Tuesday, March 29, 2011

Green Glop

Julia Child I am not. In fact, in the States I am known more for my inability to cook than for any skill in the kitchen. (Although I must say that I get RAVE reviews about a snicker salad which includes Snickers, apples and whipped cream.) Declicious....but not exactly difficult to make. There's a chance that I've managed to mess up no-bake cookies before. Sad. Anyway, I've made a friend here on my walks and today I asked her to teach me to cook. Now let's be honest. Since I didn't really cook in the States, there's a high probability that I won't cook much here either (sandwhiches do just fine for me) but I was excited to get to spend time with this girl, work on my Krio and learn something new. My suspicions that I won't cook a ton of African food were confirmed today when it took FOUR HOURS to cook ONE MEAL!! First, we went to the market to buy everything we'd need. It was a lot of stuff! We bough cassava leaf and then watched a guy grind it up (I always wondered how they got it to look that way), granut paste (like peanut butter without the sugar), rice (of course), Maggi (a spice used in everything), a LOT of peppers, salt, palm oil, some unidentifiable brown mixture to thicken the sauce, and some fish (I tried not to notice the hundreds of flies surrounding the fish). After the market we headed back to her place to cook it up. It was a really fun experience. Although my Krio is not yet good enough to have in depth conversations, I had fun trying to figure out what she and her sister were talking about. Sometimes it would get tricky because I would listen to them talk and think "man, my Krio is getting worse.....I don't understand anything they're saying" and then realize that they had switched to their tribal language and I hadn't picked up on it. No fair!! First she cooked the sauce, then the rice. All in all it took 4 hours to prepare this meal! The food was good although it was VERY spicy (as usual). I ate as much as I could but I could tell that she was disapointed I didn't eat a ton of it. Although to be fair, they usually just eat once a day so when the eat, they eat a LOT. I like to eat! But my American tummy is more used to grazing than eating one giant meal for the day! It also didn't help that I got a little fish bone caught in the back of my throat so I had to concentrate pretty hard not to look like a cat trying to cough up a hairball. We ate at around 2pm and when I asked when they usually eat, they told me that the time just depends on when they get their money. If it takes all day to get enough money, they eat at the end of the day and if they don't make enough money, they don't eat. I kept trying to figure out how they made their money because it was just these two girls (ages 19 and 14) who live with them and an aunt who isn't much older. The 14 year old sister tried to sell some cookies and candy that she made but she didn't sell any today so it certainly doesn't seem to be enough to support all of them. Anyway, it was a lovely day cooking, but definitely made me thankful that I don't have to do that every day. My friend said that next time she wants to "plate" my hair. That's right....the good ole' corn rows or braids or whatever variation it ends up being. I've yet to see it look as cool on a white girl as it does on Africans so....we'll see. Plating is probably one of the most popular social interactions between women here, so I could definitely see doing it for that reason as opposed to thinking that after 29 years my bright white scalp suddenly needed to see the light of day!

Friday, March 25, 2011


Last week WMT set out on a new adventure.....well drilling! We've been anxiously awaiting our well drilling equipment that was brought over by the medical team that came last month....and last week we started our first well! The unique thing about this well drilling process is that it's done completely by hand. So you don't have to bring over a big well drilling machine and can easily get the equipment to rural, hard to reach places. This first well we drilled was a "for profit" well for an NGO (non-governmental organization) nearby. Using this technique, you can drill a well for a significantly lower price than a lot of other methods. Our plan is to drill some "for profit" wells and use the profits to fund well drilling for poorer communities who can not afford to pay for a well. It also gives us an opportunity to train Sierra Leoneans in the process so they can eventually take over. So this was our test run......the maiden voyage.
Getting started: X marks the spot

A tripod with a pully system is used to manage moving the heavy equipment around

The well is drilled using a bore hole method and it is all done by hand. Different soils/rock require different tools.

We started off cruising, digging several feet every couple of minutes. John was very excited!Then we hit some rock. John was not very excited. We were stuck for about 5 1/2 hours and thought we might have to pull out and start somewhere new BUT......we made it through!

Then John was very happy again!(Sorry, no picture of him being really happy).

