Monday, March 26, 2012

A tough pill to swallow

Thursday, March 15, 2012  Day 7

The days in Kamakwie are long and slow and hard, but the cool breeze of the African nights makes it sooo worth it! Tonight was the most amazing night since we've been here. They didn't burn the fields today, so not only could I actually breathe for once, but there was no thick smoke layer covering the night sky. The stars were so beautiful and bright and combined with the cool breeze through the tall mango trees that stirred the hot night air, the experience was almost indescribable or at least it is a complete disservice to even try. After dinner we decided to out for another walk to try to soak in the night air more fully. When we got to the hospital, we found that the children were showing Harry Potter on a sheet hung against the wall next to the dispensary (where the medications are dispensed...aka pharmacy in US). We stopped and watched for a short time- more to experience them watching the British actors with English subtitles. It was very interesting and we pondered how much of it they really understood and what their impressions of the developed world must be like.

After a while, we decided to move on. We could hear music playing from my living room before we left, so we decided to try to follow it. We walked all the way down the road from the hospital until we arrived at the downtown market area. Much to our surprise, the music was not coming from the local hangout, but rather from several large speakers piled high on the street corner in the center of town. The DJ played more music and we watched as the people danced in the street. It was alot of fun to watch. The music has subsided somewhat now, but they continue to play the drums. I can hear them still in the distance.

Today we lost two patients in the wards- a 35yo man with Hepatitis B virus and a 3 month old baby with malaria who came in with a hemoglobin of 3.0 (for the non-medical people, back home we get worried if it's below 10 and Phillip was once told by a hematologist that no one could live at 4.0)  Both patients were having seizures and with neither did we have a clue as to why they were as sick as how they presented. I watched that baby have seizures for 3 straight days with no breaks in his 104.7 degree fevers. Dr. Tom taught us that if we could palpate the spleen on a pediatric patient that it was a good sign because it meant that the baby had chronic exposure to malaria and was more likely better prepared to fight it off (with help). This child had a non-palpable spleen.

We did the best we could with both patients, but it was still very frustrating for me. I felt very helpless, as if watching someone drown and not being able to reach them to pull them back to safety. I felt like on some level we were being forced to play God, deciding which patients get to use the limited resources that we have available to us. It is a sad moment when the doctor looks at you and says, "we only have so much of this medicine so we need to decide if this is a good use of our resources, so that we don't treat someone who will most likely not make it anyways." I did not feel comfortable answering to that, and it is still very difficult for me to wrap my head around the idea of the limitations that we have to face here. I still deny the fact that there isn't some other way, but I know the reality of it. It is a difficult and unfair decision, but today I realized it happens often here and it is a tough pill to swallow... T.I.A.

Unforgettable Moments

Monday, March 12, 2012  Day 4

Every day here seems to be one of those days that lasts so long that you really can't even remember where you started. You can't remember what you did that morning or if it was today or yesterday. It all runs together. I've been wondering if that feeling would last for 7 more weeks. It's very hard to keep up with the day or the date or even the time for that matter. I feel like the only significance of time is when the sun will go down. With no electricity, sunlight becomes a matter of importance. Luckily, they have battery operated lights that are charged by solar panels. It seems they have thought of everything. I never imagined electricity would be so easy a thing to work around, but somehow they make it appear that way. I guess after a while you become accustomed to such difficulties and it is merely a way of life. Honestly, after only a few days, I've come to not notice it as much any more. The little inconveniences have already begun to wear away and I am becoming more thankful for the small things- shade, a cool breeze, cold water, a mosquito net.

I think today I sincerely began to appreciate the phrase T.I.A. (This Is Africa, for those of you who haven't seen the movie). Not only because of the horrific cases that we saw in wards or the two patients that "expired" today, but also because of the vast expansiveness that stretches as far as I could see. My eyes were blessed with many sights today that I shall never forget...

