Kambia and Then Some

I got back yesterday from a four day trip to Kambia, a province north of here-ish. I thought it was a trip to Kambia but it turned out to be a trip to Kambia, Port Loko, Bombali, and Tonkolili. I knew there was going to be a lot of driving but what I had expected wasn't exactly what came to be. There was a bit more than expected.

Monday morning I left the centre with Francis, the driver for the four day screening trip. Along the way we picked up Bernadette, the screening nurse. Both Bernadette and I get car sick so the three of us crammed into the front. I tried throughout the trip to handle the back but with the bumpiness of the roads it was no good. So we got as comfortable as we could, the three of us in the front...

I was surprised how great the roads were once we got out of Freetown. The main roads at least.

I have to admit, the first two days were pretty frustrating. I have heard the statistics... Over 2 million women in Africa afflicted with VVF. I didn't know they would be this difficult to locate. I figured we would just have to walk into a hospital and they would come walking out. Not the case. The first clinic we went to in Kambia had one woman for us to see. She had a gynecological problem, but not VVF. At the clinic they were doing a class for mothers who had children at a young age and were not able to reintegrate back into the school system. They were teaching life skills and how to weave. We had an opportunity to share with them and asked if they knew of any women with VVF. A few people raised their hands. One woman said a prostitute nearby but she wouldn't tell us where because she was afraid of her. We found another girl who took us. This woman didn't have VVF but she said she knew someone else. We drove to this other woman's place, walked through some fields and found her. She came running out and kissed us all but again, not having VVF. It was valentines day and I got an offer of marriage from an old man living in the home. I had to sadly decline. Another girl from the school told us she knew of someone so off we went again. We drove up to a village and asked for this woman. She was out farming so someone had to go get her. We all sat to wait. Whenever we would show up anywhere, the second we step out of the car, benches get pulled out of huts and homes and from anywhere to offer us a seat. As soon as we sit, children come from everywhere. They always kept us entertained while we wait. Fatmata finally came from the fields. She walked into her hut and came out with a follow-up card from the centre. I figured the girl who brought us was confused and just brought us to see an old patient. Fatmata pulled out her card and her old operation report and we noticed that her first surgery for her RVF was back in September of 2007. She was told to come back for another surgery, for her VVF, three months later but due to unrest in the country she never came and never had enough transport money to return. Yeah! Our first woman!

By then it was starting to get late. Bernadette and Francis decided it was best to go back to Makeni to find somewhere to sleep. There were women they had wanted to visit there the next day anyway. More driving... We went to the hotel and it was fully booked. We had to go to the next village to find the next motel. We pulled up and I had such an erie feeling. There was one room left. This crazy room had a bedroom and two sitting rooms. It also had a balcony which the bathroom was built onto. I found out that I would be staying there alone. Oy. Francis and Bernadette didn't want me to stay where they were staying because when they see white skin the price immediately will double or triple or more. So they left and there I was, in my sketch motel room. Joseph, the nice man from reception said he could have someone sleep on my balcony if that would make me feel safer. Um, no thanks. Nothing like a little barricading of the doors to calm my nerves. It ended up being completely fine and I spent the next three nights there.

Tuesday we got up, screened two women who Bernadette found after they had dropped me off the night before and then went in search of a woman who lived in a village far, far away. This road was the worst of all. A whole two hours of it one way. When we finally got to her, it only took seconds of speaking with her to realize she did not have a VVF. Two hours back on the roller coaster ride of a road. After visiting another hospital and not finding anyone, my frustration was rising. We saw one other woman who again, did not have a VVF and by then had to call it a day. Oh, my highlight from Tuesday was getting to see Fatmata, the patient I wrote about in one of my last posts, the young girl who went on the radio with us. It was SO great to see her again! She was so excited to go home and see her family and we had the opportunity to meet them. She said she will have to wait until the start of the next term to return to school but she promised me she would.

Fatmata at her home.

Tuesday night I returned to my sketch room and prayed. With all my frustrations coming from so many different places I needed to be refreshed and even the passion I had for working with VVF women needed to be renewed.

Wednesday we returned to the hospital to follow up on some possible leads. I still don't know where Bernadette would come up with some of these women but we pulled up behind this bus and she said a VVF woman was going to be on the bus. I looked at her in disbelief. Somehow Bernadette had been talking with a woman who was going to bring us a fistula woman from the far north. There she was. Isatu is 17 or 18. She only speaks Fullah, a dialect not many people here can speak. She is very short and you could see the fear in her eyes. She wouldn't make eye contact and just went where she was directed. By the end of our trip, Fatmata, the first women we picked up, had taken her under her wing. She would point her in the right direction and even when we got back here to the center I saw her taking her by the hand leading her into the bathroom to show her how to shower.

At some point Wednesday morning we stopped by a home where we thought another woman was living. Nope. She lived in a village far far away but her sister would come with us to show us the way. Fatmata, the sister, piled into the back of the land rover and off we went. We drove and drove and drove some more. Such beautiful country! Eventually she told us to turn. Oy. This road looked awful. After we got up the first little hill it wasn't so bad. It was only a narrow road wide enough for one car and even then the bushes were still hitting the car. Eventually we reached a village. I thought we were there. Nope. We drove straight through the village and out the other side. I thought it was so random. How often do the people living there really see cars going through? Another village. And another. And another... and then as we left one, the road went from some resemblance of a road with tire tracks to a walking path. It looked like a car never had been that way before. We drove and drove down this small walking path, through more villages until we finally reached our destination. A small village in the interior. When we stepped out of the car, more benches came out of huts and I think there were more kids than adults living in this village. We quickly learned the woman we had come for was even further out at another village but there was no way the car would make it. A cute little boy, probably ten, took off running in jellie shoes, like the ones I had growing up, since no one else wanted to go. We were told it was far. Settling in for our long wait was fine. I was just amused at where I was and what I was in the midst of. Sierra Leone is really a beautiful country. Mountainous. Green. Lush. Three hours later...the jellie shoed boy came back with Isatu. Such a beautiful girl. We examined her and the excoriation from the urine made it impossible for her to wear any sort of pad anymore. She was positive and when we told her we could take her and do her surgery, she cried. She said she didn't have a mother and no way to pay. When we told her it was all free she was happy. Her grandmother was there as well which made for a great send off for her. Back down the long roads and after one flat tire we made it back to the motel. I felt like this was the answer to the prayers I had prayed the night before. True, we did come up with so many false leads, but it made all the difference to Isatu that we never turned back.

As we are coming up on the village.

Isatu in the blue striped shirt with the rest of her village.

Isatu in the middle with her grandmother and sister.

Yesterday we started back to the centre with seven women. Part way home we got a call that someone had thought we were already gone so they had sent a patient to Bernadette's home in Freetown...eight women then. It was a great trip overall. True, frustrating at times but it's a learning process and I'm excited to see where we can go from here and how we can improve our screening trips.