Friday, July 29, 2011

I have the right to remain silent

Yesterday was a red letter day. I was "arrested" for the first time in Sierra Leone....or any country to be precise. And I would just like to point out that at no time were any of my rights read to me. Here's the dillyo.
Last month I bought a car. His name is Boris. Boris is what you might call... a fixer upper. I've been up country for the last month so one of my friends has been working on fixing some things so that it will be ready for me to take back with me. I drove it the other day and noticed some things that weren't working so well. Yesterday I had an errand to run in Freetown so I decided to take Boris along to see if there was anything else that needed fixing. Also, Freetown is a ridiculous place to drive and I've always been afraid that I'm going to get in an accident and damage the car that my friend is letting me borrow. If someone ran into Boris....I doubt anyone would notice.
ANYWAY, Boris and I started out at about 9:30 yesterday morning. It takes about 45 min. or so to get to Freetown and I go over a very rugged mountain road to get there. Since it's rainy season, the dirt turns to mud and some places start to feel like you're driving on an ice rink. I noticed that I was sliding a TON so slipped him into 4 wheel drive and got some better control. One of the things that Boris needs is new tires. Definitely. Since I'm going to be driving up country a lot where the roads are less than ideal, I decided that if I'm going to invest in anything, it should be a good set of tires. (The vanity in me wanted a paint job it is). They're coming on Monday. Yesterday was Friday.
I made it over the mountain road with only two heart catching moments in which I started sliding toward the edge of the mountain uncontrollably, but arrived to the paved roads of Freetown without incident. I had one objective in coming to Freetown and that was to return to the internet office for the third time to see if they can please get my internet to work. After two weeks without it, I was going through withdrawls! That's half of my new niece's life in which I haven't been able to stalk her via pictures!
As I was driving towards the internet office I suddenly remembered that I left my wallet on my dresser at home. Dangit. Since I have been pulled over frequently for them to just inspect my license I knew this could be a problem. Shoot! "Well," I thought. "I was here all day yesterday and didn't get pulled over. I'll just hope it happens again today." No sooner had I thought those words than a female police officer waved me to the side of the road. Dangit. Double dangit.
She was very friendly and asked to see my drivers license which I explained to her that I'd forgotten. Then she told me that my tires were "smoot." Smoot? What the heck does that mean? Are they flat? Smoking? Not sure. I got out to take a look (keep in mind this is in the middle of a very busy area and it's a white girl in trouble so there were no shortage of onlookers!) She pointed at my very, very bald tires. The were bald. Ah ha!
"You have two great offenses" she said.
"I understand! You're absolutely right. What do I do now?"
She proceeded to get into the front seat of my car and we started driving. I asked her if she was taking me to jail. She laughed and said, "No. I don't want to take you to jail. I don't want to waste your time. We will work this out between us. You are my friend. I don't like to cause trouble for women especially"
"Ok, that sounds good. I totally understand that I broke the law. In America sometimes the police officers will give you a warning and let you go, but if I need to pay a fine I can do that. I'm just going to need a receipt for any money I give you."
"You need a receipt? I can't give you a receipt."
"Well yes, I need a receipt because I have to account for where all my money goes. Otherwise my bosses will think I've stolen the money! You don't want me to lose my job do you???"
We had this conversation about 5 times. Round and round we went as we drove around Freetown. Finally she said, "Ok, I'm not arresting you. Forget about that. You are just my friend."
"Ok," I said laughing. "You are my friend. Next time I'm in town I'll take you to lunch."
And that my friends, is where I think I made my fatal mistake.
She said "Ok, let's go back and you'll give me some money for lunch and you'll go your way and I'll go mine."