One particular case brought so much shock that I almost had to leave the room. A woman was brought to the hospital after receiving a surgery in Freetown. She had a dehiscence of the wound at the surgical site. Upon exploration, it was discovered that much of the site was necrosed. It was debrided to see the extent of injury and it was noted that the bladder was not excluded from the surgical involvement. It had been completely perforated (something that I learned early from Dr. Vaidya to fear at all costs in urology procedures). The lower half of her abdomen was now a gaping hole into her pelvis and the effects were starting to take their toll on the rest of the body. She was extremely cachectic and her muscles were so atrophied that you could clearly see all the bony structures of her small frame . She appeared to be about 60yo. Not old enough to look like this I decided.

Dr. Tom asked us to go into the OR to watch as the surgical staff cleaned her wound a second time. From the entry way into the hot windowless room, I could smell the scent of urine pounding against my nose. This poor lady, I thought...then I saw her. I don't think anything in school could have ever prepared me for this. There was no sedation used other than local anesthesia. She was writhing on the table, unable to hold still. I'm not sure which shocked me most, the extent of the wound or the lack of proper medications, but Dr. Tom noticed and offered to pick up my jaw from the floor. The combination of the two in addition to the general state of her body was almost unbearable.

After work, we went for a stroll through town up to the top of a hill to an abandoned building which is now used to house school classes. We climbed to the second floor balcony and looked out over the edge onto the beauty that is Africa. The swamps were so thick and green and you could see the layout of the whole village- it was such an amazing and spectacular view. One that could come only from the Lord above, and after the sights from earlier in the day, I think it was an even greater blessing to show how marvelous and yet complex His creation really is. Funny how something so simple as standing on that hill, can give you a moment of such clarity. I could hardly believe either sight as real, but will forget neither of them as well.

Sunday, March 25, 2012

Settling in

March 10, 2012  Day two 

Such a long day, I don't even know where to begin. We awoke early this morning to the smell of breakfast and the hustle and bustle of the city sounds below us. I looked out the front window to a most spectacular view of the sea just below the hillside atop which the city was set. Children ran through the crooked streets and motor bikes beeped a viscous warning as they sped around corner and weaved through the busy crowds. Everyone had somewhere to go.

We enjoyed our breakfast in the company of two other American travelers, who were repeat visitors of Sierra Leone, both doing temporary volunteer work. We quickly packed our bags and headed down to join the chaos of the dirty city streets below. People lined the streets and at every turn there was someone waiting to sell you something- anything from bread soda or fruit to clothing, shoes or perfumes. Anything to make some money. Soon we made our way from the city and followed the smooth paved road to a town where we stopped at the market for groceries and a local hotel for lunch.

I begin to think... third world countries are not unique- yes, each has their own individual problems, but you see the same looks on the faces of the people you pass- different faces, but all with the same look of desperation. Often, though, you are still able to find luxuries- as in this hotel with manicured grounds and a centralized swimming pool surrounded by plasma televisions with satellite dishes. It doesn't seem right. I still wonder how this is possible. It is quite perplexing to me.

We move on from lunch and left behind the smoothly paved road to a long and very torturous dirt road through the jungle. This journey amazingly continued on for over 2 hours and we finally arrived at the hosptial grounds at 4pm after leaving the US at 10pm 2 days ago.

We unloaded our bags for the second time as we tried to become situated. Phillip is staying with the Ashers and I have a room with a missionary couple from Indiana who have volunteered here off and on since the 1970's. We had a nice family dinner at the Ashers' home with the rest of the volunteers that are here right now from a church in North Carolina. It was very nice to have everyone all together and get to know them all a little better.

After dinner, Dr. Tom took us to the hospital and we checked on a few patients. The equipment here is very primal and the facilities very basic. I was very uneasy about the whole idea of practicing medicine under such circumstances. I expected basic, but I never imagined that they wouldn't even have the bare necessities such as exam gloves. All I could think was "in the US I use gloves to examine healthy patients and these people are SICK- with rashes and diseases we've only read about in text books-and you expect me to do what??" I immediately felt the guilt of my thoughts. I was so ashamed that it had even crossed my mind, but the instincts are so hard to fight.