And after five days we had water!!!

The plan is to place a solar pump as well and treat the water using UV rays. It's all completely over my head. My job was to document the adventure and serve as the anchor to keep the big metal poles in place while they were pounding around down there. (After a minor accident in which the tripod fell down and hit Chad's car. We realized the importance of the "safety zone" after that! All in all, not a bad way to spend the week! :)

Wednesday, March 23, 2011

First at the scene

Today I failed.
I was getting ready for another road trip and was filling my car up when it happened. I heard a "SMACK" and then someone said "Ohhh...accident!" I turned around and not 50 feet away from me were two people lying on the ground with their motorcycles beside them.
My background is ICU nursing. A few years ago I started working in the ER and really loved the chaos that happens there....doing some of the first assessments, figuring out what's going on, etc. In few months before I left I was lobbying to do some ride alongs with some of the paramedics I met because I wanted to be "first on the scene." I know it may sound sick....but I love the adrenaline rush!
So there I was. Two people in an accident just a few feet away. Neither were wearing helmets. One guy was moving and I thought the other one must be dead because he wasn't moving at all. All of the sudden I had a million things running through my head. It went like this.
"I need to do something. There are two patients sitting right there! What should I do? I should call 9-1-1. Wait, there's no 9-1-1- here. Ok, let me grab my first aid kit. Wait, I didn't bring it. Also, what do I have in my first aid kit that will help an unconscious, probably dead person? They shouldn't move. I need a c-collar and backboard. I have neither of these. What should I do? I could take them to the hosptial. Where's a hopsital around here? How do I get to the hospital? How do I get them there without moving them? Is that guy alive? I need to do something, it's my civic responsibility. What should I do???????"
This conversation probably happened within a few seconds.....it felt like forever. As often happens in accidents (especially here it seems) many people started converging upon the scene immediately. I started moving in that direction but paused. Then I noticed that there was an ambulance that happened to be driving along at the time of the accident. I've probably only seen 5 ambulances since I arrived. They did a literal scoop and run and picked these two guys up, threw them in the back of the ambulance and off they went. Then the traffic resumed as normal. It was incredible how fast it happened. At home that road would have been blocked for at least an hour!
Even though it happend quickly though, I still think I had time to do something. But I didn't. I totally froze. Rarely have I felt as much like a failure as a nurse...expecially an ER nurse....as I did today. I mean, this is the stuff we live for! I've literally been jealous of my other nursing friends who have happened upon an accident and were the first to get there. And today I blew it! Couldn't I have at least stabilized the neck....somehow? Wasn't there a big piece of board....somewhere....that I could have used as a backboard? I should have done something!!!
I've gone over it a bunch of times in my head and I'm not sure what exactly I would have done differently. However, this experience did make me think that I need to have some kind of plan for if/when (if you've seen the driving here you would know it's going to be a when) this happens again. I was caught way too off guard today and don't want that to happen again!! Sheesh.

Thursday, March 17, 2011

What time is it??

When I was living in the States, I always kept my phone on at night. Sometimes it was because I was on call for work and might need to go in, but it was also because in the case of an emergency I wanted to be available. If someone called me at 3 am in the morning it would surely be because something was horribly and terribly wrong right? Well the rules are a little different over here. :) I have recently become aware that many of the cell phone companies offer free calling between the hours of 2-5am. Therefore it is not at all culturally unacceptable to give people a little ring a ding in the MIDDLE OF THE NIGHT!! I have been blessed to be part of two of these calls now. At first of course I had to answer because it MUST be an emergency....but now I'm on to this scheme. Callers at 3am (who call multiple times if I don't pick up) have lost their "Uh oh I should answer because this is probably an emergency" priveleges!! :)

Another thing I've learned is that it's all about the greeting. In Sierra Leone there's no "hi, now let's cut to the chase of the conversation. A minimum of at least two greetings must take place before the real conversation can start. Now there are a lot of options you can choose from such as "how's the body?" "how's the day?" "how's the work?" "how'd you sleep" "how's your family" and my personal favorite..."how's everything?" Now, I tend to be a very "cut to the chase" kind of person so these extended greetings are definitely an area in which I need to grow. Especially when I just have a really quick question on the phone and ESPECIALLY when it comes from my 3am caller!! How's the sleep? Really? You want to go with that one when you're calling me at 3am in the morning??? :) Ha! Sierra Leone....you make me laugh. :)

