I shouldn't post this.....

I usually strategically post my blogs so that everyone at home thinks that I'm over here thinks I'm just a suffering a way. I was hesitant to post this one because...well, it blows my cover out of the water.

A couple weeks ago we had a medical team that came over. One of the girls from that team wanted to stay a little longer (who wouldn't!?!?!) so she came up to the hospital with me. I treated her like royalty by letting her sleep in my buggy, spidery room, feeding her delicious food like copious amounts of peanut butter and jelly sandwiches (ants included for free.....she really loves bugs) and letting her participate in the comings and goings of the hospital like an 80 mile an hour ride in the ambulance down a road so bad it induced vomiting in 3/6 passengers.

I took the team to the beach at the end of their trip and decided that my friend and I definitely needed to return there before she left. She decided that instead of just visiting for the day, she wanted to spring for us to stay the night!! Oh. My. Gosh. Spending the night at the beach?!!? Yes please!!

We stayed in the upstairs of this house

The whole group (team members staying in Freetown) came out for the day and then my friend and I stayed the night. We were the only guests staying there that night. It was heaven.

We ate dinner at our balcony overlooking the beach. I did a lot of reading and relaxing. So thank you thank you thank you Friend for doing that for us!!!!!

Who wouldn't want to live here?!??!

We have solar!!

A couple years ago I was hanging out with a missionary couple who had been on the field for years. They told me that the most common reason for missionaries to leave the field....is other missionaries. Since that time I've repeated that statistic to multiple missionaries and more often than not get the response "oh, I believe that!!" Fortunately I have NO concept of that because the team members that God's given me over here are a.w.e.s.o.m.e! Allow me to give you an example.

Last year we were preparing to send a container over. On that container I included a solar fridge. That's right. I'm very trendy now!

Meet John, Kaysie, and their son Aden.

John is a solar engineer and despite the fact that I'm incredibly handy at installing and maintaining all sorts of things, I decided I'd let him mess with my fridge. John and Kaysie have been incredibly busy for the last couple of months so they decided they needed a little vacation.

They are such good friends that they used a good portion of their vacation to load up their car with my (and my neighbor's) solar fridge and make the brutal drive up to my village.

John then proceeded to spend the next 3 days on my very literal hot tin roof, rummaging around in my attic of 130 degrees and living in a fish bowl while all the kids within a 20 mile radius congregated on my front porch to watch all the action. Throw this in with the fact that

they accidentally forgot their suitcase so had no clothes of their own and....you've got some pretty good friends!!

John up on my neighbors roof (did I mention he installed a whole system for her too???)

After John put in many a long day, we were ready for the dedication by putting our first item in the fridge. A most important item!

It's a beautiful sight!

In the last week I have enjoyed magnificent cold water. It really does make all the difference. In fact, the cold water combined with delicious Crystal Light caused me to have to limit my liquids...for the first time ever! I'm also enjoying cold powdered milk which is much better than warm powdered milk, and am able to save my leftovers. Truly life changing! So thank you thank you thank you John and Kaysie!! You guys are amazing!

Night Shift

Weekends are always thrilling around the village. (Insert thinly veiled sarcasm here). However! On Saturday night I got a dinner invite for pizza over at the doctor couple's house. It was a big party with med students, doctors, nurses, teachers and maintenance people. We had a blast and I learned how much fun you can have with pizza, chocolate, a blow up globe and some people who have had to learn how to entertain themselves with no TV.

I tucked myself into bed at about 10:30 (pretty late for me....I was partying hard!) but was jolted awake about an hour later by my phone. It was one of the doctors who had just been called down to the hospital because one of the staff had collapsed outside his house. Apparently he was having chest pain and collapsed. Now, of course if he was in the States we'd have him back in the ER in minutes, running a hoard of tests. Here, we gave him some nitroglycerin (which did help his pain) and something to bring his blood pressure down a bit.

I got the call because while the doc was down there, he noticed that there was one, count them one person working for the whole hospital. And he was a nursing assistant. Granted, he's a stud (you can read more about him here) but still. (We were supposed to have 3 people on but the nurse that was supposed to be on was the one having the chest pain and the other guy had worked during the day because we were short staffed then.) The doc called to see if I could go down and work for a little bit to help him out.

