Blood

I have talked about blood before. How if a patient needs blood, we are the walking blood bank. I know the blood type of my colleagues. You never know when you will need to call them up and ask when they last gave blood because you need theirs now. Usually people here will have to bring in their own blood donors if they go into a hospital knowing they will need a transfusion. Last week a VVF patient needed one so we asked her to call her family. She needed two units so we needed two people to come in. Even though she was from Guinea she still knew enough people in Freetown that her family was able to call around and find two people to come in. Even though they were not the type we needed, it still helped to give us blood in our bank and we were still able to get her the type she needed.

The blood drama of the day started yesterday. When a patient needs a blood transfusion, you know it is going to be a long day. Yesterday there was one patient and today another. We still had not finished with the blood drama of yesterday before today had started. Both the VVF patients who needed blood did not know anyone in Freetown. We did not have the correct type of blood in our bank. Next step, ask those who work at the centre. Ok. I still don't understand what it is, but giving blood is taboo here. Even the woman who is going into the community to advocate for blood donations would not give today even though she knew she was the right type. I asked probably thirty people today if they would donate. Only five people were willing to even be tested to see if they were the right match.

Here are some of my favorite excuses:

I'm fasting.

I have high blood pressure.

My menses stopped yesterday.

I don't have enough.

I am not the right type. (After hearing that we couldn't take someone with AB blood,

all of a sudden eveyone had AB blood)

I am not prepared to do it today...ask me tomorrow.

I gave a year ago and I'm still working on getting it back.

Yes. Some are legit excuses. Most just made me laugh. One man I found to be tested was a caregiver of a sick child in the outpatient pediatric clinic. He didn't work here. He was just willing to help. Too bad he wasn't a right match! Now we have him to call if we need him though. I'm sure some had health issues they didn't want known even to the lab guys and that is completely legit. It just surprises me that it was so difficult to find someone to help another person when there is so much suffering here to start with. With everyone I talked with I tried to teach them the fallacy in their thinking but there is something is so engrained in their thinking that donating blood is not something you do.

How do you change this?

Sisters. Sisters. There Were Never Such Devoted Sisters...

I can't help but picture Bing Crosby and Danny Kaye singing this song as I sit down to write this... (if you have seen White Christmas you would know what I am talking about.)

Anyway, moving on.

We have a patient advocate who brings us many patients. The last group of women she brought were all from Guinea. Three beautiful women, all with the same last name. I didn't think anything of this since Barrie is a very common name especially if you come from Guinea. I quickly found out that these three women were related. Two of them sisters with the same mother and father and the other was the daughter-in-law of one of the women. They all came from Kaiyako, a samll village in Guinea. Fatmata Barrie was examined and it was seen that the extent of her injury was too much for Dr. Lewis so she had to return home. The other two, the sisters Mariama and Zainabu are still here and they even had their surgeries the same day. They both speak Fullah, the common dialect of Guinea. It is difficult to speak with them but we do have one woman who works in the office who can communicate with them. They both lived together in the same house before they got married. They never attended school.

Mariama met Bobakar, her husband, and became pregnant very soon after they got married. She stayed with her husband during her pregnancy and during the ninth month she went into labor. She was at home for six days in labor before it was decided to take her to the hospital. She did not make it to the hospital before her mother delivered a stillborn baby girl on the road. After arriving at the hospital the doctor told her to return home. At home she felt the urine starting to leak down her legs. When she told her husband, he sent message to Mariama's mother and told her to come. When the mother arrived she asked Mariama to explain the problem. After explaining to her mother, the mother and Bobakar discussed what they could do for her. Bobakar told her mother that he did not want her anymore and she would have to care for her. Mariama's mother took her in and cared for her.

Zainabu also became pregnant very soon after marrying Ibrahim, her husband. Again, she carried her child for nine months and during the ninth month she went into labor. For seven days she labored. On the seventh day she birthed a stillborn baby boy. If the child would have survived he would be twenty years old this year. Hew was delivered by Zainabu's mother in their home. The day after delivery she noticed she was leaking urine. She never went to the hospital to see a doctor about this. Her husband did not abandon her but they are not able to sleep in the same bed because she has this problem. Zainabu is one of three wives to Ibrahim. She is the only one not allowed to share a bed or even enter into his room.

Mariama and Zainabu were met by a woman who knew about this centre and she brought them down here from Guinea. They both had surgery on the ninth of August and they are doing well. They will be here for at least another week. All I can say to them is 'jarama', meaning hello. It always makes them laugh. Usually when I tell the women I want to take their picture they stand side by side with their arms to their side. When Mariama and Zainabu stood to get their picture taken they immediately put their arm around each other. It was really cute.

On a side note, the rain today was unreal. It has not stopped! Not just a drizzle. Torrential downpour. Even the locals say this is one of the worst rainy seasons.

Thanks and Goodbye

Five of the women sportin' their Lutherhaven gear

Some thanks are in order. Not just from me but from the patients as well.