Sunday, March 13, 2011

On the Road Again. Part II

Well, after spending the night at the hospital, we headed out the next day to take Ali and his dad home. The first 3 1/2 hours were a little long as I was trying to go extra slow over the bad roads so Ali's leg wouldn't hurt. Everytime I accidentally hit a pot hole I'd turn around and ask if his leg was ok. After 25 times I think he started getting a little annoyed......
At lunch time we stopped to eat at Moyamba Junction which is a really popular place to eat. Ali was so excited because there he got to eat beef!!! (It's actually goat but I didn't have the heart to tell him). After lunch he was going on and on about how good the food was. I told him that I like beef, but chicken is my favorite! He just couldn't understand why I would want chicken when I could have beef!! (I will say that all that talking about beef did give me a hankering for my all time favorite hamburger from McDonalds).

After a long day with lots of stops along the way, we arrived at Ali's village. As we started getting closer, Ali started getting more and more excited. He started seeing people he knew and we had kids literally running after the car (they managed to keep up pretty well because the road was horrible so I had to go super slow!) As we passed a field he said "there's the field that broke my leg!"
Finally, we arrived at his village. This was one of my favorite parts. To be honest, I wasn't looking forward to going to the village very much because I knew I would be a spectacle. Those of you who know me know that I don't do particularly well in awkward social situations. Heck, I don't do super well in normal social situations. So as we were pulling up to the village I was mentally preparing myself for all the staring and gawking and people trying to talk to me in a language I didn't understand and then laughing when I don't know what they're saying. Never fear though!! As we pulled up, nobody even noticed me! Ali was the absolute center of attention! It was like a hometown celebrity coming home. Everyone was talking to him at the same time, looking at his cast, asking about his trip. It was great! He was eating the attention up...and was just so glad to be home! At one point I looked over and both Ali and his father had groups literally sitting at their feet asking them questions. I heard Ali's father tell someone that we had travelled over 200 miles!!
It was nearing dusk when we arrived so I knew that we wouldn't have much time. I make it a point to not travel at night for safety reasons, so I needed to get on the road. But apparently Ali's dad had called ahead because they had a meal prepared for us. As I took my first bite, I was shocked when I realized that it wasn't spicy!! (I really struggle with the African food here because it is SO spicy...and I don't do spicy very well. I just recently started thinking that ketchup wasn't too spicy.) Apparently one of the pastors had told Ali that I didn't really like the spicy food much and they had made it especially for me. Wow. Then they proceeded to bring out a ton of pineapple and coconut. (Ali's dad had been asking me if I liked that stuff during the trip but it didn't occur to me that he was arranging this.) Then they brought out some chickens. He remembered that I'd said I liked chicken more than beef so he gave me 4 live chickens!! I wasn't really sure what to do because it was SO much, but I didn't want to offend him by not taking them....so I loaded them up in the backseat. Sorry Chad!! (Who's car I borrowed). Anyway, I think that that experience was probably one of my best in Sierra Leone to date. The family and community were just so thankful and I was just so grateful that we'd been there when it happened and that the team had been willing to sacrifice to help this kiddo out. Even though the day was really long, I left that village on cloud 9. I told God that if I never got to see the fruits of any more labor here in Sierra Leone...that was enough. :) I'm satisfied. The next morning we headed out early to meet with someone about the team coming next month. When I got back from the meeting, this is what I saw in the car.
Oops!! Now I'm really sorry Chad!! But don't worry...I cleaned up all the poo. And I think my bag got the worst of it!

Saturday, March 12, 2011

On the Road Again.....

