Month One in Sierra Leone

Let me take a moment and reflect on the happenings of my first month in Sierra Leone...

• January 3rd I arrived. It’s not hard enough to just land and find your baggage in the midst of hundreds of people, but then having to get on a water taxi to get to the mainland. The adventure had only just begun...
• Was welcomed into an amazing group of people.
• Visited some of the most beautiful beaches around!
• Ate some of the greatest seafood!
• Was crammed and pushed and folded into poda podas and taxis.
• Sat in traffic...
• Sat in traffic...
• Sat in traffic...
• Met some amazing women with fistulas.
• Cried in front of my boss.
• Laughed.
• Stressed.
• Prayed.
• Sent away women in tears knowing where I was sending them was not where they wanted to go but knew there were no other options.
• Led my first staff meeting.
• Wanted a dog.
• Taught my first lecture on hyponatremia.
• Ate African food for lunch five days a week.
• Shook my tumba.
• Danced, and not just at gladi gladi.
• Watched season 1 of Bones.
• Got a job title.
• Questioned what I am doing here.
• Questioned why I ever questioned what I am doing here.
• Saw patients wet.
• Saw patients dry.
• Saw patients somewhere in between.
• Learned about #2 and #3 plugs.
• Slept under a mosquito net every night.
• Woke up at 0230 covered in mosquito bites.
• Breathed.
• Forgot to take my doxi for three days.
• Went to my first management meeting.
• E-mailed the girl in this job before me with tons of questions.
• Made some great friends.
• Took a shower for longer than two minutes in Africa.
• Ate haggis...twice.
• Learned to play carcassonne.
• Saw one monkey.
• Made my first roster.
• Fixed my first roster.
• Still fixing my first roster.
• Witnessed pure joy.
• Witnessed pure heartbrokenness.
• Ate my first lobster.
• Was woken up at 5am to be told there were no more diapers.
• Learning more and more what it really means to trust God.
• Walked into the ward and saw a patient standing directly in front of a large fan holding her shirt above her head.
• Watched an ultrasound.
• Saw brand new babies.
• Bonded with a nurse over scrubbing cabinets.
• Sweat.
• Got filthy from just siting in a car.
• Reunited with friends I had met on a ship last year.
• Joined two Bible studies.
• I think I may have quit one Bible study.
• Sat and talked with patients without using words.
• Heard awful screaming from the labor ward.
• Floated down a river into the ocean.
• Learned very small small krio.

And tomorrow I may be on the radio.

Two More...

The team house where most of us live. The bottom floor is where we eat together and the kitchen and laundry room. Soon we will have couches in there for a lounge as well.

I live on the second floor but I will be moving north in a couple weeks. There is a better view and a brighter room.

On the other side of the cement wall to the right, which you can't really see, is the maternity ward.

This would be why it takes so long to get anywhere. There is so much road construction and crazy drivers and unreliable cars which break down everywhere that to get anywhere is an all day ordeal.

One Photo

I've been trying to get pictures uploaded on her for the last few days. It took about ten minutes for this one. It's a start and I will try and do more later.

Here is a picture of a girl on the day of her gladi gladi surrounded by eight other patients awaiting their turn.

Burns Night

Who or what in the world is Burns night/Burns supper? I had never heard of this guy until a few days ago and tonight I had haggis for the first time, possibly the last. It's not that I didn't like it. It honestly didn't taste that bad but with every bite I had to consciously tell myself not to think about what I could possibly be eating. Jude, the manager of the clinic, is Scottish and she brought it back with her from her last trip home. It looked like a massive, massive sausage. When it was brought out it had to be walked around the table and we all stood in silence. Then Jude stabbed it with a dagger. Quite possibly the most random thing I have seen since arriving in Sierra Leone. After dinner Mikey read his poetry. Mikey isn't Scottish but I guess this is what you do at a Burns supper.

As random as this all was, this is something I really love about living in this sort of community. We all come from different places from around the globe and yet we all bring something so unique...and sometimes so strange. The funny thing is too, is that I was invited to another Burns supper/poetry reading tomorrow night. I'll have to let you know how that one goes...

Get Belly

There are two women on staff here who are trained to do advocacy teaching with the VVF women. I sat in on the first half of the day with them. Fourteen VVF women sitting in a circle talking, I felt like it was a support group, which it is in many ways. One thing I have noticed about Freetown is the large number of NGOs in the area. When you go out you can't help but pass numerous white land rovers will a different charity scribbled on the side. One of those charities is Health Poverty Action. To be honest I really don't know much about them but what I do know is that they have put together this great advocacy training program for the fistula women for when they return home. The women are taught how to advocate for other women they may find in the same situation they are in, leaking urine and alone. Not only are they taught what to do if they meet one of these women and where to send them, but they are taught what to do if they meet a woman who "get belly", is pregnant. If the woman is in labor and if they see the sun two times, one-night-two, and they still have not delivered, they must get them to a clinic or hospital where they have trained doctors.

While they were sitting in the circle, Florence had the women go around and say how long their labors lasted. I have heard these numbers before and see them daily as I enter them into the database in the computer, but to go around a circle and hear each woman say: two days, one day, three days, seven days, two days, four days, six days, ten days, three days, one day, seven days, four days, three days, two days... makes it so real. When she asked one woman how far it is from her home to the nearest health clinic of any sort, thirty miles was the answer. For most of us thirty miles isn't anything. That's a drive into Tacoma from Vaughn. Into Spokane from Coeur d' Alene. Imagine not having a car though. There is no way. And if you are in active labor...