"No, I can't do that because you've already arrested me. I can't give you anything today!"
Of course, the point was not that I needed a receipt. The point is that these police officers constantly pull people over and ask for a little something to keep them from being arrested. The injustice of it drives me insane. Abuse of power to the max. I put my crusader hat on. Maybe I should have left that one at home.
At this point we'd pulled up to the police station. She got out of the car and just stood there....seemed to be debating what to do. Then she told me to come with her. Until this point I'd been hoping that she'd just give up and let me go with a warning. Negative.
She took me into one of the rooms in the police station where she told another officer what my offenses were. There were three.
1. 2 smoot tires
2. Inconsideration for other drivers on the road (because of my smoot tires).
3. Failure to produce my license
As the new officer started taking my statement, the arresting officer stood up and left. Not even a goodbye! Some friend. If she keeps this up I'm going to revoke the lunch we were going to have next time I'm in Freetown!
After he wrote down my offenses he had me read it and see if I agreed. I read the statement, told him that I did agree but asked if I should add that the policewoman told me she would let me go if I gave her some money. He gave me a little half smile and said no, we didn't need to put that in the statement but I could talk with the magistrate about it. In hindsight I wish I would have written it down. Next time!
At this point I'm having a delightful time. As I mentioned before, I didn't have a lot to do that day, so I had the time to spare. Plus it was my first time being arrested in any country, so it was an adventure!
After they took my statement they sent me upstairs to one of the bosses. When I got up there I waited for a few minutes and eventually the bossman came out. He looked at me and then asked another officer in Krio why they brought me to him. Then he turned to me and asked if I was a diplomat. What? A diplomat? Just a volunteer. I told him what happened and that my friend was coming with my license. Then he told me to sit down here with a couple other girls....NOT over there with the guys. Okey doke.
So I sat there chatting with the girls and the other officers for the next hour while I waited for my friend. One of the benefits to working upline is that a lot fewer people speak English so my Krio is slowly but surely getting decent. When I started chatting with them in Krio everyone got really excited. "Eh, yu wan tok di Krio?" "Ah de try, Ah de try." Another benefit of having worked in multiple different areas in Sierra Leone I've picked up a few phrases from several of the different tribal languages. People always like it when I bust that out. :) The downside to this is that my fraud quickly becomes apparent when they continue the conversation in their tribal language and I stare at them blankly. Anyway, the next hour or so were spent rehashing what happened over and over again as people kept asking what the white girl was in for. But no problem. I was having fun. The officers, the other two girls and I were all laughing together, drinking sodas and eating cucumbers. Couldn't imagine a better time being detained. :)
One of the officers decided to make it her mission to get the offense for not producing my license dropped. I think it was because when one of the male officers started yelling at her I told him he needed to stop yelling and be nice to her. I said it with jest....but I think he got the point. She whispered "thank you" to me. :) Ha!
I was "arrested" at 10:30am and it was now almost noon. They told me that the magistrate court wouldn't start until 2:30 but that they were going to try and get me in early. One of the officers (the one who wanted to help me get one offense dropped) and I got in my car to drive to the courtroom. I would like to mention that this officer told me to go the wrong way up a one way street right in front of the courthouse and when I mentioned that maybe I could go up the neighboring street and then come back down she said, "Oh, yeah that's a good idea. How long have you been driving? You're a very good driver." Thank you!! I've been trying to tell people this for years!!