I went down with one of the other nurses. Um, it was kind of crazy. There was our staff member who had collapsed from the chest pain as well as a lady who had a gastro-intestinal bleed and was receiving blood. Almost as soon as I got there I saw some people carrying a guy down the hall. That's almost never a good sign. I peeked in on the GI bleeder, sent the nursing assistant "Abdul" to go make sure our chest painer's blood pressure was ok and went to find our new unconscious guy a bed. There literally were no empty beds in either of the mens wards. What's happening to the men around here??? I went to the little storage area and fortunately there was a bed in there, so in he went.

I started getting a history from his friends. Apparently the day before he had been in the bush and was accused of throwing a lighter at a group of guys (which the friends vehemently denied). The group of guys did not appreciate having a lighter thrown at them and proceeded to beat the snot out of him. Apparently he had been unconscious since that time.

Ok, unconscious. Breathing? Check. The other nurse started getting his vitals and blood sugar. All was normal, except his heart rate, which was low. His blood pressure was fine though, so it was fast enough to keep his pressure up. I proceeded with his neuro exam.

The first thing I noticed was that for being jumped by a bunch of people, he didn't look too bad. In fact, I couldn't find any bruises, scrapes, nothing. I opened his eyes and he fought me a little bit and his eyes moved all around in his head. Pupils equal, with a brisk reaction. I did some stimulation to see if he responded, and he responded to my painful stimulation. Next I did my "faker test." I learned this one in the ER and I love it. When a patient is lying down I lift their arm over their head and drop it. I know it's not perfect, but the logic is that if someone is really unconscious they won't move their arm at all and it will hit them in the head. I did it on this guy and hit himself in the face a little. I did some other things and then went back to the "faker" test. I lifted his arm over his head and dropped it....probably about 10 times. Never once did it hit his face.

The rest of his exam was also essentially normal. His abdomen was soft, good bowel tones. No obvious broken ribs and his breath sounds were normal.

Hmmm. His vitals and exam were essentially normal. He failed the "faker test" but he did seem a little "off." It was possible that he had a concussion. It was possible that he had a big bleed in his head. Either way, there wasn't a whole lot I could do because we don't have any neuro surgeons around. Since his vitals were OK, when they came to get me to tell me there was a new patient who just came and was vomiting blood, I went to see him.

After getting the new guy settled I went back to "unconscious guy." He was snoring. I was kind of naughty and snuck into his room and startled him awake. He woke up and looked right at me, something he hadn't done before. I told him I needed to give him an injection for which I got a "are you serious?" look and then he rolled over so I could inject his bum. This reassured me that at least he was following commands now...... (The injection I gave him was something for pain).

While I was in the mens ward helping with the paperwork, I heard a guy working to breathe who had been admitted earlier in the evening. He sounded like he was drowning. I went and listened to his lungs and they definitely had some stuff in them! However, I wasn't sure if it was fluid overload, or pneumonia. He had a low grade fever and a non-productive cough. The person who had seen him originally had ordered fluids for him. I sat and hemmed and hawed. If it was pneumonia, he was probably dehydrated and could use the fluids. However, if he already had too much fluid on board, the fluids that were hanging would not be helpful.

After watching him be restless for a few minutes, really working to breathe, I pulled the trigger. I stopped the fluids he was getting, went and got him a medication to get rid of the extra fluid as well as a strong, injectible antibiotic. He really needed some oxygen but our oxygen concentrator was being used by the lady getting blood, and it was almost to the end of it's 2 hour battery. Darnit!

By this time it was about 2:00am. I was planning on sleeping down at the hospital so "Abdul" wouldn't be alone. However, since things had quieted down and I had to make a 6 hour drive the next day, I decided to go back up to my house and told him to call me if he had any problems.

At about 3am I got a call saying that my respiratory distress patient had passed away. Darnit. I laid there going over and over the things I'd done. After thinking about it for awhile, I'm not sure that I could have done anything differently. In America he would have had a tube stuck down his throat to breath for him and been shipped off to the ICU. Here, we couldn't even give him oxygen.

It can be tempting to be discouraged. There is too little staff, too few resources, and too much that I don't know. However, the last few weeks I've really been convicted (once again....I always need to relearn things) that my job is not to save everyone. My job is to show people here that they are loved. By me, but more importantly, by Christ. :) Thank God!!

