on the floor or outside. Dr. Erdi had to tell him that she’s a doctor with a hospital, not a manager with a hotel. He did not want understand her, but eventually they got him to head in the direction of OPD. Dr. Erdi left and not five minutes later he was back trying to get inside the theatre to know where he was staying that night, and I just shooed him out and kept telling him no, because I didn’t understand a word he was saying.
I decided to work for an extra long time on my research project today because I really wanted to finish it and start on the second part of it, since I think that part might actually take quite a long time. Since there wasn’t really anything going on, we were all just sort of hanging around at the guesthouse. I ended up finishing my data collection portion of my research project, and decided to figure out what videos we’re going to film and who’s going to do what and write the scripts. I also researched CPR to make sure I had all the correct information because the Matron wanted me to give part one of my CPR talk soon, possibly tomorrow at Morning Handover. I finished my CPR part one lesson, and wrote the script for my antenatal care video and started on my malaria script. By four I was exhausted. It was really hot and the heat can just zap your energy. I had also convinced myself that I had all the symptoms of stage one malaria, and thought it wise to stop researching the topic and continue when I was less tired and therefore more able to defeat my silly brain for trying to be a hypochondriac.
After dinner our newest resident, Gay, came over to chat and see what we’ve bought so far while we’ve been here. Gay is a woman from Oklahoma who is African American and about four years ago decided to research into her heritage, and specifically wanted to know what African country her ancestors came from. She already knew that her ancestors had been taken as slaves to the U.S. during the slave trade, but through DNA testing and through asking her family members and so on, she was able to determine that she is Sierra Leonean. Since then she has worked hard to save enough money to come and visit. She is here for two weeks, and so far is enjoying herself. At first I was just giving her advice like I was the other AC girls when they got here, but after a bit realized that because she looks like a Sierra Leonean, and looks like a local, that a lot of my advice might not be of value. It’s very interesting to see how the locals react to her, both in the market and at the hospital. One of her main sponsors helping her with the costs of this visit is a company that provided surgical equipment for the hospital as well. When other companies got wind of what this company was doing, they sent funds and equipment as well. Gay is a photographer in her spare time, so the companies that donated asked her if she would be willing to take photos in surgery and the wards that they could use to potentially get more funding and more sponsorship, so she will also be taking a ton of photos.
Anyway, we showed Gay our fabric and wooden carvings and so on, and she really loved it all. She kept asking how the money worked, and she seemed anxious about some of the things that many first time travelers worry about. We told her we would take her into town tomorrow, and show her the market, help her buy some things, and get it to the tailor to be made into dresses and so on.
In the evening some of the guests watched a movie about the Sierra Leonean Civil War, and Steve came over. Since our shower is still not functioning properly, Gay offered us her shower and I took her up on it because I was gross. It’s crazy how much you sweat here in just a day because of the heat!
This post is dedicated to the mother who gave birth to a still born child early this morning, and to the child who died of severe malaria and anemia during the night.
Sunday, July 17, 2011
Day Forty: Lazy Daisy Sundays 07.17
Today we woke up late and hung around, writing our missed blog posts and reading. We ended playing some cards and in general just hanging out.
In the afternoon, Elliot had his third birthday party, and they had chicken on the grill, cheesy baked potatoes, corn on the grill, and salad. It was SOO good, and afterward we hung outside with Elliot and Abdulai, just playing and taking pictures. We found a chameleon hanging in the little tree outside out house and took plenty of pictures of it.
We were just hanging out, reading and such after the party, and Ashley was washing her clothes using the shower hose and the laundry bucket, when the how fixture came off the wall! Water sprayed everywhere, and we had a heck of a time getting it stopped. It was stressful.
Tonight we might head over to Steve’s to get in the pool, but only if he’s feeling better, he had malaria late last week. Last night I stubbed my toes pretty badly on the bedpost walking around in the dark, and now I have a bruised toe, so hopefully that’s better by morning. It’s weird to think that we only have one full week left, so we really have to get cracking on our videos for the hospital. I prepared part one of my CPR talk for Morning Handover, and Taylor thought it was good, so hopefully it goes well.
In the afternoon, Elliot had his third birthday party, and they had chicken on the grill, cheesy baked potatoes, corn on the grill, and salad. It was SOO good, and afterward we hung outside with Elliot and Abdulai, just playing and taking pictures. We found a chameleon hanging in the little tree outside out house and took plenty of pictures of it.
We were just hanging out, reading and such after the party, and Ashley was washing her clothes using the shower hose and the laundry bucket, when the how fixture came off the wall! Water sprayed everywhere, and we had a heck of a time getting it stopped. It was stressful.
Tonight we might head over to Steve’s to get in the pool, but only if he’s feeling better, he had malaria late last week. Last night I stubbed my toes pretty badly on the bedpost walking around in the dark, and now I have a bruised toe, so hopefully that’s better by morning. It’s weird to think that we only have one full week left, so we really have to get cracking on our videos for the hospital. I prepared part one of my CPR talk for Morning Handover, and Taylor thought it was good, so hopefully it goes well.
Day Thirty-nine: Sometimes you love it, sometimes you hate it, and sometimes you REALLY love it! 07.16
As I said yesterday, sometimes you hate this place and sometimes you absolutely love it. Today we slept in and debated about going to Kono. It’s a long drive, and Clem and Callum really wanted to go and stay overnight, but we had no idea if we could get in to see the mines at all, or if there was a place for us to stay to night. Callum just kept saying, “We’ll just go to a bar, make friends with some South Africans, and then they’ll put us up for the night for free and get us into the mines tomorrow!” The idea sounded pretty sketchy to me, plus I’m broke, so I told them I’d sit this one out. The other girls weren’t to keen on the idea either, and really wanted to see Makeni, so Danielle, Ashley, Taylor and I stayed behind while Erdi, John, Clem, Callum, and Gay left for Kono.
Buy midday, we were ready to go to Makeni, and decided to walk through some villages first. Erdi told us that if we were to cross the street and follow the path across from the hospital, it turns north and follows parallel to the main road almost all the way to Makeni. We decided to try it, and it was so fun! All the villagers were so excited to see us, and kept yelling hello to us in Timone and Creole. All the kids would run up to us and try to grab our hands, and when they saw our cameras would ask us to snap them. When we’d show them the picture we’d just taken, they would all laugh and ask for another. Eventually, the path turned and seemed to go farther away from the road, so we took another path the took us to the main road and followed that the rest of the way to Makeni. We kept taking pictures of the kids and the people and the countryside. At one gas station there was a car blaring music and a whole bunch of people our age hanging out there. We were on the other side of the street when we passed, and I noticed a little boy out on his porch dancing to the music. It was so cute! I told the other girls, but he’d already stopped dancing, so without thinking I did a little impression. All the people hanging out at the gas station started laughing like crazy, and they started dancing too, it was so fun!
Once we got as far as St. Mary’s, we stopped to get a little lunch. We all ended up buying a little cracker or something as a snack, and got four bananas for 1,000 Le, or 23 cents. Once we’d finished our lunch, we walked the rest of the way to the clock tower and started shopping for fabric and mats, which were the two things the other girls wanted to look at. I bough more fabric, and now I really am broke! Haha, not really, but I might be cutting it a little close! I have three mats now, I bought a third one because I’m not in love with one of the first ones I bought, and so I might sell it to Ashley since she likes it. If I did, that would mean I could afford to go to the beach next Sunday when they go, and I really want to join them. Now, if your name is Tim, Jane, or Andrew, or Grandma or Grandpa, (or anyone else for that matter) and you’re reading this and worrying about what’s going to happen if I run out of money, I want you to stop it right now. I’ve already told the other girls the situation, and they agreed that if I need to ‘buy’ some Leones from them, but pay them back in U.S. dollars of via a check when we get back that they’re willing to help me out. I don’t anticipate that happening, but I’ve covered my bases anyway, so stop worrying.
Once we were done in the market, we took motorbikes to the tailor to get some things made for the girls. We were walking from the tailor to St. Mary’s, which is right around the corner, to get some drinks for tonight when the hospital’s van that they use to pick up workers who live in Makeni stopped and the driver asked if we wanted a ride back. After a brief stop at St. Mary’s he drove us all back to the compound in air conditioning.
Once we got back, Marcel asked if we wanted to go down to ‘the river,’ which apparently doesn’t have a name, it’s just called The River. Danielle and Ashley opted to stay behind, but Taylor and I went with Marcel, Dr. Kelly (a friend of Marcel who’s visiting for a while) and Dr. Abel and his family to The River. It was very nice and cool, and we waded in a bit, but the water was rather muddy so only Elliot went swimming. On the way back, Marcel decided to take us the back way, which was a terrible road through all these cute little villages. It was nice to see the villages and the HUGE rice farms, but the road was so bad that I got sick. Luckily I got out of the car in time, and after that they let me sit up front. We were also really close to where the village road comes into Makeni and becomes a nice wide paved road. We passed Wousam, which is a really nice hotel that looks very out of place, and is frequented by family of Adex and Danas workers when they visit. All the rooms have AC, there’s a really fancy restaurant and a clean pool, as well as high speed internet on the whole compound.
By the time we got back the other girls had eaten dinner, so we bolted down our food and then tried to watch “Up” but the disc has a scratched and wouldn’t play. After a shower that felt wonderful because I was gross from walking around all day, it was time for bed.
Buy midday, we were ready to go to Makeni, and decided to walk through some villages first. Erdi told us that if we were to cross the street and follow the path across from the hospital, it turns north and follows parallel to the main road almost all the way to Makeni. We decided to try it, and it was so fun! All the villagers were so excited to see us, and kept yelling hello to us in Timone and Creole. All the kids would run up to us and try to grab our hands, and when they saw our cameras would ask us to snap them. When we’d show them the picture we’d just taken, they would all laugh and ask for another. Eventually, the path turned and seemed to go farther away from the road, so we took another path the took us to the main road and followed that the rest of the way to Makeni. We kept taking pictures of the kids and the people and the countryside. At one gas station there was a car blaring music and a whole bunch of people our age hanging out there. We were on the other side of the street when we passed, and I noticed a little boy out on his porch dancing to the music. It was so cute! I told the other girls, but he’d already stopped dancing, so without thinking I did a little impression. All the people hanging out at the gas station started laughing like crazy, and they started dancing too, it was so fun!