Wow, this post is really long. I'll try to speed things along. As I mentioned above, the next step was to go to the courthouse where I would speak with the magistrate. I got there at about 12:30 but he was eating lunch. They told me it would be about 5 minutes. An hour and a half later he was ready for me. I would also like to point out that while we were waiting, the officer who was wanting to help me said that since she had left her work, and came over here just to help me, when this was over she hoped I wouldn't tell her I needed a receipt for anything I gave her. Really??????? Are. You. Kidding. Me? Don't you realize that I'm mostly here on principle??????? I thought it was obvious, but now I think maybe I was the only one who realized that.....I told her I definitely would need a receipt or they would think I stole the money blah blah blah and told her that I appreciated that she wanted to help me but she really didn't need to and she could totally go. She stayed.
The magistrate finished eating lunch and I was led to his chambers. Outside the door the officer stopped me and told me that when they read the offenses I was to say "guilty." When we walked in the magistrate's assistant (who incidentally had been super cranky since I'd walked in 1 1/2 hours ago) pointed to a chair and told me to put my bag down. When I went to sit down where she had pointed she said "No! Stand up!" Oops. Party foul.
They read my offenses again one by one and I admitted my guilt to each one of them. The judge started writing a bunch of stuff down while I waited. I put my hands in my pocket and cranky lady said "Take your hands out of your pocket!!" Oops. Strike two.
After the magistrate finished writing everything down he gave me my sentence. He dropped the offense of not producing my license because I had produced it. My sentence was 200,000 leones (about 45 bucks) or 2 months in Pandemba prison. I'll be honest and say the thought crossed my mind to say that I'd take the 2 months in prison please. I wonder what kind of ruckus THAT would have caused. Ha! I giggle to myself just thinking about it. Probably wouldn't be giggling after day 1 though.
It's now almost 2:30. I need to pay my fine, get my receipt and get the heck out of there. I pay the fine to cranky lady and she tells me they will come with my receipt shortly or maybe I can wait until Monday. Sorry lady. I've spent 4 hours in this funhouse already. I am NOT leaving without my receipt. So I told her I'd wait. I start chatting with some of the officers who are waiting for the various court cases to start and text my friends and family to tell them I'm in the slammer. :) Sorry for the heart attack Mom. :)
At about 2:45 they send me to wait in the peanut gallery. As I'm waiting the magistrate comes out and the first case begins. Husband vs. wife in a "failure to support the wife and children since leaving 7 months ago." FYI per the magistrate, the wife cannot demand spousal or child support while she is still married. She needs to file for divorce first. Just in case you were wondering.
As interesting as it was to watch the legal proceedings, I had been waiting for my receipt for about 45 min. and was afraid they were going to forget about me. This is the first time that I start to feel frustrated. I mean....45 minutes to write out a receipt???
I noticed that cranky lady was leaving the courtroom periodically so I snuck out so I could ask her about my receipt the next time she left. She told me I needed to wait a little longer. They were coming with it. 15 minutes later they came with the receipts (there were a bunch of us waiting for them) but wouldn't give me mine because she needed to make a copy. I let her know I was frustrated. It had been 5 hours. I still needed to go to the internet place before it closed or I wouldn't be able to pay the WMT employees tomorrow, which I'm sure they wouldn't appreciate it.
Looking back, my biggest regret is that I let her see that I was frustrated. How cool would it have been if I never showed any anger at all the whole time??? Darn. Maybe next time.
Anyway, during this time I was chatting with the people around me. One guy came up to me and said, "Hey, you like justice."
"Sorry, what?"
"They told me what happened. That the officer wanted money and you told them you had to have a receipt. You really like justice."
"Ha, yeah," I said. But inside I thought, "Why yes, yes I do really like justice. And thank you for noticing!"
Thirty minutes later I had my receipt in hand. V.I.C.T.O.R.Y!!!!! (Incidentally I spent those 30 minutes trying to convince a 23 year old kid that if he is farsighted, he really does need to wear his glasses.....even if his friends call him "Harry Potter."
Left the courthouse, got my internet fixed and picked up some material to make some curtains for my house. All in all, not a bad day. :)
My day was fine though, because I had the 45 bucks to pay the fine. This experience gave me insight into why taxi drivers always pay the little bribes to the officers when pulled over (which they are pulled over all the time!) There's no way they could afford this fine which means they'd have to spend months in prison...not earning any money for their families. It just made me madder at the whole system! My little personal crusade was something I could afford to do, while others couldn't. I'm not saying it justifies the corruption, but my experience has helped me to understand the complexities. Maybe we could get all the taxi drivers together, collectively decide NOT to pay any more bribes....hhmmm....interesting. Taxi drivers of Sierra Leone Unite!!!
Anyway, it was an experience. Not one that I'd necessarily like to repeat but I don't regret having it. At least I got a good Facebook shock and awe comment out of it. :)