First, thanks to Camp Lutherhaven for the t-shirt donation for the women. They are now nicely decked out in Cut, Crop and Quilt weekend and Great Escape t-shirts. Lovely! A bit of home for me to look at daily as well.

Also to my mother for the donation of crochet hooks. The women are loving them and making many chop covers,covers for their food. Thanks!

I have to share a story from today which brought me to tears. We have had a patient on the ward for two weeks now. She arrived from a screening trip completely wet and completely unable to walk. She could barely move her legs and had difficulty moving her hands as well. After being seen by the surgeon it was seen that she did not have a fistula but had completely lost all sensation to her bladder and the obstructed labor completely took away her ability to walk. We do have two physical therapists here at the centre who have been working with her and although she has a very long road ahead of her to recovery, in the last two weeks there has been such an improvement. Today when she left, she could sit in her wheelchair and use her legs to push or pull herself around the ward. She always smiled and thanked everyone for everything done for her. I have seen her cry more than any patient before. You could sense the frustration but she would never show it. She was just full of thanks. A few nights after she arrived I was visiting the ward in the evening. She waved at me and told me to come over. She took my hand and said she was going to call me her momma. Today her aunt and brother came to take her home. All the patients said and waved goodbye as she left. They have all been great with helping her with whatever she has needed. I cried as Haggar prayed for her. She has an appointment to come back in three months for follow up. Please join me in prayer that she will be walking through the door at that time.

Burqa

This thought has been going through my head since I was on fabric row on Saturday.

As we walked past an outdoor shop selling fabric I noticed two women dressed as many Muslim women are, in their burqa. Completely covered from head to toe in black. You can not even see their eyes through the veil covering the thin slit for their eyes. It was a beautiful sight to see though as they were looking through a pile of bright, colorful fabrics. It seemed like such a clash of cultures. It completely caught me off guard to see this. It made me wonder what they wear under their black coverings. I picture colorful clothing that will liven their spirit when they are able to remove their burqa.

Today

This is one of the babies of a mamma on the ward.

I love his Obama diaper!

What a great Saturday! It started with me walking to the roundabout to get a taxi to Bliss to meet Sandra for lunch. I somehow got a free ride from someone I didn't know. Olga, but there is the Sierra Leone hospitality for you.

I was on a mission today to find fabric. I need to get a skirt made for my trip to Niger in November. It's never a bad idea to plan ahead. In my six months here I have not been to the big market yet or to fabric row. I always heard crazy stories of this place and how crazy it is. It was fine. There weren't many people there today so that made it nice. This market is multiple stories. From what I saw of it, the main floor is crafts and upstairs is mostly fabric. I'll have to go back sometime when I have more time. The fabric row was great too. Found some fabric now I just need a tailor!

After shopping I took a bus back to Aberdeen. A bus. Another random mode of transportation in my day. It worked though. Cheap too.

The patients watching me get my hair done.

Everyday my patients say they want to braid my hair. Today I let them. I let Mariama. She did a fabulous job. Last year in Togo I was in tears when I let a patient braid my hair. When Mariama did it, I felt nothing. Loved it. It actually feels good having my hair braided. I was the source of amusement for the day. All the

other patients came out to watch and laugh. It was great. It was great talking with Mariama too. She spoke very good english. She is 32 and has only been pregnant once. Her baby was born alive but died two days after she was born. It was really interesting talking with her about relationships and boys and how she can't find a solid guy. She was saying that whenever a problem comes, the guys up and leave and find someone new on the streets. She was so frustrated with it. I was asking her where her worth comes from. I always hear how for women, their worth here is found in how many children they have so I found it intersting that she is 32 and has only been pregnant once. In her family they stressed education. She works for a mobile company and supports herself and her mother. She told me that if she lived in the villages, she would have many babies. Here, her family was able to give her an education and she only wants two children. She couldn't take care of more than that. It was really encouraging for me to hear. It's not like the stories I usually hear from the women here.

After she was done it was time for dinner. I don't usually eat dinner on the ward. Tonight I didn't recognize what it was. Yele I was told. Cassava, mango, fish, potato and palm oil. I was nervous to try it but it was good. Really spicy. Not all the women liked it so I bought them boiled groundnuts from outside the gate and we all ate those too.

Great end to a great day.

The Grace

The grace of our Lord and saviour Jesus Christ

And the love of God

And the sweet fellowship of the holy spirit

Bless your name and abide with us all

Now and forever more

Amen

Rain on a Tin Roof

When it rains here I think of the Julie Roberts song, Rain on a Tin Roof. I like the song and I've always liked the sound of rain on a tin roof.

I sleep under a tin roof.

It's rainy season.

I don't think my love for the sound of rain on a tin roof is the same as it used to be.

Pekins Post Fistula

(Pekin is Krio for child)

I knew there was one more story I wanted to share yesterday...

I was sitting with the women yesterday evening right before dinner. When the dinner cart comes rolling out, all the women sit on benches on the opposite side of the wards and wait to be served. There was a maternity patient and her new pekin who was staying on the fistula side since maternity was full, and she came out and sat down with her child. Haggar, our main teacher for the patients, was there. She told us that this woman had a fistula, was healed at the centre, and returned to have her pekin here. Haggar went on to preach to the patients about how there is hope and possibility to have more children after having a fistula. Some women can't, but this woman did and now she has a beautiful child. Do not lose hope!