Magnet.....

In the hospital we have a term for certain doctors. We call them......."poop" magnets, if you catch my drift. This means that for whatever reason, whenever they're on call or around, you know that you're going to have a rough night. The crazies seem to come out of the woodwork for these folks and you're going to be busy. I'm beginning to have that complex about myself. Yesterday someone made the comment that it seems like when I'm in the OB ward, things get crazy. It definitely felt that way yesterday.

I walked into the OB ward at about 8:15am and the nurse that had been on the night before called out from the labor ward "Emily, come and catch this baby!" So I went and caught the baby. Both mom and baby were doing fine....not a bad way to start the day! :)

About 20 minutes later we got a call for the ambulance. Then we got another call for the ambulance. Two places to go, only one ambulance. Since nobody seems to really like going on the ambulance runs and I still get a little adrenaline rush from it, I volunteered (along with a friend of mine that's visiting from Canada). They told us to go to the farthest place first. I asked how far it was and was told it's "far small". I've learned better than to try to get more specific but since they didn't tell me it was close, I knew we were looking at at least an hour.

Off we went.

Whenever I go in the ambulance, I always get the "Oh my gosh I can't believe this is my life" feeling. Traveling at breakneck speeds over some of the worst roads of my life with the siren going full blast and people in small villages jumping out of the way, will do that to a person. Toss in the fact that we're in the middle of nowhere and headed into who knows what kind of a situation where there may or may not be cell service.....and you can get a bit of a rush. That's what my friend and I were feeling as we were flying down the road.

After a little backtracking and about 1 hour, 20 minutes on the road, we found the village we were looking for. I got out our little maternity box and headed into the health center. When I got to the room I saw that the pregnant woman was walking around so phew....at least I know she's not almost dead. I laid her down to examine her and asked the nurse what the problem was. She told me that this was the woman's ninth pregnancy and she has eight living children. She had been in labor for 1-2 days but had just come to the health center that morning. She was concerned because the child was breech was afraid that her uterus would be more prone to rupture because it had been pregnant so many times. Valid concern.

I checked her for myself and sure enough, there was the little tooshie right there ready to come out. Ok, that's enough for me...let's go. I was afraid that she might drop that baby right then and really didn't want to try and deliver a breech baby by myself. I really, really didn't want to deliver a breech baby by myself, on that road!

As we turned to leave, the nurse told me that there was another woman who had come to the clinic complaining of severe headache and although she had been treated for malaria, continued to have the headache. Sure, throw her in too.

I told my friend that I wanted to sit in the back with the patient because I just wasn't convinced things weren't going to fall out. As they piled more and more people in the back, I began to question my choice. But at that point it was too late, so off we went.

I can't imagine being in labor and driving on that road. She couldn't brace herself very well because she was lying down and there was a metal box right by her head so I spent the trip trying to brace myself and trying to protect her from splitting her head open on the corner of the box. I had multiple arms grabbing onto my own as we were tossed about in the back. All of the sudden I hear someone heaving and....sure enough, the woman next to me is tossing her cookies. A few minutes later the grandmother lost her lunch in the back of the ambulance and another woman followed after that. Lord, please please please let us get there soon!!

After what seemed like an eternity we finally got back to the hospital with our two pregnant women, their families, their rice and the majority of their earthly possessions.

I wasn't feeling so hot after that ride so I delegated someone else to take the next ambulance run and went to check on the women we'd just brought. We checked the woman in labor first. No fetal heart tones. Crap. I hate that. We decided to try and augment to see if we could get her to push this baby out. If she failed to progress, we'd go ahead and do a c-section. We try to avoid that when we can.

About the time we finished with the first woman, the second ambulance returned with a young girl, about 17 who had been in labor for about a day and was failing to progress. We checked her and she was about 6 cm dilated with strong fetal heart tones!! Woo hoo! She was pretty small but it was her first baby so we wanted to give her a chance to birth the baby for herself.

After about 2 hours we decided that the breech lady just wasn't going to be able to deliver for herself so we took her to the OR. They pulled the baby out...and it was rough. You could tell it had been dead for awhile. The smell....ugh. It was a boy and he had been a big one. I cleaned him up and gave him to the family.