Friday, July 15, 2011

Sad, Frustrating, GROSS!!!

Two days ago I was working the evening shift. It was a relatively steady evening so I was popping in and out of the wards doing different things when I noticed a patient sitting on the bench in front of the nurses station (which is essentially our ER at night). I went to go see what was up. There was a kiddo about 10 years old sitting in front of the bench. Since I'd say about 97% of our pediatric patients come in with malaria and anemia, when I asked the "Ok, what happened, what brought you here" question, I was expecting what I hear 97% of the time which is "warm body for 3 days" with or without a cough or diarrhea.

Instead, the father went to pull away the lapa (big piece of material) the child was wrapped in....and I couldn't believe it. HUGE chunks of this child's right leg were missing. From mid calf up to the child's buttocks there were huge craters covered with dead skin. The leg was covered in gingin violet which is a common thing to place on wounds here. It actually has bacteriostatic properties (can kill bacteria) so we often prescribe it because it's not going to hurt, it might help, and most importantly it will hopefully prevent any other potentially harmful substance from being applied. The leg also had dried gauze that had adhered to the dead tissue. As soon as I saw all of this, I was immediately angry. One of the most frustrating things about working here is when parents bring their children in so so so so late! When I asked what happened and how long this had been going on, the father told me that he had a "swelling" 2 weeks ago and then this happened.

When I worked in the ER, one of the questions we often had to ask was "how much have you been drinking tonight." An experienced nurse once told me that you have to at least double the amount that the patient tells you. Here, one of the nurses told me that if you ask how long someone has been sick you have to triple it. There's no way that what I was looking at happened in two weeks. So I was angry.

Then as I continued to interview the father, I found that he had actually taken his son to the health center in the area and they had been treating him. Ok, now I'm not so angry at the father....he tried to do the right thing. Now I'm angry at the health center. Clearly, they didn't know what they were doing but didn't refer to a higher level of care. In their defense, health centers are often poorly equipped with supplies and often aren't able to treat what comes to them. However, in this case I got no letter of referral so I can only assume that they were going to continue trying to treat the patient (which CLEARLY wasn't working!) but the father decided it was time to take him somewhere else. Frustrating.

The kiddo had a temp of 103 and was slightly delirious.

My diagnosis for the patient was WTH (what the heck!!!); probable sepsis from wound

What's the diagnosis for the majority of someones leg being rotted off? Seriously, if someone knows what it is, it would be helpful. I've come to recognize the scent of rotting flesh as this is not the first time I've seen something like this here.

Anyway, I admitted the patient, started antibiotics, Tylenol and IV fluids. I debated on trying to get the gauze off but decided to wait until the OR team came in in the morning. This kid needed to be knocked out for what they were going to have to do to debride the wound.

Yesterday as I came into work the OR team was doing the debridement. They had to cut off the majority of the skin on his leg. Aside from a miracle from God, I don't see how this kid is going to make it. We were talking about skin grafts yesterday but weren't sure where to get the skin from. (I wanted to donate myself because A: I have plenty and B: he'd look kind of cool!) but unfortunately it doesn't work that way.

Last night I went in to replace his IV which he'd accidentally pulled out and he was awake and the most lucid that I've seen him. He was acting like a normal, scared 10 year old kid. It broke my heart to think of the painful road he has ahead of him....and whether or not he'll still be alive on the other side. Bleh.

Side note: Since the kiddo was asleep I did take some pictures but have decided that if I posted them my sister would say "Emily!! Social filter!!!" So I'm filtering them but will have copies available for my nursing/friends who like gross stuff when I come home in Dec. :)

If you think about it, pray for this kiddo and his family. Pray that the hospital staff will have wisdom in how best to treat him and that I will know how best to love on he and his family! Thanks!

Monday, July 11, 2011

Snapshots of my life....

Here are a few snapshots I've taken over the last couple of weeks. Enjoy. :)

Every morning I do rounds in the pediatric ward. The kiddos are usually about this age. And they're usually terrified of me. I've gotten really good and listening to lung sounds while kiddos are screaming. The other day though, I met this little chica. Totally NOT afraid and very snuggly!! I may or may not have carried her around with me for an hour or so while I worked. Good day! :)

The neighborhood boys have discovered my fear/loathing of snakes. So now they bring me every snake they find after they've killed it.....just to torture me. I kind of like it. :)

A few weeks ago the pump that pumps our water was struck by lightening and destroyed. This week we ran out of water. We have a big tank in front of our house but couldn't find anyone with the key to open it. Fortunately, the top of the tank blew off in a storm so we got some neighbor boys to climb up and give us water from the top.

