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.
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