Once we got as far as St. Mary’s, we stopped to get a little lunch. We all ended up buying a little cracker or something as a snack, and got four bananas for 1,000 Le, or 23 cents. Once we’d finished our lunch, we walked the rest of the way to the clock tower and started shopping for fabric and mats, which were the two things the other girls wanted to look at. I bough more fabric, and now I really am broke! Haha, not really, but I might be cutting it a little close! I have three mats now, I bought a third one because I’m not in love with one of the first ones I bought, and so I might sell it to Ashley since she likes it. If I did, that would mean I could afford to go to the beach next Sunday when they go, and I really want to join them. Now, if your name is Tim, Jane, or Andrew, or Grandma or Grandpa, (or anyone else for that matter) and you’re reading this and worrying about what’s going to happen if I run out of money, I want you to stop it right now. I’ve already told the other girls the situation, and they agreed that if I need to ‘buy’ some Leones from them, but pay them back in U.S. dollars of via a check when we get back that they’re willing to help me out. I don’t anticipate that happening, but I’ve covered my bases anyway, so stop worrying.
Once we were done in the market, we took motorbikes to the tailor to get some things made for the girls. We were walking from the tailor to St. Mary’s, which is right around the corner, to get some drinks for tonight when the hospital’s van that they use to pick up workers who live in Makeni stopped and the driver asked if we wanted a ride back. After a brief stop at St. Mary’s he drove us all back to the compound in air conditioning.
Once we got back, Marcel asked if we wanted to go down to ‘the river,’ which apparently doesn’t have a name, it’s just called The River. Danielle and Ashley opted to stay behind, but Taylor and I went with Marcel, Dr. Kelly (a friend of Marcel who’s visiting for a while) and Dr. Abel and his family to The River. It was very nice and cool, and we waded in a bit, but the water was rather muddy so only Elliot went swimming. On the way back, Marcel decided to take us the back way, which was a terrible road through all these cute little villages. It was nice to see the villages and the HUGE rice farms, but the road was so bad that I got sick. Luckily I got out of the car in time, and after that they let me sit up front. We were also really close to where the village road comes into Makeni and becomes a nice wide paved road. We passed Wousam, which is a really nice hotel that looks very out of place, and is frequented by family of Adex and Danas workers when they visit. All the rooms have AC, there’s a really fancy restaurant and a clean pool, as well as high speed internet on the whole compound.
By the time we got back the other girls had eaten dinner, so we bolted down our food and then tried to watch “Up” but the disc has a scratched and wouldn’t play. After a shower that felt wonderful because I was gross from walking around all day, it was time for bed.
Day Thirty-eight: Sometimes You Love It, Sometimes You Hate it, TIA. 07.15
I’ve learned a phrase since I’ve been here that is a typical phrase of NGOs and Expats, and they abbreviate it TIA. This Is Africa. They use it when things aren’t going the way they should, or the locals are behaving in a way we don’t understand. Sometimes I love this place, it’s so beautiful and the locals are so nice. But sometimes I hate it, because I see so much sadness and so much pain, and easy ways to fix it, and easy ways to improve the development of this country, and either it’s not my place to say anything, or I do say something and the locals just look at me with blank faces. There is trash everywhere here, just on the ground, and when I told Musa, a local worker, that he shouldn’t throw trash on the ground, he asked me where else he would put it. I was so surprised that to him, the trashcan fifteen feet away isn’t a clear choice for where trash goes. I told him this, and went to pick up the plastic bag that he’d just thrown on the ground, and he told me not to, that the hospital hired someone to pick up trash around the compound, and that if everyone put their trash in the cans, that he would be out of a job.
I knew today would be a TIA day at Morning Handover. Dr. Erdi was late, and because she wasn’t there it was chaos. Nurses were coming and going during reports, just stepping outside if it pleased them to talk to a friend outside, answering their cell phones in the meeting room and talking loudly to the person on the other end. At one point I got really upset by it, and went to the door where a group of nurses were talking, and said, “If you’re going to ignore the meeting, could you do so over there so that those of us who care can actually hear what’s being said.” And they looked at me like I was speaking Chinese.
Taylor and I wanted to do rounds with Dr. ABD, but he wasn’t there right away. After waiting about fifteen to twenty minutes, which didn’t brighten my mood, he showed up and joined us on rounds. Before he arrived, CHO Alpha had started rounds and we had been following him. I like following Alpha on rounds because he takes the time to explain what’s going on with the patients, so you can really understand what’s going on. I recognized one patient as a surgical patient from yesterday. He’d been opened up to remove a severely infected appendix. Not only had his appendix already burst, but also it had become necrotic and caused infection. They had to suction out a ton of pus, and remove some of the dead tissues and hope that his intestines weren’t affected. They’d left his incision open, and just packed it with gauze and covered it so that later today they can go back in and see if there’s still more pus or dead tissues. His bandage had become lose during the night, and his bed sheets were covered with blood and other fluid discharge from his abdomen. I was waiting for CHO Alpha to tell the nurse that leaving someone in their bloody sheets all night is not acceptable, and to change them, but he never did. Eventually I said, “Look at all the blood on his sheets, why haven’t they been changed?” The nurse said in reply that he was going to theatre today, and I just started at her. I was so mad, I really wanted to say, “Yea, and my favorite book is ‘The Hobbit,’ but why are we wasting time exchanging irrelevant information rather than changing the patient’s sheets?” Instead I just shook my head.
There’s a patient in male ward who has a severe infection covering the backside of his entire right thigh, and some of his butt as well. His leg is ridiculously swollen and he has a couple of patches that look like skin ulcers, but are actually dead skin and dead tissue that’s still around because it’s held in place by the skin around it. The top layer of skin has died and started to flake off like when you get a sunburn and it flakes, but it was coming off in HUGE chunks, and because his skin is dark the dead skin had turned pitch black. Yesterday they tried to get him to the theatre to do an I and D, and incision and draining. However, halfway to the theatre, he collapsed and went into septic shock. Today when we saw him on rounds, CHO Alpha scolded him for going into septic shock, and kept telling him how important it is that he not go into septic shock today when they try again to get him to theatre. Now I’m very curious as to what Alpha knows about septic shock, because last I check you can’t keep yourself from going into shock by shear force of will.
Another patient in male ward who I’ve seen at wound care has an open wound covering most of his right butt and his thigh. When we saw him today, Alpha was about to pass over him after some brief questions about his general health, and just wrote, ‘Continue with dressings’ in his file. When I saw this man in wound care yesterday, I noticed that he looked wasted, like he wasn’t eating, so I asked him and his caretaker what he’d been eating. They told me he was afraid to eat because he didn’t want to defecate, and I had tried to tell them how important it is for him to eat well so that he can heal and stay healthy. I told Alpha this, and he thanked me and was able to tell the patient yet again how important it is for him to eat plenty, and told him that if he’s not going to eat, they may as well not treat him because no matter what they do he’ll die anyway. It sounds very harsh, but sometimes they don’t understand the importance unless you put it in very severe terms.
When we went on rounds in Female Ward, Dr. ABD told us the whole story about what had happened to CHO Hasinatu. There is such a negative stigma to divorce, especially for women, and men are still very much the gender in power, that it’s clear that even ABD is bias toward believing a male in a domestic dispute. It’s very sad, and I don’t know what to believe. According to ABD, Hasinatu’s husband came down to talk to him, and apologize for the police disrupting the hospital’s workday in order to arrest Hasinatu. According to him, he helped out Hasinatu’s family greatly after her father left her mother and children. She was very young when he took over paying for her school fees, and paid her mother to let Hasinatu stay in school rather than work at home. When she turned 16, her mother asked her to marry him, and she agreed. Because he’s fairly older than her, he had some fears about her attempting to run off with a younger man. He asked her to find local work, and told her he wanted children. He also told her that he knew he was going to die first, and that once he passed she was welcome to find herself a new husband. Around March, she ended up in the hospital but didn’t tell him because she had found someone to abort her baby and didn’t want him knowing. Up until this part of the story, everything seems pretty reasonable, but then Dr. ABD told me that the husband had found out about Hasinatu’s American boyfriend. There aren’t any American companies working in Sierra Leone right now, so how did she meet and start dating someone from the US? Anyway according to the husband, Hasinatu told the boyfriend what was happening and asked him to come get her and move to Makeni with her, which again doesn’t fit with the whole ‘the boyfriend is American’ bit, but whatever. At the same time, the husband found out where she was and also was on his way to see her, but they apparently ‘got away’ before he arrived. He asked her family where she was, and they ‘pretended’ not to know. He told the police his wife was missing, and they have been looking for her ever since. Apparently it’s the law that if you’re married, you’re not allowed to go off and live with a boyfriend or girlfriend, and that if you find out your husband or wife is doing so, you can have them arrested. I have no idea how true this is, or if it really holds true for women the same as it does men, but I think that’s bogus. Sure, it’s not very nice to just up and leave without telling your husband, but sometimes there’s more to the story than meets the eye, and I think Hasinatu felt that she wouldn’t be allowed to divorce her husband, and feared the consequences of trying. Dr. ABD seemed upset that Taylor and I were siding more with Hasinatu, wanting to give her the benefit of the doubt, rather then blindly believing the husband.
After a short break for lunch, we went back to the theatre where they had just finished examining the young man who’d been opened for his appendix. Apparently there was more pus, so they opened up his whole abdomen to try and find the source, and felt that it had gone well. [The next case was an examination of a guy who’d fallen out of a tree in 1987 and injured himself in the genitals/buttocks region. He apparently has not been able to pass urine well since, and when he fell received a puncture wound right behind his scrotum but before his anus that had never healed, and now he was leaking clear fluid from it. Dr. ABD determined that his urethra had regenerated itself, and made a different path for urine to leave his body, and that it was urine that was leaking out the hole. Dr. ABD isn’t sure what he can do for the man, but hopes for the best.]
The third and final case was the man with the infection who’d gone into septic shock yesterday. When they brought him in, I immediately understood why he’d gone into septic shock. They were expecting him to move himself!!! They weren’t helping him at all! I was so upset by this, and then they started yelling at him for taking so long to get up on the operating table. If I actually had a leg to stand on here, I would have ripped all those nurses a new one for treating the patient that way, but as it is I have no grounds on which to tell them that, so I just had to sit there. Once they got him on the table and removed all the flaking skin, the skin underneath actually looked pretty good, which is a good sign. They ended up removing the patches of skin that were clearly dead, and making some choice incisions to help the leg drain. It was pretty intense, especially because Dr. ABD kept sticking his fingers inside the guys skin and moving them around. Unfortunately, even when these cleanings go well, on injuries this big the patient normally doesn’t survive, but there isn’t really any other choice because they’ll die anyway if we don’t do anything.
After a great meal, we met Gay who is African-American and visiting Sierra Leone for two weeks. She found out she has some Sierra Leonean heritage, and has come back to visit her roots. She is about 45 and has four children, and hopes to photograph the hospital a lot. After dinner was also watched Blind Side, which is always good no matter how many times I see it.
This post is dedicated to the man who died of PUD (peptic ulcer disease), the man who died of liver disease, and a child who had severe malaria and passed early this morning.