The next day no neighbor boys could be I did it. :)

Sierra Leonean lawn mower! Hard hard work, but I'm very thankful because snakes just love hiding in tall grass!

Whenever we do any baking with flour we sift it first to get all the bugs and their larvae (is that the right word?) out first. It's gross....but a little bit fun too. Instant gratification!

These are my boss's two nephews. They came over to visit the other day and we had a photo shoot. The littlest one was the primary photographer.

This little guy showed up in our house the other night. It was seriously the BIGGEST cockroach I have EVER seen! And it flies!! Unfortunately as soon as we saw it the lights went out so then we were trying to find it with a flashlight. I saw it behind the table and as I bent down to take a picture my roommate sprayed it with bug spray. I thought the bug was spraying me and I screamed bloody murder and jumped back. But we got the last word! I love bug spray!

Wednesday, July 6, 2011


The last few days have been contemplative for me. After my last post I think some of you might have been concerned about a mental breakdown but don't worry, all is well!!! :)

The morning after that rough day (this would have been Monday morning) I decided to go for a walk before work. Psych myself up. :) As I was walking I started thinking. As I was thinking I started praying. As I was praying I started crying. I started telling God that it was too much. That in case He hadn't noticed, I'd reached my breaking point and something needed to give. I'm tired.

There are two things that I believe are true. (Well of course more than two, but these two principles are what I belive have allowed me to stay here up to this point and make me think that I can stay here as long as God calls me.) Number one is that "I don't have to act the way I feel." There have been many a mornings when I've been tired and cranky as I walk down to the hospital. However, whenever I feel this way I start telling myself that just because I'm cranky does NOT mean that I have to act cranky. So I put on a smile and make it a point to be chipper. It's pretty incredible how acting this way...even when I do NOT feel like it makes my day so so so much better! I forget that I'm supposed to be cranky! I know myself and I know that if I wallowed in my crankiness and made sure everyone knew how I was feeling that I would ruin my day. I've done it too many times not to know this. :)

The second thing that I'm slowly learning to be true is that God is the giver of joy and it is not dependent on my circumstances. This one has been HUGE to learn here! I can't tell you how many times I've thought something like "if only these kids wouldn't die" "if only I lived nearer my friends" "if only my family was here" "if only it wasn't so. stinkin. hot!" THEN everything would be so much better and I'd be happy. I've heard that God is the giver of joy for years. I've read the verses in my Bible to back it up. But I've never really tested that theory like I have here. When I arrived at the hospital it didn't take me long to see that this might be a little harder than I was anticipating. I wanted to pout. But shortly after I arrived I listened to a sermon (shout out Pastor Dee) that kicked my butt and I made a decision. I decided that I would focus on God being the giver of my joy and would try not to complain but to rejoice always. It wasn't easy. After 29 years my family can tell you that I've perfected the art of complaining! :) But I was FLOORED at the amazing freedom I felt when I said "God, some of theses circumstances are absolutely not what I would have chosen. But I know that you know me best and You've placed me here so I will trust that this is what is best for me so thank you. I don't see how some of these circumstances can make me happy so I'm going to trust you to keep up your end of the bargain and give me joy." I'm not kidding you about a week after I started doing this I couldn't believe how happy I was! No change in my circumstances....just God being God, doing His thing! It was incredible. Of course then I thought I had the whole "rejoice always" thing nailed down and I fell flat on my face and had to "relearn" everything all over but....well, that's just me. Slow learner.