On Thursday, I left for a three day road trip. I just got back tonight and it was great!!! I had six objectives over the three days, so needless to say...the days were long! My first job was to go pick up "Ali" from the hospital where his leg was casted and take him home. The hospital that he's staying at is also the hospital that I'm goinng to be working at in the beginning of May so I was really excited to go take a look. Here's where I'll be living.
I'm going to be living with another nurse practitioner/nurse midwife so that'll be fun!
I arrived at the hospital at about 3pm and wasn't really sure where to go. After checking in with Ali and finding that he was doing great and was really excited to go home, I set off to find Dr. "B". I found him in the clinic and was directed to the guest house. My friend and I (the experienced navigator...he was very shocked at my unfortunate direction sense....or lack thereof) settled in and hung around for awhile. At about 6 I went to find Dr. "B" again but couldn't find him. I tried calling, but no answer. At about 8pm I decided to hit the showers and then head to bed. Just as I was climbing into bed I got a call from Dr. "B". He invited me over to have a chat with him...and I was confronted with the difficulties of practicing medicine here.
It turns out that I came on one of the worst days. Now I'm going to get a little "medical" here so if you're not interested go ahead and skip to the end or to part 2 coming tomorrow. :)
Dr. "B" had a pregnant woman who had been in the hospital for about half a day. He was called to the OB ward because his patient just "didn't look right." After doing some tests, he thought that she might becoming ecclamptic....but it wasn't a sure thing either way. So the dilema. The only way to cure ecclampsia (really high blood pressure in pregnancy) is to deliver the baby. But her blood pressure was only boarderline. She had some protein in her urine and some slight swelling, but nothing that said...we need to deliver right now! Nobody here knows how far along they were but the midwives were estimating about 35-36 weeks. Baby's heart tones were strong and about 150 bpm. They could go in and take the baby via c-section but here's the dilemna. Mom is only about 18 or 19 and the don't do VBAC's (vaginal birth after c-section) here because they are too risky. They will also usually only do 3 C-sections because then they become too risky as well. So does he take an 18 girl to the OR and limit the number of children she'll be able to have (when having a lot of children is EXTREMELY important in this culture....and you usually have at least one die) if he's not sure that she needs it? But on the other hand, it would be worse to have to take her to the OR and have a C-section for a baby that has already died. Since baby was still looking fine and there were no clear signs that mom needed to be taken to the OR, he decided to wait and re-evaluate later. So he came back a little bit later and heard some crackles in the bases of her lungs and a slight heart murmur that he hadn't heard before. Also, baby's heart rate had dropped to 120bpm. That was enough to convince him and off to the OR they went. They did the c-section and baby came out floppy and not breathing well on its own. They also suctioned out a lot of meconium. They don't have oxygen tanks here but they have an oxygen concentrator so they hooked baby up to that and started bagging. After about 5 minutes, he started coming around....started looking like a normal newborn. He had lung sounds all throughout and was breathing well on his own. The OR was getting really hot because of all the windows so they decided to move baby to the OB ward. They unhooked him from the O2 and went to the ward. In the few minutes it took to get there, baby completely decompensated and stopped breathing on his own again. here The generator had been turned off so they were yelling to start it again right now! How much gas is there? We need more gas...where can we get more gas? This down doesn't have any gas. Oh, yes they do have gas but it's going to be twice what you normally pay...... In the end, they tried to get him back again, but he never recovered. I was sitting with Ali and his dad when I heard people start crying/wailing and they told me that someone had died. I learned later that it was this baby.
Unfortunately, that's not the end of the story. During dinner, Dr. "B" was called down to the hosptial again. This time it was for this deceased baby's mother. According to the nurse, at 7:00pm she had been sitting up, asking her husband for a glass of water. All of the sudden she started becoming restless and short of breath. When they tried to get a blood pressure they found it to be 60/palp (very very low). They started another IV, had fluids racing in, put the O2 concentrator on (her sats were in the low 80's....very low) but within about 20 minutes of her first showing any signs that something was wrong...she was gone. That fast. With no clear explanation as to why. That was what was so frustrating for Dr. "B." It sounded like it had to have been a pulmonary embolus but how do you keep that from happening again? He could have given an anit-coagulant but that wouldn't be good for every patient, plus you don't have the resources to do that even if it was the right thing. And we'll never know what it was that actually killed her. It was a hard day. For the man who lost both his wife and his child, and the man who was unable to save them.
I was talking to the Sierra Leonean who came with me and said, "Yeah, it's frustrating because we don't know why she died." He gave a small chuckle and said, "Well yeah, only God knows." Because of where I grew up, I usually have an answer for the pathophysiology of why people die. But I do often struggle with why God allowed them to die. For this man, they were not different questions. I don't have a poetic way to end this post. That time just made me think about things...medicine....God....
More about my trip tomorrow. And a happier post!