I knew today would be a TIA day at Morning Handover. Dr. Erdi was late, and because she wasn’t there it was chaos. Nurses were coming and going during reports, just stepping outside if it pleased them to talk to a friend outside, answering their cell phones in the meeting room and talking loudly to the person on the other end. At one point I got really upset by it, and went to the door where a group of nurses were talking, and said, “If you’re going to ignore the meeting, could you do so over there so that those of us who care can actually hear what’s being said.” And they looked at me like I was speaking Chinese.
Taylor and I wanted to do rounds with Dr. ABD, but he wasn’t there right away. After waiting about fifteen to twenty minutes, which didn’t brighten my mood, he showed up and joined us on rounds. Before he arrived, CHO Alpha had started rounds and we had been following him. I like following Alpha on rounds because he takes the time to explain what’s going on with the patients, so you can really understand what’s going on. I recognized one patient as a surgical patient from yesterday. He’d been opened up to remove a severely infected appendix. Not only had his appendix already burst, but also it had become necrotic and caused infection. They had to suction out a ton of pus, and remove some of the dead tissues and hope that his intestines weren’t affected. They’d left his incision open, and just packed it with gauze and covered it so that later today they can go back in and see if there’s still more pus or dead tissues. His bandage had become lose during the night, and his bed sheets were covered with blood and other fluid discharge from his abdomen. I was waiting for CHO Alpha to tell the nurse that leaving someone in their bloody sheets all night is not acceptable, and to change them, but he never did. Eventually I said, “Look at all the blood on his sheets, why haven’t they been changed?” The nurse said in reply that he was going to theatre today, and I just started at her. I was so mad, I really wanted to say, “Yea, and my favorite book is ‘The Hobbit,’ but why are we wasting time exchanging irrelevant information rather than changing the patient’s sheets?” Instead I just shook my head.
There’s a patient in male ward who has a severe infection covering the backside of his entire right thigh, and some of his butt as well. His leg is ridiculously swollen and he has a couple of patches that look like skin ulcers, but are actually dead skin and dead tissue that’s still around because it’s held in place by the skin around it. The top layer of skin has died and started to flake off like when you get a sunburn and it flakes, but it was coming off in HUGE chunks, and because his skin is dark the dead skin had turned pitch black. Yesterday they tried to get him to the theatre to do an I and D, and incision and draining. However, halfway to the theatre, he collapsed and went into septic shock. Today when we saw him on rounds, CHO Alpha scolded him for going into septic shock, and kept telling him how important it is that he not go into septic shock today when they try again to get him to theatre. Now I’m very curious as to what Alpha knows about septic shock, because last I check you can’t keep yourself from going into shock by shear force of will.
Another patient in male ward who I’ve seen at wound care has an open wound covering most of his right butt and his thigh. When we saw him today, Alpha was about to pass over him after some brief questions about his general health, and just wrote, ‘Continue with dressings’ in his file. When I saw this man in wound care yesterday, I noticed that he looked wasted, like he wasn’t eating, so I asked him and his caretaker what he’d been eating. They told me he was afraid to eat because he didn’t want to defecate, and I had tried to tell them how important it is for him to eat well so that he can heal and stay healthy. I told Alpha this, and he thanked me and was able to tell the patient yet again how important it is for him to eat plenty, and told him that if he’s not going to eat, they may as well not treat him because no matter what they do he’ll die anyway. It sounds very harsh, but sometimes they don’t understand the importance unless you put it in very severe terms.
When we went on rounds in Female Ward, Dr. ABD told us the whole story about what had happened to CHO Hasinatu. There is such a negative stigma to divorce, especially for women, and men are still very much the gender in power, that it’s clear that even ABD is bias toward believing a male in a domestic dispute. It’s very sad, and I don’t know what to believe. According to ABD, Hasinatu’s husband came down to talk to him, and apologize for the police disrupting the hospital’s workday in order to arrest Hasinatu. According to him, he helped out Hasinatu’s family greatly after her father left her mother and children. She was very young when he took over paying for her school fees, and paid her mother to let Hasinatu stay in school rather than work at home. When she turned 16, her mother asked her to marry him, and she agreed. Because he’s fairly older than her, he had some fears about her attempting to run off with a younger man. He asked her to find local work, and told her he wanted children. He also told her that he knew he was going to die first, and that once he passed she was welcome to find herself a new husband. Around March, she ended up in the hospital but didn’t tell him because she had found someone to abort her baby and didn’t want him knowing. Up until this part of the story, everything seems pretty reasonable, but then Dr. ABD told me that the husband had found out about Hasinatu’s American boyfriend. There aren’t any American companies working in Sierra Leone right now, so how did she meet and start dating someone from the US? Anyway according to the husband, Hasinatu told the boyfriend what was happening and asked him to come get her and move to Makeni with her, which again doesn’t fit with the whole ‘the boyfriend is American’ bit, but whatever. At the same time, the husband found out where she was and also was on his way to see her, but they apparently ‘got away’ before he arrived. He asked her family where she was, and they ‘pretended’ not to know. He told the police his wife was missing, and they have been looking for her ever since. Apparently it’s the law that if you’re married, you’re not allowed to go off and live with a boyfriend or girlfriend, and that if you find out your husband or wife is doing so, you can have them arrested. I have no idea how true this is, or if it really holds true for women the same as it does men, but I think that’s bogus. Sure, it’s not very nice to just up and leave without telling your husband, but sometimes there’s more to the story than meets the eye, and I think Hasinatu felt that she wouldn’t be allowed to divorce her husband, and feared the consequences of trying. Dr. ABD seemed upset that Taylor and I were siding more with Hasinatu, wanting to give her the benefit of the doubt, rather then blindly believing the husband.
After a short break for lunch, we went back to the theatre where they had just finished examining the young man who’d been opened for his appendix. Apparently there was more pus, so they opened up his whole abdomen to try and find the source, and felt that it had gone well. [The next case was an examination of a guy who’d fallen out of a tree in 1987 and injured himself in the genitals/buttocks region. He apparently has not been able to pass urine well since, and when he fell received a puncture wound right behind his scrotum but before his anus that had never healed, and now he was leaking clear fluid from it. Dr. ABD determined that his urethra had regenerated itself, and made a different path for urine to leave his body, and that it was urine that was leaking out the hole. Dr. ABD isn’t sure what he can do for the man, but hopes for the best.]
The third and final case was the man with the infection who’d gone into septic shock yesterday. When they brought him in, I immediately understood why he’d gone into septic shock. They were expecting him to move himself!!! They weren’t helping him at all! I was so upset by this, and then they started yelling at him for taking so long to get up on the operating table. If I actually had a leg to stand on here, I would have ripped all those nurses a new one for treating the patient that way, but as it is I have no grounds on which to tell them that, so I just had to sit there. Once they got him on the table and removed all the flaking skin, the skin underneath actually looked pretty good, which is a good sign. They ended up removing the patches of skin that were clearly dead, and making some choice incisions to help the leg drain. It was pretty intense, especially because Dr. ABD kept sticking his fingers inside the guys skin and moving them around. Unfortunately, even when these cleanings go well, on injuries this big the patient normally doesn’t survive, but there isn’t really any other choice because they’ll die anyway if we don’t do anything.
After a great meal, we met Gay who is African-American and visiting Sierra Leone for two weeks. She found out she has some Sierra Leonean heritage, and has come back to visit her roots. She is about 45 and has four children, and hopes to photograph the hospital a lot. After dinner was also watched Blind Side, which is always good no matter how many times I see it.
This post is dedicated to the man who died of PUD (peptic ulcer disease), the man who died of liver disease, and a child who had severe malaria and passed early this morning.
Thursday, July 14, 2011
Day Thirty-seven: Giant Cysts, anyone? 07.14
Today I discovered that it requires four reminders for nurses to get blood for a surgical patient at the doctor’s request. The work ethic of some of the locals here just astounds me. After Handover, we discovered that Hasinatu had been arrested when she arrived at the hospital that morning, and was being taken back to Bo to her husband. Apparently she left him without his consent and he did not want her to go to work, so he had her arrested. Dr. Erdi was fairly upset that such a thing was allowed to happen, but there wasn’t much she could do about it.
I had hoped to help with wound care again today, but no one could find the keys to the theatre so I went to find Dr. ABD and follow him on rounds. He however was busy giving a tour of the hospital to some friend of his and after he told me he’d be right back, and I waited outside the female ward for ten minutes, I decided to go down to the TFC to weigh myself (I’ve lost two more kilos) and then head back to the theatre to see if they had gotten in and started wound care yet.
I found that they had started wound care, and I helped Kady with that until around 11h00. Taylor joined me around 10h30 because Dr. Erdi had gotten called into an interview with a lab technician, and we are in dire need of one so she jumped at the opportunity to find one.
After working on my project and having lunch, I went back to the theatre, where I was told that they would be starting surgery soon. This was at 13h00, but they didn’t start until 14h30. Sometimes things just take way longer than they should here.
In the mean time, I found Dr. Erdi finishing rounds in the maternity ward, and joined her in time to hear that a baby who weighed 4.8 kg at birth weighed 3.6 kg when they measured here today, just 48 hours later or so. Dr. Erdi looked at me, and I said what she had written all over her face. “That’s impossible. The baby looks healthy and normal, and a healthy baby does not drop 2.5 lbs over night!” All the nurses laughed, and when Dr. Erdi finished seeing that patient, the patient said, “Thank you, sir!” Dr. Erdi looked back and told her, “I’m a ma’am, not a sir!” Which prompted all the nursing staff to tell Dr. Erdi that the patient made that mistake because being a doctor is ‘man’s work.’ I told them that’s ridiculous, but they couldn’t be convinced.
Around 14h30 surgery started with appendicitis, then a cystectomy on an elderly woman. The woman looked very normal, a little chubby for a Sierra Leonean maybe, but she looked just fine. When they opened her, Dr. ABD pointed to an egg sized yellow and milky mass and said that it was the cyst, and a large one. Then he pulled out the rest of the organ it was attached to. Or that’s what I thought until he cut the entire mass out. I was so surprised until I realized that it was all cyst that he had removed, and it was about eight inches long, five inches wide, and four inches thick. When they cut it open, most of it was filled with brown fluid, but part of it was partially formed tissue, which is a bad sign. Such cysts are normally indicative of cancer.
After one final procedure, which was just a vaginal exam, Taylor and I went back to the house to plan our videos some more. We barely got started when Dr. Erdi came by asking if we wanted to go to town with her to pick up some things. We all ended up going, and while Dr. Erdi was in a small shop buying some things for the guest house I took the girls down the street to Foday’s woodcarving shop to show them what he had. He remembered me, and the girls enjoyed looking at all his things. None of them had any money, and we told them that we would be back sometime to look again. After we left the girls asked if Ali, another wood carver I know, makes the same kinds of things. They decided that I should give him a call, and ask him to bring some things by for them to see. I think I’ll ask him to come by sometime next week.