After the training the women are given a book about Fata. It is written in simple language so some of the women can read it if they have had any schooling. Fata becomes pregnant and gets a fistula. It tells her story and it tells what needs to happen next and what could be done about it. The women can use it as a tool when they get back to their villages to help prevent fistulas.

This evening I was walking through the ward and I heard someone reading, slowly, but trying, and it was Mariama. Mariama is sixteen and only got her fistula two months ago so it is too early for her to have surgery yet. She will be with us until it is time though. She needs to be "built up" so she will be better physically for surgery. Vitamins, ensure and three meals a day will help with that. I sat with her outside for a bit this evening. I was trying to hear her story but the nurses who were translating for me got busy. I had her open her book on Fata and read instead. She speaks Mende and small small Krio but she knows her alphabet. She is slow reading but not bad. If she got to a word she didn't know she would spell it without any problem and usually figure it out from there. Such a beautiful girl. I'm sure I'll share more about her later.

Esther left today, the girl I wrote about two posts back. She wasn't able to sit in on the advocacy training so before she left I pleaded with her that if she heard of anyone with piss problems from obstructed labor to send them in. She said she would and I know she will. That girl is a strong one. So funny too. She was helping me with my Krio which is still non-existent. She is still wet but will be back in two weeks for a checkup. For now, it's back to school for her.

Tell God Tenki

One of my favorite things that happens in the morning during rounds is when the patient is asked how she is feeling. Her response, more often than not, is:

"Tell God tenki."

Tenki means thank you in krio, the local language. Tell God thank you. Even through all these women have been through, their daily response is:

"Tell God tenki."

Their response isn't:

"Why did God allow this to happen to me?"

or:

"Can you PLEASE take this catheter out!"

or:

"When can I get out of here and go home?"

or:

"When can we eat?"

it's:

"Tell God tenki."

On another note, there is a woman who had surgery yesterday and now she has three drains coming out of her. A catheter and two stents which come out from the kidneys. Those will be removed in seven days. When she gets out of bed she carries the stents around in a bed pan. Don't worry, it's super clean. But that's not what I want to share about. So today was visiting day and her husband came! That in itself is always a beautiful sight to see. So many of these women are abandoned by their husbands. But I looked over and he was bending over cutting her toenails with a razor blade. That was a tremendous picture of love! She was sitting there with a foley bag and a bed pan full of two other bags and tubes and he was lovingly cutting her toenails. I walked over to them and they both looked up at me and laughed, as did I.

Esther

This weekend when we were driving home from the beach we passed and man and his daughter selling beautiful fruit on the side of the dusty road. We stopped and for Le 3,000 I was able to get half a dozen perfect sweet star fruit then on top of that he piled that many more sour ones so I could try them. That was less than a dollar. I just ate one and it was delicious!

I walked past a patient today who was leaning over her bed digging around inside the plastic bin all the patients are given for their personal belongings. I noticed she had a stack of those composition notebooks. When I asked her if she was in school she said yes. She told me she was studying agriculture. Instead of being in school she is laying in a hospital bed trying to not leak urine. We got to talking for many reasons but it was also nice being able to talk to a patient in english. She learned english in school and spoke it very well. I opened her agriculture book and quizzed her on the difference between substance agriculture and commercial agriculture. Pretty smart cookie she was. She told me that she didn’t want to be a farmer but someday she hoped to become a nurse. At seventeen she has her life in front of her.

Here’s a bit of Esther’s story: She became pregnant about a year and a half ago and was in the midst of taking her exams when she found out she was pregnant. She decided to continue with school though. The “young man” who got her pregnant continued to help her with her school fees. When she started feeling a little pain she told someone but she told me that because she is only a child, she didn’t know what to expect from labor. She thought that when her labor started her whole belly would start moving around and everything would hurt. When this small small pain started the woman took her to the TBA, traditional birth attendant. For three days she labored. She asked them to take her to the hospital but they said they could not afford an ambulance. It would cost Le 20,000, about $4. She gave the TBA a small amount of money to call her boyfriend but they took the money and never called him. She told me the baby tried to come out but it got stuck. “It wouldn’t go up and it wouldn’t go down.” Eventually they gave in and took her to the hospital. The surgeon there said he would only do the operation for Le 200,000, money she did not have. Another day went by and that night she passed her dead child on its own.

In the hospital they inserted a catheter. She was having a small amount of urine coming out but the rest just fell out of her. By the third day nothing was coming from the catheter. It was all just pouring out. She went home.

There was a car that came to her village. It was the screening team from AWC, where I work. The nurses met her and although there were other women in the same condition, they all ran away but she stayed. Others told her to run because these nurses would eat her. She knew she needed help though. She came and had her surgery but was still wet and had to come again for another one. She had her second surgery yesterday.

Esther told me that when she went home after her first surgery, although she was still wet, she didn’t tell anyone. She dressed fine and made herself look happy because she wanted to help the other women in her village. She wanted them to see that she went and was healed. She wanted them to come as well. Even if after this surgery she is still wet, she will do the same thing. She knows she is the one who can help her friends find healing.