So these are the thoughts I was thinking the other morning as I was walking...and thinking....and praying....and crying. And as I kept praying and just pouring out my heart telling my Friend that I was tired of rejoicing and I just wanted to whine and complain I heard Him tell me that it was ok. He knew. Then I started thinking about Jesus' life on earth. And the verse "Jesus wept" popped into my head. And I was struck with the fact that Jesus' heart was broken too. He knew exactly what it was like to be tired and to deal with death. Besides that, He knows me better than anyone so he not only knows how He felt but how I was feeling as well. And it was ok to cry!! It was ok for me to say that death really sucks!! And that it's hard to deal with it a lot! And that it's ok if sometimes I need to cry about it! He tells me that I don't have to act the way I feel and that I need to rejoice always because He is the giver of joy because that's what's best for me..... which I know is true becasue I've seen the results! But it doesn't mean that it's easy or that he's unsympathetic. He knows it's not easy. This led me to think about the verse in Hebrews that says, "For we do not have a high priest who cannot sympathize with our weaknesses, but One who has been tempted in all things as we are, yet without sin. Therefore let us draw near with confidence to the throne of grace, so that we may receive mercy and find grace to help in time of need." So. Awesome. That's what He did on our walk. He once again showered me with His grace and I was refreshed.

I'm not meaning to sound preachy at all and I know this is not one of my most exciting posts, but the last couple of days I have been so unbelievable encouraged and excited! I wouldn't have got to have these intimate moments with Jesus if I hadn't been brought to my knees. And that's just exciting!
Thank you so much to my friends and family as well!!! You have no idea how much your thoughts, prayers and words of encouragement have lifted my spirit!! So thank you thank you thank you! Today on my walk I was very excited that this is my life!!!

Sunday, July 3, 2011

One of those days. Sorry, it's really long......

Today was one of those days. Since I need to process today for myself and don’t think I have the energy to write it in my journal and here, this will serve as my journal for today. Welcome to my inner thoughts. :)

Today was supposed to be my day off. However, when I looked at the schedule, I noticed that the guys who was supposed to work today was going to have to work two weeks in a row without a day off. Since I’d just come from having 10 days away from the hospital in Freetown and he’d had to pick up the slack with some crazy busy days, I offered to work in the morning for him so he could go to church.

Since it was a Sunday and weekends tend to be low key (in America at least) I took my IPOD and a book, planning on listening to a sermon when I had time. I arrived to the hospital at 8am and all was quiet. They’d had a pretty quiet night with only a couple of admissions. They had one guy who came in vomiting blood and with diarrhea with blood clots in it. Ok, I thought. He’s definitely sick. His hemoglobin was 8 when he came in last evening so I went and asked the lab man if he could draw another hemoglobin this morning since he was still having bloody diarrhea. (Sorry if that’s too graphic….I tried to warn you…these are my inner thoughts!)

While I waited for the lab to come back I went to check on him and checked his blood pressure. It was 70/50. Low. Very low. He had some fluids running but I knew what he was really going to need was blood! Since we don’t have a way to give packed red blood cells but give whole blood here, it’s a lot of volume that we give. I didn’t want to overload him so decided that when that fluid finished I would wait to give him the blood. So I started to wait.

At 8:30 they started coming. The outpatient department (kind of like the ER or Urgent Care) isn’t open on Sundays so all the patients that come to the hospital are seen by the senior person (in this case me). Praise the Lord we had the lab open today so as the sick kiddos started coming, I took the history (almost always the same….fever, vomiting, with maybe diarrhea or a cough) and sent them down to have their blood checked for malaria and hemoglobin. After the first two cases we ran out of malaria tests so I just started treating for malaria (since 98% of them are positive). Two out of the first 4 had a low hemoglobin so they needed blood. No problem. I sent them down to the OR and one of the nursing assistants (there were two of them and I to cover the hospital today) put the IV in and started the blood.

An odd phenomenon kept happening though. Even though I kept seeing patients, the line of patients waiting to be seen kept getting longer, not shorter. In addition to seeing the outpatients, I still needed to do rounds on the inpatients. While I try to round on everyone, I could see after 2 ½ hours of seeing outpatients that today only the “critical” patients were going to get seen. This included new admissions from last night and patients with fevers. At about 10:00am the peds nursing assistant started coming and asking me to go to the Peds ward and see some patients. Some wanted to go home and some needed to be seen. I still had a line of patients waiting to be seen. Whenever I start to get a little overwhelmed I have a thing that I do. I literally stop whatever I’m doing and I think about what’s the most important thing I need to do. Seeing the sick peds was pretty high on the list. So was my guy who needed blood. I looked at the outpatient and the cases that were there didn’t look emergent so I decided they could wait. I went to check on my guy who needed blood (M2). They had found a donor for him and were looking for the adult blood bags. We didn’t have any. We only had pediatric blood bags. This meant that the donor would have to get poked twice to fill up two pediatric bags. She did not want to do that. Are you kidding me? You’re not going to donate because it means you have to get poked twice?? Now, maybe I’m being judgmental because while I don’t enjoy getting poked, I am not deathly afraid of it. Maybe she was. Well, I had to be frank with her and tell her that if she didn’t donate, her uncle would probably die. She went back to the lab.