Darkness cam after dinner and I found myself having to get accustomed to life without light. A few things are battery operated or solar powered, but I mainly used a flashlight since the sun's gone down. It's amazing how dark it can get here.

The group of volunteers decided to go to a local hangout in the village that shows films via a projector in an open courtyard, so we agreed to tag along. We made our first trip into town in the darkness of the pitch black night with people jumping onto the streets out of nowhere. Often you couldn't see them, but you could hear them or sense them watching you. The projector was broken, so we did not watch the film, but I did enjoy a COLD sprite as we sat beneath the several strands of large Christmas lights that adorned the courtyard. Children ran along the fence line, often popping their head in for a closer look at the white people, as if were glowing in the darkness. They are still a little stand offish with us at this point, but hopefully they will warm up to us soon.

As we sat and enjoyed the cool breeze of the night, the volunteers began to tell us stroies of the tribal rituals in town and how the children are taken "into the bush" and taught to become men and women as they are initiated into a "secret society". It was all a bit overwhelming for me, so we soon decided to retreat back to our rooms. Maybe tomorrow I will try to learn more of these rituals...


For reference, Kamakwie is directly above Makeni and a little west, toward the northern border of Guinea before you get to the River Kaba. I could not find a map that had it marked...

Saturday, March 24, 2012

"Sah Lone"

Since I have failed miserably at maintaining a current and updated blog site, I have decided that while I continue to work on the stories of the recent past (the time between November and February), I would type up some excerpts from my journal during the time we have been in the village of Kamakwie, West Africa. But first, a little background...

The capital city of Sierra Leone is Freetown, named by slaves who were freed from the US, Nova Scotia and Great Britain and returned to their home country in West Africa. Slaves from all over Africa were returned to this British colony, and the settlement became a mixing pot of many cultures. The country thrived as a trading grounds for West Africa for many years.
Between the years of 1991 to 2002, the country was devastated by one of the worst civil wars ever known. (If you've seen the movie, then you have some idea.) The country has been left with a shaky infrastructure and the government is left merely trying to survive. Thousands were killed and injured, women were beaten and raped, children were torn from their homes and forced to fight.
The country today is slowly beginning to rebuild- there are signs, if you look hard enough- but the people have not lost hope. They continue on with their Krio greetings..."Cushe, How de body?" as if nothing ever happened...
These are my accounts of my time in Sah Lone as they say:

Friday, March 9, 2012

After two long days of travel, we arrived in Freetown, Sierra Leone. Yesterday we spent our day in the heart of consumerism in a high end shopping district of D.C. and today I'm just glad I have electricity and running water.

We arrived at the Freetown airport just after dark, and after re-reading our instructions on "how to survive customs and baggage claim" in Sierra Leone, I will admit I was a bit intimidated. We unloaded from the plane and I could instantly feel the weight of the hot night air (just like I miss from those hot Louisiana nights). We shoved our way through the lines and onto an airport shuttle bus. I had no idea where we were going, but I was bound and determined to appear confident- a valiant effort that did not last. We exited the bus and immediately entered one of three lines, two of which were for Sierra Leoneans. We showed our visas and received our stamps, and all the while I'm standing there dumb-founded by the stark contrast of my earlier statement with the realization of exactly where I am...I'm not in West Virginia anymore!!

The sounds of the people yelling in some language that although it sounded very familiar, I could not understand; resonated through the concrete building. The smells seemed to linger in the air from all around with nowhere to go because the thick motionless air trapped it under your nostrils for far longer than you'd like.

We made our way through the lines and past the Yellow Fever doctors. "They have the right to detain you for 7 days if they find you suspicious of Yellow Fever," I recalled Dr. Asher's instructions. I shoved my way through to the front of the baggage claim, weaving and sliding in between people in the crowd. After snatching our bags, we passed them to a porter who loaded them and helped us carry them outside. As we exited, people were yelling and tugging at us trying to persuade us to take their taxi or to use their service to exchange our American money. Everyone had signs for something they were selling or promoting. Everyone wanted money.