It's neat how having a maternity centre here brings it all full circle. After the women have their fistula surgeries they are given a card which will allow them to have a free c-section if they ever become pregnant. If they were to try and have a child again vaginally, the chances of getting another VVF or going into obstructed labor again are very high, putting the mother and child at great risk. If a previous VVF patient registers with us they are admitted at 38 weeks. They will wait until they start feeling labor pains and then they will have a caesarean. While the women are waiting they usually wait on the VVF side since we usually have extra beds. It's a great example to the patients waiting for their surgery and wondering if there is hope for another pregnancy since one of the major ways a woman has status in this country is by her ability to bear children.

Stories

Yes. It has been a long while since I posted on here. So much has happened and so much has changed. My attitude being one, but more on that later.

I went home for four weeks from mid June to mid July. I actually had known since about two weeks before I arrived that I would be coming home. I wanted to make it a surprise though so no one knew. It was wonderful being back on familiar soil for a bit. It came at just the right time as well. To tell you the truth, when I left I didn’t know if I wanted to come back. So much was happening and I was struggling to keep my feet under me. Rest came at a perfect time.

Home was great. I spent four weeks with my sister and her family and was able to see all my nephews and niece. Many friends came to visit as well. I ate a lot and slept. Celebrated the 4th of July. Cooked on a campfire. Canoed. Hiked in the forest. Went fishing. Stocked up on some goodies for friends back here. It was great, to say the least.

I have been back a few weeks and honestly, it has been great being back. Having a time of rest, of real rest, renewed my strength. It helped too, that when I returned back here, nothing but good reports came from when I was gone. Bernadette and Esther, the two Sierra Leoneans I have been training to be the ward supervisors have been doing such an amazing job. Truly. It couldn’t have gone better. There was a visiting surgeon who came while I was away and he did 22 surgeries in a week. That is double what can be done on a good week, which we don’t see too much, but all my nurses pitched in and did a fabulous job. They told me that now that I am back, they can slack off. I told them absolutely not! And they haven’t. They are really showing me what they can do. It’s been great for me because I have been able to do more teaching and more detailed things to encourage and really try to get things right into place for when I leave in December. I pray this all continues.

Updates from the ward:

You wouldn’t believe it. So there was a woman who showed up with her sister and her daughter-in-law. All with VVF. The daughter-in-law has already gone home. Her injury was too extensive and there was nothing Dr. Lewis could do for her. The other two, sisters, both had their surgeries yesterday. Both are dry and doing great! More to come on them in the future...

Seibatu. The visiting surgeon attempted her again. Her third VVF. When I came back she still had her catheter in and was becoming wet. I decided to leave her catheter in longer than normal because she had said that her wetness was improving. The first thing I had noticed when I returned was that she still had her colostomy! She was soposed to get it reversed the day I returned home, four weeks before. Nope. They saw she still had a small hole so they left it longer. She was given another appointment at Emergency Hospital where she was going to get her reversal and last week she did!!! Two days ago I went to visit her so I could change her catheter but when I showed up they said she wasn’t having any urine from it so I just took it out. Her surgery failed, once again. Dr Lewis will examine her again this week and see if there is anything more she can try. Her colostomy reversal was a success though! Her RVF was closed!! The good news is that Seibatu has pooped! This is such a victory! For the last year it has all been coming out of her vagina and now, with the colostomy giving her bowels time to heal after her RVF surgery, she has pooped, three times! Every time is a victory for her! Chances are she will go home soon. After six months, she needs to go home and visit her children and husband and family. She told me she will not go if she is not dry. It will be hard to see her go but sometimes there is nothing more that can be done here.

It is Ramadan. In a country where you are either Muslim or Christian, this is a big thing. I have had old patients call me and ask if I am fasting. Nurses taking time in their day to pray. Breaking their fast in the evening. Having a VVF patient find out she is pregnant and the only question she has for us is if she can still fast. It’s a different world here sometimes...

This woman who found out she was pregnant, I was in tears. We do pregnancy tests on all our women. She came back positive. The obstetrician did an ultrasound but couldn’t see anything, so she did a vaginal one and yes, I got all choked up. So tiny on the screen. About six weeks along and you could see the tiniest little flutter of a heartbeat. It was incredible. She was given an appointment to return to have her baby here.

Oh, and last week we had such an overflow of patients that one night two beds were pushed together and three women shared and the next night an mattress had to be put on the floor! A full week this week and next week we already have a full OR schedule as well!

Last week Jane stayed with me for a bit for her vacation time. One night we were walking down the street and passed the side gate to the centre. There were five of my women there staring out and said they wanted groundnut. Jane bought them groundnut and we shared with all the patients. Now everyday they say, ‘Sarah, I want groundnut.’It makes me laugh whenever I hear this.

More stories to come. Off to bed for now though!