Next, I went to round on the kids. There were about 5 who had high fevers. Most of them had come in last night and started the malaria treatment. I wasn’t too concerned because the medicine hadn’t really had time to work yet and they all looked stable. There were two kids that still had fevers but their parents were requesting to go. They both looked sick. One of them had started the treatment for malaria yesterday but hadn’t started to perk up yet. I wanted to keep her but her mother was adamant to go. I knew that if I kept her here when she didn’t want to be here, she would either A) leave in the middle of the night and not take any of her medicine with her and/or B) not come to the hospital next time her child was sick. So I sent her home with some malaria treatment and Tylenol. The second kid that wanted to go home had come in 2 days ago super super sick. He was really febrile, seizing, very sick. Well, He had started to turn around and was looking better but the family was tired of waiting and wanted to leave to go try herbal medicine. Ill admit this frustrates me a little. Sometimes I feel like people expect miracles here and if their kids aren’t better in a day, then they give up and want to go. This kid was almost dead! It’s going to take more than 2 days of medicine for this kid to perk up! Frustrating! Fortunately she still had some money on her bill and they won’t let her go until her bill is paid. Since they kid now had bad sounds in his lungs, I started him on an antibiotic and asked them to please wait. They were kind of held captive.

I went back to my little bench where I see patients and started seeing patients again. A kid came in with a crush injury to his hand from his hand getting caught in a rice machine. The OR guy was still around so he took him to the OR to do what he could to patch him up. Then a super sick kid came in. I could tell right away that she needed to be part of the critical patient protocol so before I sent her to the lab I gave her two shots of Quinine to treat malaria and sent her to the lab to have her blood drawn. I went to get all of the supplies I was going to need as soon as she got checked so I could start her IV and give her the antibiotic that’s part of the protocol while we waited for her family to donate the blood. While I was waiting on her, I went to see if M2 had his blood hanging yet. He didn’t. I hurryidly told the outpatients waiting that I’d be back and went down to the lab to find out what was going on. When I got down there they told me that the girl was still afraid to donate but they had some 0+ blood in the refrigerator. We would give this guy that blood and his niece would come back the next day and replace it when we had the adult blood bags again. Fine. Awesome. I grabbed the blood and ran down to the mens ward. He actually wasn’t looking too bad. He was talking to me and asking questions. I paused to wonder if I really should give him this blood. Because we can’t screen the blood as well as they do back home, I only give blood here if I think the patient will die without it because a reaction could kill him. He looked pretty good. But when I asked him if he was still having diarrhea he said he was and that there was blood in it. So I decided to go ahead with the blood. His pressure was still in the tank and blood would really help. I started it slowly and was going to come back and check in a few minutes.

I went back out to my outpatient bench and saw another patient. After about 10 minutes the wife of M2 came to get me. He was not looking good. He started breathing rapidly and with difficulty. Crap. This looks like a reaction. Crap. I immediately stopped the blood. When I went to give him some IV fluids his IV had infiltrated. And we have no more IV canulas. At this moment my critical peds patient who I had sent to the lab came back. I ran to get some steroids from the cabinet to give to M2 while the nursing assistant worked on starting an IV using a blood collection device. I told him to keep working on that while I ran down to the OR to put an IV in this kid to get his blood going. As we were going down to the OR I looked down at the blood result. His hemoglobin was 2.6. I’ve never seen that compatible with life. Shoot. I started to run. We got him down to the OR and I spiked the blood bag and got ready to start the IV. As I did that his mother told me to look at him. He was gone. Died on the OR table.