We explained, over the noise of the chaos behind us that we had been instructed to meet Dr. Asher from Kamakwie in the parking lot. We cross the dirty street and leave the crowds behind. There is a street light where we rest our luggage on the curb (if you want to call it that). Immediately we were surrounded by 5-7 Sierra Leoneans asking in a rapid dialect if we would like to use their cell phones. Finally, one guy stepped forward and informed us that he was Wesleyan and he knew a friend of the Ashers. As he stepped aside to make the phone call, a police officer came to us. We told him our story and he assured us that he would be around to help if we needed him. He seemed very suspicious, but then again maybe I just had my guard up. I am always distrusting, but even more so now. He left and the man with the phone came back with word that Dr. Asher was running late because the ferry was delayed, but he was on his way. We thanked the man for his help, but he did not leave. With still no sign of Dr. Asher, the police officer returned. He began to explain to us that because the man with our bags was a porter, he worked without a salary and he had a big family to support. He encouraged us to pay him. I spoke up saying that we did not yet have any money in Sierra Leone. This answer was apparently not good enough as he came closer and spoke more firmly when saying, "This man is here to help you and you have nothing for him? You need to pay him for his work!" I stood my ground, "I have nothing to give!" He walked away, but only to return a few moments later to tell us that the airport was beginning to clear and if our ride did not show, he would "find for us a taxi- a nice taxi with air conditioner". Over 30 minutes had passed. Fear and anxiety were beginning to settle in, and I think he could sense it. He was becoming quite pushy, but again I was persistent in saying we had a ride. "Fine," he says "I will check back in 15 minutes and if your ride has not yet come, then I will find for you a taxi." And with that he disappeared again.

Finally, I look up to see through the clearing of the airport doors from across the street, the blue and gold of a Mountaineer shirt walking toward us. At first sight, I forget that that should be a surprising find, but then I remember where I am. He looks over towards us, "Phillip? Angela?" Thank you JESUS! Just as he stuck out his hand for a greeting, the crowds swarm in again. Each of the men wanting to be paid for their work in helping us...from the phone call to the bags and even the police officer for "protecting" us (even though I was under the impression that it was his job). They were all demanding money from him. It was a quick uproar, which died down just as quickly. I then realized that all these people kept hanging around in hopes that they would be able to collect money for taking good care of the white man. Even the officer's boss came over and collected his share.

As the men took their pay, we walked towards the truck and threw our bags in back. Our driver, Stephen, pulled out and headed towards the ferry. A short 15 minutes later we arrive at the dock. The smell of fishy salt water hoovered in the air. I notice that there are people everywhere. Men, women, and children were gathered along the roadside. Some directing traffic, other selling produce, but many just watching and waiting, for what I do not know. Just watching the world pass them by, I suppose. As if they had nothing better to do. A few seconds later, loud music begins to play and there are children dancing in the street. "It is very late," I'm thinking "Why are all these people here so late?"

After we load the truck onto the ferry, we get out and walk upstairs. Dr. Asher led us into a room that much resembled a bar that I had a vague recollection of from back home. Somewhere a feeling of a New Orleans night life enters my head and it is slightly comforting. We enjoy casual conversation as we make the 45 minute ferry ride into the actual city of Freetown.

Once docked, we walk off and watch Stephen back the truck up across the shaky wooden ramps that loosely connected the boat to the shore. We quickly jumped in and took off. All the smells of any large city came into play and it was at that point that I realized in that regard, all cities are exactly the same no matter the country. We curved our way around through the one lane dimly lit city streets that would be considered alleys in any other place, until we finally reached our destination at the guest house.
We've enjoyed a nice long chat with Dr. Asher about the perils of western medicine and how that contrasts greatly with what we will see in Sierra Leone.

Tomorrow we will make the 5 hour drive "up country" to the village of Kamakwie and after all out talking and discussing I am excited to jump in and start forming my own opinions on healthcare and the kinds of changes, type of impact I want to have on what healthcare will become in the future. I can't wait to see how broad my vision becomes as my eyes are opened to so many new ways of thinking about the world.