This post is dedicated to a child who died of severe malaria today.
I had hoped to help with wound care again today, but no one could find the keys to the theatre so I went to find Dr. ABD and follow him on rounds. He however was busy giving a tour of the hospital to some friend of his and after he told me he’d be right back, and I waited outside the female ward for ten minutes, I decided to go down to the TFC to weigh myself (I’ve lost two more kilos) and then head back to the theatre to see if they had gotten in and started wound care yet.
I found that they had started wound care, and I helped Kady with that until around 11h00. Taylor joined me around 10h30 because Dr. Erdi had gotten called into an interview with a lab technician, and we are in dire need of one so she jumped at the opportunity to find one.
After working on my project and having lunch, I went back to the theatre, where I was told that they would be starting surgery soon. This was at 13h00, but they didn’t start until 14h30. Sometimes things just take way longer than they should here.
In the mean time, I found Dr. Erdi finishing rounds in the maternity ward, and joined her in time to hear that a baby who weighed 4.8 kg at birth weighed 3.6 kg when they measured here today, just 48 hours later or so. Dr. Erdi looked at me, and I said what she had written all over her face. “That’s impossible. The baby looks healthy and normal, and a healthy baby does not drop 2.5 lbs over night!” All the nurses laughed, and when Dr. Erdi finished seeing that patient, the patient said, “Thank you, sir!” Dr. Erdi looked back and told her, “I’m a ma’am, not a sir!” Which prompted all the nursing staff to tell Dr. Erdi that the patient made that mistake because being a doctor is ‘man’s work.’ I told them that’s ridiculous, but they couldn’t be convinced.
Around 14h30 surgery started with appendicitis, then a cystectomy on an elderly woman. The woman looked very normal, a little chubby for a Sierra Leonean maybe, but she looked just fine. When they opened her, Dr. ABD pointed to an egg sized yellow and milky mass and said that it was the cyst, and a large one. Then he pulled out the rest of the organ it was attached to. Or that’s what I thought until he cut the entire mass out. I was so surprised until I realized that it was all cyst that he had removed, and it was about eight inches long, five inches wide, and four inches thick. When they cut it open, most of it was filled with brown fluid, but part of it was partially formed tissue, which is a bad sign. Such cysts are normally indicative of cancer.
After one final procedure, which was just a vaginal exam, Taylor and I went back to the house to plan our videos some more. We barely got started when Dr. Erdi came by asking if we wanted to go to town with her to pick up some things. We all ended up going, and while Dr. Erdi was in a small shop buying some things for the guest house I took the girls down the street to Foday’s woodcarving shop to show them what he had. He remembered me, and the girls enjoyed looking at all his things. None of them had any money, and we told them that we would be back sometime to look again. After we left the girls asked if Ali, another wood carver I know, makes the same kinds of things. They decided that I should give him a call, and ask him to bring some things by for them to see. I think I’ll ask him to come by sometime next week.
This post is dedicated to a child who died of severe malaria today.
Day Thirty-six: Missing Food From Home 07.13
This morning it was raining, so Morning Handover started late of course. Once the meeting started, almost immediately Dr. Erdi became appalled by a report from one of the nurses that a baby who needed blood didn’t receive blood because none of the nurses would consent to donate blood in her name. It’s so frustrating that no matter how many times you explain that it’s fairly painless, and that it’s so easy and saves lives, that they refuse because it’s ‘scary.’
After Morning Handover we went on Big Rounds, but some of the CHOs and nurses that are supposed to go with us didn’t even show up. The baby who had the germ cell teritoma removed is doing really well, and will be discharged tomorrow! Another man came in with a horribly swollen and septic leg, and it seems like they are using the same cream that is coming from Asia. Dr. ABD is beginning to wonder if it’s safe, or if people are using it incorrectly. He will have to go for an I and D (and incision and draining) tomorrow to get as much pus as possible out.
Another patient on Big Rounds had been prepared for a hernia repair yesterday, but when Dr. Erdi did a physical exam in the operating room, she found that he also had a severely infected testical. When some has an infection like that, you can’t operate until they’ve been on antibiotics for a while, so the nurses must not have done a proper exam when they deemed him fit for surgery. Dr. Erdi wanted everyone to see that patient on Big Rounds to demonstrate the importance of a good physical exam.
After Big Rounds, I went to the Children’s Ward to see a couple patients there that I have gotten to know and wanted to check on. They were all doing well, except for one of the little boys who had surgery last week, who now has a fever, which could mean infection. Not good.
After Big Rounds I went back to the house to work on my research project, and in the afternoon the girls and I spend a good chunk of time planning and writing scripts for our videos that Dr. Erdi would like us to make while we’re here. So far they seem decent, but I also need to prepare my CPR presentation. Taylor and I were also considering presenting on some things we’ve seen going on that would not be proper practice in the U.S.
After dinner, I was beat, so Ashley and I watched Blood Diamond, which is about Sierra Leone. I’d never seen it, and it was pretty good, but they got some stuff wrong. There aren’t any traditionally African animals in Sierra Leone, and there’s only real jungle in the far north, and there’s not much of it. They also used names for characters that were supposed to be native Sierra Leoneans that aren’t Sierra Leonean names. It’s sad to be able to see that people are still recovering from the civil war here, you can still see how it’s affecting the people.
This post is dedicated to the infant who didn’t receive blood in time and died, and the two children who died of a plethora of aliments in children’s ward.
After Morning Handover we went on Big Rounds, but some of the CHOs and nurses that are supposed to go with us didn’t even show up. The baby who had the germ cell teritoma removed is doing really well, and will be discharged tomorrow! Another man came in with a horribly swollen and septic leg, and it seems like they are using the same cream that is coming from Asia. Dr. ABD is beginning to wonder if it’s safe, or if people are using it incorrectly. He will have to go for an I and D (and incision and draining) tomorrow to get as much pus as possible out.
Another patient on Big Rounds had been prepared for a hernia repair yesterday, but when Dr. Erdi did a physical exam in the operating room, she found that he also had a severely infected testical. When some has an infection like that, you can’t operate until they’ve been on antibiotics for a while, so the nurses must not have done a proper exam when they deemed him fit for surgery. Dr. Erdi wanted everyone to see that patient on Big Rounds to demonstrate the importance of a good physical exam.
After Big Rounds, I went to the Children’s Ward to see a couple patients there that I have gotten to know and wanted to check on. They were all doing well, except for one of the little boys who had surgery last week, who now has a fever, which could mean infection. Not good.
After Big Rounds I went back to the house to work on my research project, and in the afternoon the girls and I spend a good chunk of time planning and writing scripts for our videos that Dr. Erdi would like us to make while we’re here. So far they seem decent, but I also need to prepare my CPR presentation. Taylor and I were also considering presenting on some things we’ve seen going on that would not be proper practice in the U.S.
After dinner, I was beat, so Ashley and I watched Blood Diamond, which is about Sierra Leone. I’d never seen it, and it was pretty good, but they got some stuff wrong. There aren’t any traditionally African animals in Sierra Leone, and there’s only real jungle in the far north, and there’s not much of it. They also used names for characters that were supposed to be native Sierra Leoneans that aren’t Sierra Leonean names. It’s sad to be able to see that people are still recovering from the civil war here, you can still see how it’s affecting the people.
This post is dedicated to the infant who didn’t receive blood in time and died, and the two children who died of a plethora of aliments in children’s ward.
Wednesday, July 13, 2011
Day Thirty-five: The Day of Hysterectomies. 07.12
Today I had graham crackers for breakfast, and offered them to anyone who wanted one, because I’m starting to wonder if I’ll be able to finish some of my snacks in the rest of my time here, and I don’t want to take it home or waste it. I think I’ll be having graham crackers and peanut butter for breakfast until they’re finished.
At morning handover, one of the nurses started arguing with Dr. Erdi that she was wrong, that they had given the correct treatment, even though the patient had died. Dr. Erdi got pretty upset, and seemed pretty disappointed by the nurse’s inability to take constructive criticism.
After Handover, Taylor and I decided to go to wound care and help Kady clean some wounds. When we first got there she wasn’t ready to get started, so we organized the woman’s scrubs that are in the woman’s changing room. It has bothered me since I got here that they are so unorganized. We folded all of them nicely, and organized them by size. I’m sure it won’t last, but at least for today they looked nice.
For most of the morning, we watched and helped Kady clean wounds. It was really hard to watch some of the, because some people have huge open soars that stretch over major parts of their body, and they pour hydrogen peroxide over it. Most people barely make a noise too, but their faces are so contorted that it’s just awful to watch.
At around 11h00 they started surgery. The first one was a hernia repair for a little boy of about eight. He was so scared, so Taylor and I went into the operating room with him, and showed him the bed and the machines that would tell the doctors if he’s doing okay, and told him that he would “get cheuck and go sleep, then feel nothing. Wake up, and be fine, fine.” A ‘cheuck’ is Creole for shot, and when he heard he had to get another shot he had a momentary freak out. But then I told him that thing in his arm (an IV line) was there so that they could give him more medicine but without more shots. He calmed down a bit after that. Taylor got to scrub in on that surgery.
After the hernia, we went back to the house for a quick lunch, then back to the theatre where I scrubbed in on a hysterectomy. I felt like Dr. ABD was getting frustrated with me, but afterward he apologized if he seemed short with me, but his back was really hurting him. The next surgery was also a hysterectomy, but for a woman who had a prolapsed uterus. That’s when the uterus comes out the vagina and can be seen outside the body. It happens in older women who have had LOTS of pregnancies, and can be very painful.
After surgery was done for the day, I read for a bit until dinner, which was spaghetti with spicy meat sauce, mango and cucumber, and bread fries. The bread fries tasted good but we couldn’t figure out what they actually were, and David just kept telling us they were bread fries, although at one point he said breadfruit, whatever that means. After dinner we played euchre until we were tired and ready to shower up for bed time.
This post is dedicated to the mother who gave birth to a still born child, the mother who gave birth to an infant who didn’t develop a brain or skull (he will die within a week) and the child who died in the TFC from dehydration.
At morning handover, one of the nurses started arguing with Dr. Erdi that she was wrong, that they had given the correct treatment, even though the patient had died. Dr. Erdi got pretty upset, and seemed pretty disappointed by the nurse’s inability to take constructive criticism.
After Handover, Taylor and I decided to go to wound care and help Kady clean some wounds. When we first got there she wasn’t ready to get started, so we organized the woman’s scrubs that are in the woman’s changing room. It has bothered me since I got here that they are so unorganized. We folded all of them nicely, and organized them by size. I’m sure it won’t last, but at least for today they looked nice.