In between cases I checked on the woman who had come with the headache. She was about 32 weeks and said the last time she'd felt the baby move had been the day before. But maybe she had felt it that morning. We listened for fetal heart tones and didn't hear anything. Then we got out the ultrasound to see if we saw any little heart beating. Nothing. Darnit.

I moved on to prepare for the next c-section. Our smaller girl just wasn't going to be able to birth this one. I got everything ready with more adrenaline this time. This woman had been in labor for a while, but she still had fetal heart tones. The baby might not be doing well though, so I went through my mental checklist of what I could/would do if the baby came out in distress. The surgeon made the cut and I got my receiving blanket ready. As he pulled out the little kiddo he gave a good scream. Ah, I love it when that happens. I took him and got him all cleaned up and ready to show the family. There's always lots of onlookers and everyone gets so excited when there's a new baby. Some things just cross all cultures. :)

It was a long day with ups and downs....like a lot of days here. But two mamas got to go home with babies that they might not if they hadn't come so....we are trying, small small. :)

Lost in translation

As I mentioned in my last post, we had a medical team that came from the US/Canada/Chile. I've lived in Salone for about a year now so compared with the team that was visiting, I knew the language a little better. I might have gotten a little cocky. Oops. Fortunately, God loves to bring me down a little notch when this happens......and He did a great job today!

I was in the OB ward giving one of the other nurses her lunch break, so I was by myself. As commonly occurs, a pregnant woman walked in. I sprang to action.

Me: "Hi! Is your belly hurting?" (Said in Krio)

Her: Head nod.
Me: Ok, when did the pains start?

Her: Three times

Me: Huh? Did they start today?

Her: In the night

Me: Ok, well let's go get you checked.

(Inside I'm thinking Woo Hoo!! Baby time!!)

I took her back to the labor ward to check her. First I got the little doppler out to check the fetal heart tones. 174. Good!! Next, I decided to do a vaginal exam to see if she was dilated. To be honest, I haven't done a ton of vaginal exams but after my last little orientation up here, I was feeling a lot more confident. However with this woman, I couldn't seem to really get my bearings. I guessed....maybe 4 cm dilated? (I really had no good idea). Next I went to palpate the abdomen to see where the baby was (head down, etc). Any good nurse can tell you I absolutely should have done this as the FIRST step!! As I went to feel the baby, it felt really small and really movable. Huh, that's weird. I went to measure her and see how big the baby was and she measured at about 28 weeks. Now that's REALLY weird. I hope she's not in labor! I think I need some clarification. I helped her up from the table and we moved back to little office area to chat.

Me: So....when exactly did these pains start?
Her: Well, I was riding a motorcycle 3 days ago and ever since then I've had some pain in my lower abdomen.

Eh? I looked at her card once more. Wait a minute, this is today's date. Wait a minute, there are medicines that were already ordered for today. Wait a minute, this lady was already seen by someone today and they prescribed medicines for her.

Me: So you bought these medicines today?

Her: Yes. (And she showed me her receipt).

All of the sudden it clicked. This woman had been seen by someone earlier in the day and had been prescribed some medicines. She returned to the OB ward with her medicines and receipt to see if she needed to do anything before she returned home. I proceeded to confuse her as a woman in labor and re-do her examination, this time throwing in a vaginal exam for free. Oh. My. Gosh.

I got too excited that there was a woman in labor and jumped the gun. I can list about 50 things that I did wrong in that scenario.....oh so so many things. Fortunately the woman was a good sport about it....but man did I feel like an idiot. Thanks Lord, for the humble pie!! Now back to my Krio lessons.

Oregon takes over Sierra Leone!! (Ok, with a little help from Arizona, Chile and Canada...)

Every year we have a couple medical teams that come over to Sierra Leone. The "March Team" is one of my favorites because it always has lots of

people that I know and love on it. It was on just such a team that I came to Sierra Leone for the first time oh so many years ago and...now I get to sleep with coc

kroaches, sweat profusely while doing nothing, get "arrested" for bald tires and....pretty much have an awesome life!!

Since I didn't have internet access during the trip and am headed up country

tomorrow, I wanted to note some of my most memorable moments from the trip.