I wanted to be compassionate and caring. I told them I was very sorry. They started wailing. I wanted to stay in the room with them for awhile, but I knew that I had the guy in M2 who was NOT doing well. So I left them in their grief and ran down to M2. (They technically needed to pay their bill because I’d given some medicine and they’d had labs etc. but I just didn’t have the heart to make them pay before they took the body. I can settle up with the hospital later if I need to). M2 was still not doing well, but he was looking a little better. Please GOD let him live! Abraham (the nursing assistant) wasn’t having any luck getting the IV in. Dangit we needed an IV catheter. This way just wasn’t working. I had been trying not to bug the guy who I was working for and was expecting him at any time but so far he hadn’t come. He’s the one with the keys to get things like IV caths so I finally decided I had to call him. As I stepped out of the ward to call him I saw an unconscious woman being carried down the hall. They went to stop at the OPD bench but I just waved them down further down the hall towards the womens ward. They were going to need a bed anyways so might as well see them there instead of on a bench. I called my friend as I followed this patient down the hall and told him that now we were really desperate for IV catheters. He told me he was coming. When I asked the nursing assistant to check a blood pressure, she said it was 40 and that she needed fluid. 40? Either it was REALLY low and/or she wasn’t really sure what it was. Either way I knew it was low and she needed fluid so I took of to get the stuff we’d need. Her family said she’d started having diarrhea and vomiting the night before (time is very relative here) so I knew she was probably super dehydrated. Just then my friend arrived so I gave him the low down on this new patient while I grabbed a couple IV catheters and ran towards M2. Sorry OPD patients. You’re going to have to wait a bit longer.

I tried multiple multiple times to get an IV in this guy but just could not do it. I’m not a horrible stick so I wasn’t sure what my deal was, but I finally went down to get my friend and have him try. Neither the nursing assistant or I could get it. After a couple tries, my friend got the IV in and we started his fluids. There was really nothing else we could do (at least that I know of and that they usually do here) but wait and see.

I went out to see some more outpatients and was seeing my first one when M2’s family came and got me to go check M2. He was gone. I don’t even know what to say. In hindsight, I wouldn’t have given the blood. I think I might have killed him. But with what I knew at the time, I don’t think I necessarily made the wrong decision, but now knowing what happened, I would have made a different one. I still feel like I killed a patient. It sucks. I’ve never heard so much wailing as I watched his wife and especially his daughter in their pain. Their daughter was probably about 16. What would I have done if I’d lost my father at 16? It really stinks.

Things settled down a little after that. The evening shift started arriving so we had a little more help in terms of staff. I went down to check on the woman we’d admitted and she was coming around while she was getting her second liter of fluid. I think she might be ok….hopefully! I went to tie up some loose ends, gave report to the nurse coming on and headed home.

I’m not a drinker. Today I was glad because I think it was the kind of day that might have driven me to the bottle. But since I can’t stand the taste and don’t think that would have been the best idea anyway, I went home and made up a big ole’ thing of Raspberry Crystal Light and drank a quart of it. (I forgot to drink anything all day so I figured I could handle it). Then I grabbed my Bible, my computer, my journal and my keys and hit the road. I didn’t really know where to go, but I just needed to get away. My days at this point consist of going to the hospital and then going home. And repeat. I needed a change of scenery so I took my car and went for a little drive…..up the road. Right now I’m parked on the side of a deserted jungle road putting all my thoughts on a computer.

So that was my day. Sorry it was so long and jumbled. I know some days are just like this. I had rough days at work in America and I have them here. The one downside here is that in America God blessed me HUGELY with awesome roommates who would listen to my rants, nod encouragingly and help me process things. Here, death is just such a part of things that when I try to talk to Sierra Leoneans about days like this I get “well, yeah, they died. We did everything we could. That’s all.” Not quite what I’m looking for. J I had too many counseling majors as roommates….I got spoiled!

But praise God for today huh? It was hard, but He was there. And I know He won’t give me more than I can handle!