For most of the morning, we watched and helped Kady clean wounds. It was really hard to watch some of the, because some people have huge open soars that stretch over major parts of their body, and they pour hydrogen peroxide over it. Most people barely make a noise too, but their faces are so contorted that it’s just awful to watch.
At around 11h00 they started surgery. The first one was a hernia repair for a little boy of about eight. He was so scared, so Taylor and I went into the operating room with him, and showed him the bed and the machines that would tell the doctors if he’s doing okay, and told him that he would “get cheuck and go sleep, then feel nothing. Wake up, and be fine, fine.” A ‘cheuck’ is Creole for shot, and when he heard he had to get another shot he had a momentary freak out. But then I told him that thing in his arm (an IV line) was there so that they could give him more medicine but without more shots. He calmed down a bit after that. Taylor got to scrub in on that surgery.
After the hernia, we went back to the house for a quick lunch, then back to the theatre where I scrubbed in on a hysterectomy. I felt like Dr. ABD was getting frustrated with me, but afterward he apologized if he seemed short with me, but his back was really hurting him. The next surgery was also a hysterectomy, but for a woman who had a prolapsed uterus. That’s when the uterus comes out the vagina and can be seen outside the body. It happens in older women who have had LOTS of pregnancies, and can be very painful.
After surgery was done for the day, I read for a bit until dinner, which was spaghetti with spicy meat sauce, mango and cucumber, and bread fries. The bread fries tasted good but we couldn’t figure out what they actually were, and David just kept telling us they were bread fries, although at one point he said breadfruit, whatever that means. After dinner we played euchre until we were tired and ready to shower up for bed time.
This post is dedicated to the mother who gave birth to a still born child, the mother who gave birth to an infant who didn’t develop a brain or skull (he will die within a week) and the child who died in the TFC from dehydration.
Tuesday, July 12, 2011
Day Thirty-four: So Many C-Sections 07.11
This morning around 4h00 the power came on, so we assumed there was another C-Section. There have been so many C-sections in the past three days or so, it’s crazy! When I got up to turn off the lights and go back to sleep, Ashley and Daniel asked me if I’d heard the yelling, which I hadn’t, so I asked them more about it. They said that there had been two episodes of yelling, one of people wailing and it sounded like it was coming from the hospital, which I told them was probably the family of a patient morning their death, and the second they said had been male voices fighting and yelling back and forth to one another, and they thought that at one point they heard Dr. Erdi yell, “Get out of here! You’re not supposed to be in here!” I told them I had no idea what actually happened, but that the first week Nicole and Charlotte were here someone snuck in and stole some of the parts from their brand new van that was donated to them so they could pick up their workers who live and Makeni and bring them to work. Most of the parts were non-essential, like AC and such, but it was still very disappointing, and they were fairly sure that whoever took the parts either was a worker or friends with a security guard, otherwise they wouldn’t have been able to get in.
At Morning Handover, I almost left. It was a very sad report, from almost every ward. Dr. Erdi even gave some short comments after the weekend reports pleading with the staff that in the future if a patient comes on a weekend or during the night that they get admitted and don’t get turned away. When patients make the decision to come and be admitted, especially when it’s the middle of the night or on a weekend when they know the hospital OPD isn’t open that it means they believe their illness is serious enough that is should be treated right away. There were too many deaths this weekend, and Dr. Erdi saw almost every single one. No wonder she gets stressed and sad sometimes.
After Morning Handover, Taylor and I were going to help Kady in wound care, but she wasn’t going to get started for a while and Dr. ABD was about to start rounds, so we followed him instead. Because Taylor is new to rounds, he went through all the patient files in detail with us, and explained what was going on and so on. I really like when he does that, it makes it so much easier to follow what’s going on versus when he just speaks to the patient in Creole and says, “Continue treatment.” I have noticed now, with the new group being here, that I understand a lot more Creole than I thought I did. At Morning Handover, Taylor and John both said afterwards that they didn’t understand hardly any of the reports given, and I was able to tell them almost everything that was said. They both seemed surprised and asked how I had picked up so much, but Creole is surprisingly easy to understand if you speak English, once you get used to the sentence structure. It’s harder to speak though, because I feel like you’re just butchering the nice English grammar I was taught in school.
After Dr. ABD finished rounds, I worked on my research until lunchtime, and then after a quick lunch went back to the hospital with Taylor. The power was still on even though it was 13h15, so we went to the theatre to see if they were in surgery. Mary, one of the midwifes, was there preparing for a C-section that would occur as soon as the mother arrived from the ward. We gowned up and went into the theatre, and when the mother came in I said, “Ooo! Twins!” because she looked so much larger than the norm for mothers here, but Mary said, “No, no, no. Single fetus, pre-eclampsia.” Dr. ABD was there, ready to perform the C-section, and I looked at him and said, “Wow, that’s going to be one big baby!” I asked Dr. ABD why pre-eclampsia and eclampsia are so dangerous, and he said that the real danger is eclampic fits, which can occur once a patient has progressed from pre-eclampsia to eclampsia. It is a condition that can present with many symptoms, such as swelling of the feet and ankles, weakness of the body, and dizziness. The real problem though, is the high blood pressure that characterizes pre-eclampsia and eclampsia. The high blood pressure can lead to fits, which can cut off oxygen to the brain of the mother, and the fetus. It can be life threatening for both, as every minute the fetus is without oxygen their chance of survival goes down, and every minute the mother’s brain is without oxygen her chances of having brain damage go up.
Once the C-section started, and the baby removed, it was completely obvious that it was twins, and that there was another baby. The problem there is that two people are supposed to be ready to take the babies, and only Mary had prepared to take one baby. When she said, “Please, can someone watch this child so I can get the other one?” no one answered! So I ran over and told her to go, and put gloves on quickly and started doing what I had seen the midwifes do with infants that are crying well after delivery: rub their back like crazy. Mary said it helps to keep them crying, and when they cry it helps clear the fluid from their lungs. When Mary brought the second twin over, it wasn’t breathing at all, and it took a long time for her to get it to cry. It seemed to be trying to take in air and couldn’t. Eventually it let out a weak cry, but not very convincing and it stopped soon after.
Later when we went to the ward to check on them, both seemed fine, but the second twin is clearly smaller. All the family was gathered around, cooing over the babies. When we came in to see the babies, Mary told them that Taylor and I had helped deliver the twins, and they wanted to know our names so that the girls could be named after us. I’m not sure if they actually will, but we were both kind of like, “Um, you don’t have to do that…”
It was around four, and things seemed to be winding down. We thought about stopping by Dr. Abel’s office to see how his day was going, but he seemed really busy so we went down to the TFC to see Abdulai and so that Taylor could see where the business office is. We didn’t really find much to do there, so we ended up back at the house to nap and read.
Dinner was awesome again, and reminded me a lot of chili! It was so good, and afterward we watched a strange movie that is all outtakes from Anchorman and therefore doesn’t have much of a plot or make sense. Now we’re just chilling before bed!
This post is dedicated to the two babies who were delivered as still births, the baby that died shortly after delivery via C-section, a mother who died of post-delivery complications, a child who died of malaria, and the two patients in male ward who died because there wasn’t blood available for them to receive, all of whom passed over the weekend.
At Morning Handover, I almost left. It was a very sad report, from almost every ward. Dr. Erdi even gave some short comments after the weekend reports pleading with the staff that in the future if a patient comes on a weekend or during the night that they get admitted and don’t get turned away. When patients make the decision to come and be admitted, especially when it’s the middle of the night or on a weekend when they know the hospital OPD isn’t open that it means they believe their illness is serious enough that is should be treated right away. There were too many deaths this weekend, and Dr. Erdi saw almost every single one. No wonder she gets stressed and sad sometimes.
After Morning Handover, Taylor and I were going to help Kady in wound care, but she wasn’t going to get started for a while and Dr. ABD was about to start rounds, so we followed him instead. Because Taylor is new to rounds, he went through all the patient files in detail with us, and explained what was going on and so on. I really like when he does that, it makes it so much easier to follow what’s going on versus when he just speaks to the patient in Creole and says, “Continue treatment.” I have noticed now, with the new group being here, that I understand a lot more Creole than I thought I did. At Morning Handover, Taylor and John both said afterwards that they didn’t understand hardly any of the reports given, and I was able to tell them almost everything that was said. They both seemed surprised and asked how I had picked up so much, but Creole is surprisingly easy to understand if you speak English, once you get used to the sentence structure. It’s harder to speak though, because I feel like you’re just butchering the nice English grammar I was taught in school.
After Dr. ABD finished rounds, I worked on my research until lunchtime, and then after a quick lunch went back to the hospital with Taylor. The power was still on even though it was 13h15, so we went to the theatre to see if they were in surgery. Mary, one of the midwifes, was there preparing for a C-section that would occur as soon as the mother arrived from the ward. We gowned up and went into the theatre, and when the mother came in I said, “Ooo! Twins!” because she looked so much larger than the norm for mothers here, but Mary said, “No, no, no. Single fetus, pre-eclampsia.” Dr. ABD was there, ready to perform the C-section, and I looked at him and said, “Wow, that’s going to be one big baby!” I asked Dr. ABD why pre-eclampsia and eclampsia are so dangerous, and he said that the real danger is eclampic fits, which can occur once a patient has progressed from pre-eclampsia to eclampsia. It is a condition that can present with many symptoms, such as swelling of the feet and ankles, weakness of the body, and dizziness. The real problem though, is the high blood pressure that characterizes pre-eclampsia and eclampsia. The high blood pressure can lead to fits, which can cut off oxygen to the brain of the mother, and the fetus. It can be life threatening for both, as every minute the fetus is without oxygen their chance of survival goes down, and every minute the mother’s brain is without oxygen her chances of having brain damage go up.
Once the C-section started, and the baby removed, it was completely obvious that it was twins, and that there was another baby. The problem there is that two people are supposed to be ready to take the babies, and only Mary had prepared to take one baby. When she said, “Please, can someone watch this child so I can get the other one?” no one answered! So I ran over and told her to go, and put gloves on quickly and started doing what I had seen the midwifes do with infants that are crying well after delivery: rub their back like crazy. Mary said it helps to keep them crying, and when they cry it helps clear the fluid from their lungs. When Mary brought the second twin over, it wasn’t breathing at all, and it took a long time for her to get it to cry. It seemed to be trying to take in air and couldn’t. Eventually it let out a weak cry, but not very convincing and it stopped soon after.
Later when we went to the ward to check on them, both seemed fine, but the second twin is clearly smaller. All the family was gathered around, cooing over the babies. When we came in to see the babies, Mary told them that Taylor and I had helped deliver the twins, and they wanted to know our names so that the girls could be named after us. I’m not sure if they actually will, but we were both kind of like, “Um, you don’t have to do that…”
It was around four, and things seemed to be winding down. We thought about stopping by Dr. Abel’s office to see how his day was going, but he seemed really busy so we went down to the TFC to see Abdulai and so that Taylor could see where the business office is. We didn’t really find much to do there, so we ended up back at the house to nap and read.