Tuesday, March 8, 2011

"Ali" Part 2

Well, after some telephone troubles I was finally able to talk to the doctor in charge of Ali's care today. He's doing great!! It turns out that he had a spiral fracture of his tibia and fibula (both the bones in his lower leg). There was a small chip missing but other than that, it was a clean break. It had about a 2 in. overlap. They were able to do some traction and cast it and he's good to go until the beginning of May when he gets it off. He's enjoying himself at the hosptial and doesn't want to go home yet (we think it's probably in large part because he remembers his painful ride over). So he's doing well! He was pleasantly suprised that the tribe in the area was nice to him and that the Christians weren't at all mad when his dad went to the mosque to pray. Nice. :)

Monday, March 7, 2011

Every Year

It seems that every year when I come to Sierra Leone with one of WMT's medical trips there is at least one patient that really gets to me. Some people might even say that I have a tendency to tear up (ok, I cry like a baby) when I meet one of these patients. I was wondering if it would be the same this year...being that I live here now. Yup. Still the same. This year the patient's name was *Ali (names have been changed for HIPPA purposes). Ali was carried to the clinic by some friends and family. I learned later he came from very far away.
The story goes like this. Ali was playing soccer with some friends the day before when he collided with another player. His leg snapped in half. He came to us in a great deal of pain. We didn't have an x-ray machine but from the cracking in his bones that we felt when we were assessing his leg, it appeared that he probably broke both of the bones in his lower leg and probably broke them in more than one place. Shoot.
When I asked him how old he was, he said he was 22 but when I asked him again later, he admitted that he didn't really know his exact age (very few people here do) and to me, he didn't look like he could be more than 17.
In the States, this kid would have been x-rayed, splinted and then probably taken to surgery to have pins or plates placed. Then he would have been in a cast for several weeks, gotten his cast taken off and continued on his merry way. That's not what's going to happen here.
I felt utterly helpless. After two unsuccessful attempts, my friend Katie and I were finally able to splint his leg with old school plaster. During each attempt he would cry out in pain as we shifted his leg. We couldn't even offer him crutches because we were too far away from anything to buy him a pair. He left being carried by some friends with his leg on a pillow, some Aleve for the pain and instructions to stay off of his leg for 4 weeks.
As I saw him leave....I kind of lost it. It wasn't the pain that I caused him that affected me. Maybe I've grown cold, but I'm used to having to hurt patients at times to ultimately make them better. It killed me that most likely, if his leg heals, he'll never walk normally again....never play soccer again. He was such a strong, healthy kid and because of this one accident that would be so easily treated in the States, his life is changed....forever. It killed me. And I cried.
BUT! Fortunately, that's not the end!! We held a team meeting and decided that we wanted to do what we could to help this kid! I called my friend who was in Freetown and asked if he knew of any options. I didn't even know if there were any orthopedic doctors in Sierra Leone so I didn't know where to even start. I explained the situation and he went to see what our options were.
After chasing down a bunch of leads, our two options were an emergency hosptial that only deals with emergencies and a private hospital that would be pretty expensive. The emergency hospital was full so our only option was a private hospital. We took up a collection and that was that. By this time, it was the end of the week and we were leaving for Freetown in the morning.
The next morning we went to church and then a few of us went to find the boy to tell him our plan to bring him to Freetown.
We found his home and there he was, lying on the ground with his leg on a pillow (the splint that we made nowhere to be found....they said it got too tight.) His leg was significantly larger than when we originally saw him a few days ago but he was in good spirits. We gathered his guardians (his parents were in another village) and explained our plan. He didn't love it. In fact, he said he wanted to stay where he was. What??? So we explained it again. We explained the severity of what we thought he had...the fact that if he didn't get it fixed he would probably never walk right again and wouldn't play soccer again. We didn't want to bully him, but we also wanted it to be clear that this was very serious. He became very solemn and finally nodded his head that he would go. My dad told me that I should tell him that we were going to pay for the treatment if the community would provide the rice for him while he was there. I thought "I don't think we need to do that...it's assumed that we're going to pay for it." But I decided to humor him and told him that we would pay for his treatment...etc etc etc. All of the sudden his face lit up and all his family and friends started smiling.
I'd been wrong. I'd been giving them a dismal prognosis with little hope because they knew they wouldn't be able to pay to go to the hospital. Oops! So we discussed some more details and told them we would be contacting them once we had everything arranged to come to Freetown. It was a good moment. :)
The next morning was "Beach Day" and I went to pick up the team at their hotel. And who should be there but the doctor of the hospital that I'll be working at in a couple months. I spoke with her about the boy and she said that they would be able to take care of it at that hospital!! For $300! Awesome! What an amazing "coincidence."
So after lots and lots of calling around, we arranged a ride for him (I dreaded that ride for him....the roads are less than ideal for a normal person, set alone someone with a busted up leg!)
and the driver went to pick him up.
And he refused to go. He and his family were afraid that they were going to cut off his leg. So we spoke with several people, assured everyone that they definitely wouldn't cut off his leg...and off he went.
He arrived safely, if in quite a bit of pain and they took his x-rays. I haven't heard anything but am going to call tonight and check on him.
There is a lot of hopelessness here.....especially in terms of medicine. This is one case that I'm praying will turn out awesomely!!!