#1. We started off the team by the ferry. I've flown in and out of Sierra Leone countless time but have never, ever, ever missed the ferry. It has always

been one of my biggest fears in bringing a team in...missing the darn ferry. Well, this was the year. Since our bus couldn't make it on the ferry I had everyone grab their carry on luggage and walk on. My friend Robin was HUGE in helping us get that mess sorted out and John and Chad were amazing and came down in the middle of the night to pick up the team. Thanks guys!!

My dad, another hardcore friend Kim, and I decided to wait back with the bus so ....we buckled down for a night at the docks. At one point my dad got up to go the the bathroom and Kim and I drifted back to sleep. All of the sudden Kim bolted up and said, "WHERE'S YOUR DAD!!" (I felt horrible that it was SHE who woke out of her stupor while his own flesh and blood n

odded on....oops!) We prepared to go defend his honor when he sauntered back. Man, those potential bad guys are lucky....

#2. We got to stay in a village this year which was challenging in a lot of ways, but also really really neat. We got to know the people better and had a lot of fun. There was a downside to having one bathroom for 12 people (and we realized halfway through the week that no, it wasn't just shower water that was on the floor.....but our toilet leaked from the bowl when we flushed it. Thank you Jesus for shower shoes!

#3. One shower for 12 people working in Africa can pose a problem. However, we discovered a local shower....and it wasn't bad!! There was something kind of cool about showering in the middle of the jungle, under the moon. The smell of urine reminded us that this place had multiple uses, but if you just kept that out of your mind it was ok. One of my favorite quotes from the trip was when there was a group of us girls down at the shower and for some reason we were debating on going back up for some reason. From inside the shower we hear someone shout "HEY! You don't leave naked ladies in the jungle!!!" Touche' my friend....touche'.

#4. I love coming with first timers (especially nurses) because they always get to learn a lot. Any minor surgeries are always really exciting. Here's one of our nurses and our doc removing something (cyst? lipoma? some kind of alien lifeform? I'm not sure) from a patient.

#5 When I was home in November I bought some flannel graph stuff and then a sweet lady from one of the churches I visited gave me a lot more. I plan on using them during Sunday School but wanted to practice them out during the trip. They were a big hit! (Especially with the adults! :)

#6 I got to see my friend "Ali" who I met last year when he fractured his leg playing futbol. We've kept in touch over the last year and we were both really excited to see each other. His leg is doing awesome....which is....well, awesome.

#7 Math has never been my strong point. Right now, when I go change money I get 4,350 leones for every one dollar. We didn't need to have the giant bus with u

s the whole time so I decided to hire a "poda poda" (the local transport....like a van) to take us to and from clinic each day. Even though we only needed him for an hour in the day, you have to pay him for the whole day because he can't go make money on

his long transport runs. Great. Well, he was late picking us up (which was kind of annoying since he only had to be around for an hour) and then his van ended up breaking down on the way home. I waschatting with some of the team members about how it was ridiculous to pay $200 a day and then still have to cart people home....later than we'd expected. So we decided to save our $200 and all cram in "African style." It was great! :) (Especially for me since I was driving so I had my own seat). Well, after carting people back and forth like (along with fans, coolers, etc) a couple times and more importantly, reviewing my math that it was only $80

and not $200 per day.....we hired a new poda poda driver. Emily, bad math but good memories.

:)

#8 The limited bathrooms made us improvise. This was our teeth brushing station.

#9 My good friend from Seattle (well really Virginia if we're going to go WAY back) came all the way over here just to see me!!! (And maybe do a little medicine too). I was so blessed by her coming!

#10 We had some girls from Chile who came with us on our team this year. They were rock stars!! One of the girls started learning English just 2 months ago but was already seeing patients in English. Mad skills! On a side note, I found out that I now cannot speak one word of Spanish. Every time I tried to say anything, Krio just came out. Guess my brain is a 2 language max.

#11 Since we were sleeping in a village, night time was social time. It frequently became "plant (braid) the white people's hair time." I let them do a couple braids but so far have not succumbed to the pressure of getting my whole head braided. There's a LOT of scalp under this hair.....not sure the world's ready for it. But I'm afraid I'm weakening.....

#12 Of course it's always great to hang out with my family, so having my dad here was a special treat!!

I'm sure there are a lot more buy my brain is shutting down, along with my computer battery so thank you all so much for making it so great!!