Dinner was awesome again, and reminded me a lot of chili! It was so good, and afterward we watched a strange movie that is all outtakes from Anchorman and therefore doesn’t have much of a plot or make sense. Now we’re just chilling before bed!
This post is dedicated to the two babies who were delivered as still births, the baby that died shortly after delivery via C-section, a mother who died of post-delivery complications, a child who died of malaria, and the two patients in male ward who died because there wasn’t blood available for them to receive, all of whom passed over the weekend.
Monday, July 11, 2011
Day Thirty-three: Another Lazy Day 07.10
Early this morning the power came on around 8h00, and we considered going to watch, but I suspected that Dr. Erdi would be tired and grumpy from being called so much in such a short period of time, so we decided to sleep some more.
Around 11h00, Dr. Erdi came back and we asked what happened. She said that the government hospital had sent over a C-section because their surgeon was out. The C-section was necessary because the baby was too big to fit through the pelvis. The mother was fine, but the baby died shortly after delivery.
We hung out most of the afternoon, playing euchre and talking, until dinnertime when Dr. Erdi suggested that we get ourselves over to the Clubhouse Bar to have dinner. All the cars were in use, so we decided to take the “public transport,” or the motorbikes. Luckily I had advised that everyone trade one of their 10,000 Le bills for 1,000 and 2,000 Le bills so that they could pay the motorbike drivers. Some of the girls were scared when we started, but as soon as we started riding they started having fun.
We got to the Clubhouse just fine, and we going to sit outside for dinner, and had just ordered drinks when it started raining so we moved inside. We ordered, and almost immediately Dr. Erdi got a call from the hospital requesting her to come back. She had to leave us, so we told her that we would bring her food home in a box if need be, and that we would find our way home on motorbikes as soon as we were finished.
While at the Clubhouse, we watched woman’s soccer, USA vs. Brazil, and ate our pizza. USA won in a shoot-out after time ran out. The pizza was great, and afterward we took motorbikes back to the compound. As soon as we got back and were walking in, Dr. Erdi was driving out to come meet up with us. We decided to watch Hercules before calling it a night, but unfortunately Dr. Erdi couldn’t join us because she had to see patients again.
This post is dedicated to the woman who lost her baby this morning.
Around 11h00, Dr. Erdi came back and we asked what happened. She said that the government hospital had sent over a C-section because their surgeon was out. The C-section was necessary because the baby was too big to fit through the pelvis. The mother was fine, but the baby died shortly after delivery.
We hung out most of the afternoon, playing euchre and talking, until dinnertime when Dr. Erdi suggested that we get ourselves over to the Clubhouse Bar to have dinner. All the cars were in use, so we decided to take the “public transport,” or the motorbikes. Luckily I had advised that everyone trade one of their 10,000 Le bills for 1,000 and 2,000 Le bills so that they could pay the motorbike drivers. Some of the girls were scared when we started, but as soon as we started riding they started having fun.
We got to the Clubhouse just fine, and we going to sit outside for dinner, and had just ordered drinks when it started raining so we moved inside. We ordered, and almost immediately Dr. Erdi got a call from the hospital requesting her to come back. She had to leave us, so we told her that we would bring her food home in a box if need be, and that we would find our way home on motorbikes as soon as we were finished.
While at the Clubhouse, we watched woman’s soccer, USA vs. Brazil, and ate our pizza. USA won in a shoot-out after time ran out. The pizza was great, and afterward we took motorbikes back to the compound. As soon as we got back and were walking in, Dr. Erdi was driving out to come meet up with us. We decided to watch Hercules before calling it a night, but unfortunately Dr. Erdi couldn’t join us because she had to see patients again.
This post is dedicated to the woman who lost her baby this morning.
Day Thirty-two: The Day of Delays 07.09
Today we were all exhausted and slept in way too late and spent a lot of the day being very lazy. Around noon we went over to the other house for brunch, and just hung out reading books and playing cards.
We got around in the afternoon to go to Makeni and exchange money, go to the post office, and get some things from St. Mary’s. We had just gotten into the car when Dr. Erdi got a call from Dr. Conteh, who is the first on call doctor today, asking for her help with a patient. We all rode over to the hospital, and decided to follow Dr. Erdi as she assessed the situation.
The woman that Dr. Conteh wanted help assessing was complaining of tingling in the hands and feet, as well as acute pain in the chest that would come and go. The acute chest pain felt like it was her heart, and she kept asking if she was going to die, and wouldn’t answer Dr. Erdi’s questions honestly. She was saying that the pain and spasms started “just now,” which is African for “it started this morning,” but Dr. Erdi wanted to know what time it started, in case it was a heart attack. Once we determined that she was having some odd reactions because she’s taking heart meds that you shouldn’t take if your hypoglycemic, and they never tested to see if she was, they put her on IV fluids and made sure to get her blood sugar within a good range. It seems like Dr. Erdi has to do everything though, because Dr. Conteh just watched as Dr. Erdi ran over to the dispensary to get the right drugs, then ran to maternity ward to see if they had any because the dispensary was out, then back again. And all this time there was a woman hoping to be admitted, standing there waiting. She had a giant infected wound on the entire side of her face, and it was dripping and oozing all down her face. When I mentioned to Dr. Conteh that she was waiting, in hopes that he would realize he was being lazy and see her, he basically told me that he couldn’t be bothered, and that her case was chronic (yea, chronic my butt) and that he had other patients that could die any minute that he needed to attend to. But then, rather than attending to these ‘other’ patients that might die any minute, he sits down and watches Dr. Erdi run around seeing patients.
After Dr. Erdi found the right medication and started the patient on it, she noticed that a mother was waiting to have her little boy be seen. Rather than wasting her breathe trying to make Dr. Conteh understand that he could have admitted this boy while she was seeing the woman, she just shook her head and took him to children’s ward. When she examined him, she diagnosed a bowel obstruction, as he had not defecated in four days but had been urinating. She ordered IV fluids and antibiotics, and for a surgical team to be ready in an hour in a half.
In the mean time, Dr. Erdi still wanted to take us to town to exchange money and get her package, and go to the supermarket. We rode in and pointed out the big stuff, the University, the supermarket, the clock tower, and so on. When we parked on the rode near the money traders, they found us right away and came right up to our car to trade with us. One of them was a guy I’ve traded with before, and he was very happy to see us. We tried to get 4,500 Le to the dollar, but as always they would only give us 4,400 Le to the dollar, which is still fine.
When we stopped by the post office, it was very hot so we got out of the car to wait beside it. When we did everyone who passed by stared at us, and a small crowd gathered to watch us. Some kids ran up yelling, “Apoto,” and wanting to shake our hands. After the post office it was on to St. Mary’s for Laughing Cow cheese and powdered pudding that was made in Holland for Dr. Erdi, along with some breakfast things for the house. We also went across the street where they sell fruits and veggies, and got a nice big fresh pineapple for about a dollar.
When we got back, we cut up the pineapple and had a snack while Dr. Erdi went back to the hospital to check on the boy again. After a little while, the lights came on, so we knew they’d decided to start surgery and went over to watch. When we got there we found out that after operating on the little boy, they were going to do a laporotomy on a newly admitted maternity ward patient who was a referral from the government hospital with an acute abdomen. She is 17 weeks along, and Dr. Erdi had a suspicion that it was her appendix that was causing the problem.
The laporotomy on the young boy went well, and the problem turned out to be a typhoid perforation. Just after surgery there was a huge improvement already from before. By that time it was way past dinnertime, and it was starting to rain, so the girls and I decided to run back and have dinner and tell David to please send an umbrella for Dr. Erdi and John, who decided to stay and watch the surgery.
Dinner was so good, prawn crackers and couscous with chicken. After dinner we read for a while before going to bed.
This post is dedicated to the woman with the wound on her face, who was never admitted because she left ignored and left.
We got around in the afternoon to go to Makeni and exchange money, go to the post office, and get some things from St. Mary’s. We had just gotten into the car when Dr. Erdi got a call from Dr. Conteh, who is the first on call doctor today, asking for her help with a patient. We all rode over to the hospital, and decided to follow Dr. Erdi as she assessed the situation.
The woman that Dr. Conteh wanted help assessing was complaining of tingling in the hands and feet, as well as acute pain in the chest that would come and go. The acute chest pain felt like it was her heart, and she kept asking if she was going to die, and wouldn’t answer Dr. Erdi’s questions honestly. She was saying that the pain and spasms started “just now,” which is African for “it started this morning,” but Dr. Erdi wanted to know what time it started, in case it was a heart attack. Once we determined that she was having some odd reactions because she’s taking heart meds that you shouldn’t take if your hypoglycemic, and they never tested to see if she was, they put her on IV fluids and made sure to get her blood sugar within a good range. It seems like Dr. Erdi has to do everything though, because Dr. Conteh just watched as Dr. Erdi ran over to the dispensary to get the right drugs, then ran to maternity ward to see if they had any because the dispensary was out, then back again. And all this time there was a woman hoping to be admitted, standing there waiting. She had a giant infected wound on the entire side of her face, and it was dripping and oozing all down her face. When I mentioned to Dr. Conteh that she was waiting, in hopes that he would realize he was being lazy and see her, he basically told me that he couldn’t be bothered, and that her case was chronic (yea, chronic my butt) and that he had other patients that could die any minute that he needed to attend to. But then, rather than attending to these ‘other’ patients that might die any minute, he sits down and watches Dr. Erdi run around seeing patients.
After Dr. Erdi found the right medication and started the patient on it, she noticed that a mother was waiting to have her little boy be seen. Rather than wasting her breathe trying to make Dr. Conteh understand that he could have admitted this boy while she was seeing the woman, she just shook her head and took him to children’s ward. When she examined him, she diagnosed a bowel obstruction, as he had not defecated in four days but had been urinating. She ordered IV fluids and antibiotics, and for a surgical team to be ready in an hour in a half.
In the mean time, Dr. Erdi still wanted to take us to town to exchange money and get her package, and go to the supermarket. We rode in and pointed out the big stuff, the University, the supermarket, the clock tower, and so on. When we parked on the rode near the money traders, they found us right away and came right up to our car to trade with us. One of them was a guy I’ve traded with before, and he was very happy to see us. We tried to get 4,500 Le to the dollar, but as always they would only give us 4,400 Le to the dollar, which is still fine.
When we stopped by the post office, it was very hot so we got out of the car to wait beside it. When we did everyone who passed by stared at us, and a small crowd gathered to watch us. Some kids ran up yelling, “Apoto,” and wanting to shake our hands. After the post office it was on to St. Mary’s for Laughing Cow cheese and powdered pudding that was made in Holland for Dr. Erdi, along with some breakfast things for the house. We also went across the street where they sell fruits and veggies, and got a nice big fresh pineapple for about a dollar.