Friday, March 4, 2011

Clinic: Part1

Well, I've been out of touch for the last week and a half for a couple of reasons. One, when I purchased my internet I had to do it based on usage. What I bought to last a month actually lasted about 1 1/2 weeks. Oops! Then I lost my internet stick. For those of you who have seen my bedroom/house at home....this won't come as a suprise. After literally tearing my room apart from top to bottom, I found it wedged in between my boxspring. Score! I've also been out of internet/cell phone range because we had a medical team arrive from my hometown and went to a really rural village to conduct a medical clinic for a week. So needless to say I have a lot to catch up on!

The medical team was great...and included some firsts for me. I had my first breakdown in Sierra Leone. And it was a bus....with 20 people on it...stranded in the middle of NOWHERE!! It started with the bus overheating. Now I'm not big into cars, so maybe this is normal, but this bus had the radiator inside the bus. Unfortunately, when the driver opened the cap, scalding water started shooting out inside the bus! The driver's apprentice actually got quite the nasty burn on his forearm. So scalding water is shooting everywhere and the steam is making it hard to see inside the bus. One of the team members who was in the back had to feel her way out because she literally could not see anything. So that was a bad sign.

But we put some more water in and on we went. For like...10 minutes. It started overheating again so we pulled over and parked the bus in a delightful little village....in the middle of nowhere!
We were told that another bus would be coming from Bo, which is about an hour and a half away. So we hunkered down to wait. Well, that time came and went...no bus. Then we found out that it wasn't really coming from Bo, but from Freetown which was about 3 1/2 hours away. An hour later we received a call that the bus coming to rescue us had a flat tire. And no spare and no jack. Also, the driver either couldn't or wouldn't tell us where he was. So one driver was screaming into the phone of the other driver asking him where he was. After some more waiting, he finally rolled up. Wait time? 5 1/2 hours. By this time it was getting to be dusk and the road was narrow with small bridges so we really didn't want to be driving at night. We quickly changed the tire, unloaded everything from one bus to the other bus and we were off! For about 4 minutes. And our bus got a flat tire. Fortunately since we hadn't driven very far, we took the jeep back to the original bus and took some more tires from that bus. And we were off again! Only the bus wouldn't start. After about 20 min. of working on it and some fierce praying by the team members, we really were off. We were hoping to arrive around four or five but got in at 11pm instead. When he first arrived in the country, my dad said that things were just going too smoothly. Problem solved! :) More about the clinic tomorrow!