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!

Seibatu

It is hard to know Seibatu’s age. She has a very thin frame despite our attempts to fatten her up. She carries her perfect apple cheek bones without any trouble and she has had five pregnancies. I would put her into her mid to late twenties, although she could not confirm nor deny this. Here is Seibatu’s story…

Seibatu has been here at the centre for 153 days. Yes, you heard me right, 153 days. Her first surgery took place on January 19, 2011, but I am getting ahead of myself. Like I said, Seibatu has had five pregnancies. From those five, she has four daughters which I am sure are as beautiful as she. Zainab, Fatmata, Isata, and Jariatu. It was during her fifth pregnancy that she came into trouble. She went into labor at home. For three days she labored before she went to the nearest government hospital to her home. There she had her child without a caesarean section. The baby was born alive. A boy. Within one day he died. The next day Seibatu noticed she could not control her urine and one month later she realized she could not control her bowels either. She had both a VVF (vesico-vaginal fistula) and an RVF (recto-vaginal fistula). This happened ten months ago.

Soon after her problems started another woman in her village returned from Freetown where she became dry after having this same problem. Seibatu was taken to the Paramount Chief of her village by her in-laws to seek help. He told her to go to Aberdeen to get help like this other woman had done. She was brought by her husband, Umaru, a very thin man like Seibatu but with the same infectious smile. At home they work together as farmers: cassava and rice. Since Seibatu has been here they have not been able to farm. Umaru travels between home and Freetown to visit Seibatu and care for his family. He has been seen on the ground here cutting her toenails and taking care of her, a beautiful sight to behold.

January 19, 2011 Seibatu had her first VVF surgery. She came out of surgery with two stents and a foley. Quickly we noticed her surgery did not work as her bed was still wet. After she had time to recover from this first surgery, on March 1 she was sent to a nearby hospital to have a colostomy placed. When the colostomy was placed, her RVF was closed. To give her body time to heal she would need to keep this colostomy for three months. Three weeks ago she went back for a check up and it was noticed that the RVF was only the size of a pin point! This Sunday she will return to have the colostomy reversed. The first step to full healing. Her RVF is closed!

May 18 she went back in to have her VVF attempted once again. Again it failed. Seibatu does not have a lot of healthy tissue to use to close her VVF. The greater part of the VVF was healed though. That was great news. Next month another surgeon will be visiting the centre and hopefully he will be able to do the final part of her healing, to finally close her VVF once and for all.

I asked her how she feels about being here for so long. She said she is happy. She wants a ‘well body’ to take home. She desires healing so much. There have been many tears shed on behalf of Seibatu by her, by myself, by the nurses. Seibatu has come so far and we can only pray that she will leave here completely healed and she would go home dancing.