When we got back, we cut up the pineapple and had a snack while Dr. Erdi went back to the hospital to check on the boy again. After a little while, the lights came on, so we knew they’d decided to start surgery and went over to watch. When we got there we found out that after operating on the little boy, they were going to do a laporotomy on a newly admitted maternity ward patient who was a referral from the government hospital with an acute abdomen. She is 17 weeks along, and Dr. Erdi had a suspicion that it was her appendix that was causing the problem.
The laporotomy on the young boy went well, and the problem turned out to be a typhoid perforation. Just after surgery there was a huge improvement already from before. By that time it was way past dinnertime, and it was starting to rain, so the girls and I decided to run back and have dinner and tell David to please send an umbrella for Dr. Erdi and John, who decided to stay and watch the surgery.
Dinner was so good, prawn crackers and couscous with chicken. After dinner we read for a while before going to bed.
This post is dedicated to the woman with the wound on her face, who was never admitted because she left ignored and left.
Sunday, July 10, 2011
Day Thirty-one: Showing the New Kids the Ropes 07.08
Today I got up as normal and went to breakfast, followed by three very tired girls and one very tired boy. I hadn’t realized it last night, but all of John’s luggage was left in Brussels on accident by the airline. Unfortunately there’s not a lot we can do to get it, since we’ve been having trouble getting a hold of the airline, and even if we did get them to send it to Freetown, it would be very expensive to make the extra time down to get them.
We all went to Morning Handover and Dr. Erdi introduced the new students. Then we went around on a tour of the place, ending with the TFC. Once we were down at the TFC we sort of stood there talking about different stuff and they kept asking me questions about what goes on here. By the time we were finished, it was 11h00. Ashley and Daniel went to the Under-Fives clinic to help Musa, and Taylor and I came back to the house to work on my research and nap. I worked, Taylor napped, haha.
After a quickly lunch, Daniel and Ashley came back from TFC and had lunch and they started asking questions again and wanted to see what I’ve gotten so far. I showed them and talked with them until almost 14h00, and then Taylor, Daniel and I went back to the hospital and took a tour of the wards. While we were out we stopped in the maternity ward to ask if anyone was in labor, and they said that one woman was in labor but wasn’t progressing so she was going to have a C-section later that day. In the late afternoon I took a nap, and around 17h00 or so the power went on so we rushed over to watch. When we got there, Dr. ABD looked at me and said, “Ali!!! You need to scrub in!” so I got to scrub in on a C-Section!!! I was so excited, because C-sections are harder and you have to have confidence in your assistant, and the assistant should know the steps pretty well. I had been asking him about C-Sections a lot, but I never thought he would ask me to scrub in so soon! It went really well, and I was able to help cut the umbilical cord!
After a wonderful dinner we watched Elf. It wasn’t very fitting of the warm weather, but oh well. Steve showed up partway through the movie and finished it with us, then asked us over to his place to get in the pool. We all went over to his place and got in the pool and had a great time talking and having drinks, then we went inside and had coffee and sat around talking until about 2h00.
This post is dedicated to the woman in female ward who died during the night. She was admitted yesterday but didn’t respond to treatment.
We all went to Morning Handover and Dr. Erdi introduced the new students. Then we went around on a tour of the place, ending with the TFC. Once we were down at the TFC we sort of stood there talking about different stuff and they kept asking me questions about what goes on here. By the time we were finished, it was 11h00. Ashley and Daniel went to the Under-Fives clinic to help Musa, and Taylor and I came back to the house to work on my research and nap. I worked, Taylor napped, haha.
After a quickly lunch, Daniel and Ashley came back from TFC and had lunch and they started asking questions again and wanted to see what I’ve gotten so far. I showed them and talked with them until almost 14h00, and then Taylor, Daniel and I went back to the hospital and took a tour of the wards. While we were out we stopped in the maternity ward to ask if anyone was in labor, and they said that one woman was in labor but wasn’t progressing so she was going to have a C-section later that day. In the late afternoon I took a nap, and around 17h00 or so the power went on so we rushed over to watch. When we got there, Dr. ABD looked at me and said, “Ali!!! You need to scrub in!” so I got to scrub in on a C-Section!!! I was so excited, because C-sections are harder and you have to have confidence in your assistant, and the assistant should know the steps pretty well. I had been asking him about C-Sections a lot, but I never thought he would ask me to scrub in so soon! It went really well, and I was able to help cut the umbilical cord!
After a wonderful dinner we watched Elf. It wasn’t very fitting of the warm weather, but oh well. Steve showed up partway through the movie and finished it with us, then asked us over to his place to get in the pool. We all went over to his place and got in the pool and had a great time talking and having drinks, then we went inside and had coffee and sat around talking until about 2h00.
This post is dedicated to the woman in female ward who died during the night. She was admitted yesterday but didn’t respond to treatment.
Friday, July 8, 2011
Day Thirty: Goodbye to Tanis and Elizabeth 07.07
Today Tanis and Elizabeth left to go back home, which meant that I needed to pack up to, because there are a lot of guests arriving this month so Dr. Erdi decided that all the Alma College girls could stay together in one of the doctor’s apartments, which has been empty since Saskia left. Saskia is a doctor from Holland who came with Dr. Erdi, but left last year I believe.
In the morning I did rounds with Dr. Erdi in children’s ward, which is always such an interesting experience. Sometimes when you ask a mother if their child has a fever they say yes even if they don’t because A.) they think that if he’s taking meds, it must be because he has a fever, and B.) if the fever is gone he wont get meds any more and wont get any better. They also just don’t understand the concept of telling the nurse their child has a fever when the fever is actually present, especially with night fever. Dr. Erdi and all the nurses tell all the caretakers repeatedly that when the child has a fever, you must tell the nurse right then, when they have the fever, and not later so that the nurses can measure the fever. But time after time the mothers say the child had a fever at night, and that they told the nurse, but the nurses notes clearly state that the mother didn’t tell the nurses until the morning, so when they took the child’s temperature in the morning they no longer had a fever.
At around 10h00 we all went to the house to say goodbye to Tanis and Elizabeth and hang out with them one last time. We also gave them our passports to get our stamps extended at customs and then have the driver bring them back. We have been assured that it’s safe to do so, but I’m still a little nervous about it.
After the girls left, I went into surgery to watch some procedures and I also scrubbed in on one today. The first surgery was a hernia repair for a young girl, which took all of about fifteen minutes. The second was a hysterectomy for a woman who had vaginal bleeding profusely. They weren’t sure what the problem was, but the decided that a full removal was really the only choice. Once they got in, it became clear that she had cancer that was terribly progressed. They finished the hysterectomy, but normally if they had known how far the cancer was they would not have put her through the agony of surgery, since they were unable to remove all the cancer and she will die anyway, but now she has to deal with recovering from an invasive surgery on top of that. The procedure was supposed to be about an hour and a half long, but ended up being three hours long.
The third surgery was a cystectomy for a woman who was told that the cyst wasn’t causing any problems and did not need to be removed, but who insisted on having it removed anyway. She was clearly very wealthy, and her family comes from the diamond mining area. I was able to scrub in, and it turned out to be quite an interesting surgery. First we couldn’t locate the cyst, but could see lots of little blood clots and little blood pools from infection that were probably very painful. When we finally located the cyst, it ruptured as we were trying to remove it. When it was removed and we were trying to close we had a heck of a time because she wasn’t responding well to the anesthesia and kept tensing and relaxing the muscles of her abdomen, making it difficult to sew her up nicely and prevent a scar.
After surgeries, I went and rested because I was so tired. We had a late dinner because we were hoping that the new students would arrive soon enough to eat with us. Fairly late, around 21h30, they arrived and had dinner. We were in the middle of watching Blood Diamond, which is about the civil war and the diamond trade in Sierra Leone. We decided to watch the rest tomorrow night so that the newcomers could get settled. They had a lot of questions about how things work here and the routine. The internet was down today, and it was down last night too, so I haven’t been able to post new blogs. We think it’s because of a big storm nearby yesterday.
This post is dedicated to the woman who died just as she arrived at the hospital with her family.
In the morning I did rounds with Dr. Erdi in children’s ward, which is always such an interesting experience. Sometimes when you ask a mother if their child has a fever they say yes even if they don’t because A.) they think that if he’s taking meds, it must be because he has a fever, and B.) if the fever is gone he wont get meds any more and wont get any better. They also just don’t understand the concept of telling the nurse their child has a fever when the fever is actually present, especially with night fever. Dr. Erdi and all the nurses tell all the caretakers repeatedly that when the child has a fever, you must tell the nurse right then, when they have the fever, and not later so that the nurses can measure the fever. But time after time the mothers say the child had a fever at night, and that they told the nurse, but the nurses notes clearly state that the mother didn’t tell the nurses until the morning, so when they took the child’s temperature in the morning they no longer had a fever.
At around 10h00 we all went to the house to say goodbye to Tanis and Elizabeth and hang out with them one last time. We also gave them our passports to get our stamps extended at customs and then have the driver bring them back. We have been assured that it’s safe to do so, but I’m still a little nervous about it.
After the girls left, I went into surgery to watch some procedures and I also scrubbed in on one today. The first surgery was a hernia repair for a young girl, which took all of about fifteen minutes. The second was a hysterectomy for a woman who had vaginal bleeding profusely. They weren’t sure what the problem was, but the decided that a full removal was really the only choice. Once they got in, it became clear that she had cancer that was terribly progressed. They finished the hysterectomy, but normally if they had known how far the cancer was they would not have put her through the agony of surgery, since they were unable to remove all the cancer and she will die anyway, but now she has to deal with recovering from an invasive surgery on top of that. The procedure was supposed to be about an hour and a half long, but ended up being three hours long.
The third surgery was a cystectomy for a woman who was told that the cyst wasn’t causing any problems and did not need to be removed, but who insisted on having it removed anyway. She was clearly very wealthy, and her family comes from the diamond mining area. I was able to scrub in, and it turned out to be quite an interesting surgery. First we couldn’t locate the cyst, but could see lots of little blood clots and little blood pools from infection that were probably very painful. When we finally located the cyst, it ruptured as we were trying to remove it. When it was removed and we were trying to close we had a heck of a time because she wasn’t responding well to the anesthesia and kept tensing and relaxing the muscles of her abdomen, making it difficult to sew her up nicely and prevent a scar.
After surgeries, I went and rested because I was so tired. We had a late dinner because we were hoping that the new students would arrive soon enough to eat with us. Fairly late, around 21h30, they arrived and had dinner. We were in the middle of watching Blood Diamond, which is about the civil war and the diamond trade in Sierra Leone. We decided to watch the rest tomorrow night so that the newcomers could get settled. They had a lot of questions about how things work here and the routine. The internet was down today, and it was down last night too, so I haven’t been able to post new blogs. We think it’s because of a big storm nearby yesterday.
This post is dedicated to the woman who died just as she arrived at the hospital with her family.
Day Twenty-nine: Tanis and Elizabeth’s Last day 07.06
Today is Tanis and Elizabeth’s last full day in Sierra Leone, tomorrow they leave Magbenteh at noon and head to the Lungee to catch their flight home, and the plane that is taking them away is bringing Taylor, Daniel, Ashley, and John when it arrives. The driver is also going to take our passports to the customs agent to get another stamp for us, because when you enter the country and get a stamp it only lasts for a month.
At morning handover, Henry who works in the physiotherapy ward gave a report on a woman who has been complaining of back pain, saying she’s unable to sit up on her own. He was going to try and do some exercises with her, but she refused to even try to sit up. Henry went and rubbed water on her back, telling her it was medicine, and she sat up just fine. She was just afraid of the pain! It’s so interesting that people here can have incredibly painful wound cleanings without pain killers that would be cause for a lawsuit in the U.S. but they’re afraid of things that are so minor, like sitting up and having a back spasm, or giving blood. Grown men who work in the hospital have to be coerced into giving blood, and when they put in the needle they writhe around in pain like it’s the worst pain ever.
Wednesday is big rounds, so we went around and saw some patients with interesting symptoms. One man has had a cough only at night for six years, and Dr. Erdi breezed through the file and said, “Asthma!” and started walking away. The CHO who had diagnosed him almost smacked his own forehead, saying, “I should have known that!” It was funny, but it shows how a fresh pair of eyes can be a very large asset.
After big rounds, I shadowed Dr. Abel in his office as he saw patients. One woman came in complaining of foot pain that started suddenly two weeks ago. The moment this woman walked in I could smell infection and knew it would not be pretty. Dr. Abel asked to see the foot, and there was a huge soar that was terribly infected, all the way to the bone. Dr. Abel asked what happened and she said, “Nothing, it just happened.” Dr. Abel asked, “So, two weeks ago, you suddenly had a huge infected gash in your foot?” and she said yes. He of course didn’t believe her, and we took her to Dr. Erdi to assess. She was admitted and her foot will be cleaned and she’ll be given antibiotics before she can be operated on.
In the afternoon I worked on my project, then Tanis and I went to Makeni to find some last things she was hoping to get while here. We got everything she was hoping to get, and everything I was hoping to get! So the rest of the afternoon was spent eating the pineapple we bought, rearranging our things, and just resting and hanging out.
After dinner we played some cards and just enjoyed the heat…sort of!
This post is dedicated to a little boy in children’s ward to passed away last night.
At morning handover, Henry who works in the physiotherapy ward gave a report on a woman who has been complaining of back pain, saying she’s unable to sit up on her own. He was going to try and do some exercises with her, but she refused to even try to sit up. Henry went and rubbed water on her back, telling her it was medicine, and she sat up just fine. She was just afraid of the pain! It’s so interesting that people here can have incredibly painful wound cleanings without pain killers that would be cause for a lawsuit in the U.S. but they’re afraid of things that are so minor, like sitting up and having a back spasm, or giving blood. Grown men who work in the hospital have to be coerced into giving blood, and when they put in the needle they writhe around in pain like it’s the worst pain ever.
Wednesday is big rounds, so we went around and saw some patients with interesting symptoms. One man has had a cough only at night for six years, and Dr. Erdi breezed through the file and said, “Asthma!” and started walking away. The CHO who had diagnosed him almost smacked his own forehead, saying, “I should have known that!” It was funny, but it shows how a fresh pair of eyes can be a very large asset.
After big rounds, I shadowed Dr. Abel in his office as he saw patients. One woman came in complaining of foot pain that started suddenly two weeks ago. The moment this woman walked in I could smell infection and knew it would not be pretty. Dr. Abel asked to see the foot, and there was a huge soar that was terribly infected, all the way to the bone. Dr. Abel asked what happened and she said, “Nothing, it just happened.” Dr. Abel asked, “So, two weeks ago, you suddenly had a huge infected gash in your foot?” and she said yes. He of course didn’t believe her, and we took her to Dr. Erdi to assess. She was admitted and her foot will be cleaned and she’ll be given antibiotics before she can be operated on.
In the afternoon I worked on my project, then Tanis and I went to Makeni to find some last things she was hoping to get while here. We got everything she was hoping to get, and everything I was hoping to get! So the rest of the afternoon was spent eating the pineapple we bought, rearranging our things, and just resting and hanging out.
After dinner we played some cards and just enjoyed the heat…sort of!
This post is dedicated to a little boy in children’s ward to passed away last night.
Wednesday, July 6, 2011
Day Twenty-eight: Cooking like a Sierra Leonean 07.05
At about 5h00 this morning, the light in our room suddenly went on. I was so confused at first, but then realized that there must have been an emergency surgery. I thought briefly about going to the hospital to watch, but instead just turned off the light and when to bed. At breakfast Dr. Erdi told us that it was an emergency laperotomy for a woman who went into labor and delivered the head of her baby fine at home, but couldn’t get the sholders out. Because they waited so long to come here, she also ruptured her uterus, so they had to perform a total hysterectomy. Her baby didn’t make it.
This morning Elizabeth and Tanis gave a presentation at Morning Handover about interacting with coworkers and patients. It was definitely needed, because I’ve seen nurses yell at each other and patients, as well as nurses hitting patients and giving shots and so on without even telling the patient. They did little skits and everything, and all the nurses were laughing because they recognized some of the behavior and were able to see how ridiculous it really looks when you act that way. It was a lot of fun.
I spent part of the morning doing rounds with Dr. ABD and the other part working on my project. After lunch I went to the theatre to watch some hernia repairs. They were fairly straight forward, and there wasn’t anything more intense because the patients who needed them hadn’t paid yet, and if it’s not life threatening you must pay first.
In the afternoon I went back to the house to talk to David and help him cook so that I could write down the recipes. He was really nice and let me take pictures, and took pictures of me helping. He also asked me about life at home and if I have a boyfriend (I may have said yes) and followed that question directly with, “Do you and your boyfriend have children?” I was semi-shocked and said no of course, and then he asked if my boyfriend and I live together. When I said no, he asked why, and I told him that I either live with my parents when I’m not in school, or at the school while school is in session. He told me that because weddings are so expensive, couples get engaged, then live together and save up for their wedding. Sometimes it takes years to save enough, and David had three of his six children before he and his wife had enough to marry.
David asked me what my house looks like, and I started to tell him about my life back home, and eventually just grabbed my computer and showed him pictures. As soon as I came back with my computer and started showing him pictures, all the other workers came and watched too, and they were amazed. I also showed them a video of me singing, and they were very impressed, asking if I was famous back home, which made me laugh.
After showing David the pictures, he let me help him cook and showed me how to fry eggplant and how to make a batter for them, and how to make spicy meat stew (almost anything is spicy here) and a little concoction to soak cucumbers in that is delicious. He also told me that Sierra Leoneans like spice so much because it protects them from sickness. He told me that malaria can’t handle the spice in his body, so he hasn’t gotten malaria in a really long time. Just goes to show you how Sierra Leoneans view sickness and how that whole thing works. He also told me that he would take me to the market on Saturday so that I can help him buy dinner and then help him cook the whole thing so I can really know how to do it. He also told me that I should buy the powder that they make from drying the African peppers and grinding them up, so that I can take it home and use it when I cook for my family.
Dinner was excellent, of course, because I helped, and just as our Tuesday routine some of out expat friends joined us. Now we’re just relaxing and I’m thinking about going to bed early, since I’m exhausted! I find that I’m tired all the time here; the heat really takes a lot out of you.
On one final note, thanks to all for their well wishes and prayers, especially since my bout of sickness. I’m feeling so much better!
This post is dedicated to the infant who died this morning from complications, and his mother who had an emergency hysterectomy, as well as the child in children’s ward that died during the night.
This morning Elizabeth and Tanis gave a presentation at Morning Handover about interacting with coworkers and patients. It was definitely needed, because I’ve seen nurses yell at each other and patients, as well as nurses hitting patients and giving shots and so on without even telling the patient. They did little skits and everything, and all the nurses were laughing because they recognized some of the behavior and were able to see how ridiculous it really looks when you act that way. It was a lot of fun.
I spent part of the morning doing rounds with Dr. ABD and the other part working on my project. After lunch I went to the theatre to watch some hernia repairs. They were fairly straight forward, and there wasn’t anything more intense because the patients who needed them hadn’t paid yet, and if it’s not life threatening you must pay first.
In the afternoon I went back to the house to talk to David and help him cook so that I could write down the recipes. He was really nice and let me take pictures, and took pictures of me helping. He also asked me about life at home and if I have a boyfriend (I may have said yes) and followed that question directly with, “Do you and your boyfriend have children?” I was semi-shocked and said no of course, and then he asked if my boyfriend and I live together. When I said no, he asked why, and I told him that I either live with my parents when I’m not in school, or at the school while school is in session. He told me that because weddings are so expensive, couples get engaged, then live together and save up for their wedding. Sometimes it takes years to save enough, and David had three of his six children before he and his wife had enough to marry.
David asked me what my house looks like, and I started to tell him about my life back home, and eventually just grabbed my computer and showed him pictures. As soon as I came back with my computer and started showing him pictures, all the other workers came and watched too, and they were amazed. I also showed them a video of me singing, and they were very impressed, asking if I was famous back home, which made me laugh.
After showing David the pictures, he let me help him cook and showed me how to fry eggplant and how to make a batter for them, and how to make spicy meat stew (almost anything is spicy here) and a little concoction to soak cucumbers in that is delicious. He also told me that Sierra Leoneans like spice so much because it protects them from sickness. He told me that malaria can’t handle the spice in his body, so he hasn’t gotten malaria in a really long time. Just goes to show you how Sierra Leoneans view sickness and how that whole thing works. He also told me that he would take me to the market on Saturday so that I can help him buy dinner and then help him cook the whole thing so I can really know how to do it. He also told me that I should buy the powder that they make from drying the African peppers and grinding them up, so that I can take it home and use it when I cook for my family.
Dinner was excellent, of course, because I helped, and just as our Tuesday routine some of out expat friends joined us. Now we’re just relaxing and I’m thinking about going to bed early, since I’m exhausted! I find that I’m tired all the time here; the heat really takes a lot out of you.
On one final note, thanks to all for their well wishes and prayers, especially since my bout of sickness. I’m feeling so much better!
This post is dedicated to the infant who died this morning from complications, and his mother who had an emergency hysterectomy, as well as the child in children’s ward that died during the night.
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