Sunday! Allelujah!

Sunday, March 18, 2012  Day 9

What a beautiful day Sunday can be!! I awoke early this morning and Phillip and I went to what we were told was 8am mass. When we walked the short path over through the woods, we approached a man ringing the church bell out back of the church. (Very much made me think of the old church bell outside of St. Catherine’s in Noble!) We said our hellos and walked passed him to the main entrance of the church. Empty. Not even a sound. The doors were wide open, but no one was around so we walk back to the guy ringing the bell. “8:30,” he says. We decided to walk into town and come back.

We walk down to the swamp that separates Kamakwie I from Kamakwie II and stand on the bridge taking in the beauty of the green all around. We stayed and watched the field workers tend their small crops as the Muslim school children hurried past on their way to class. Finally we decided it was getting close to time for mass to start, so we headed back. 8:30 and a few more people were entering, but still a long way from being even half full. And still no sign of a priest! At some point around 9am the processional began with loud singing and clapping. My best guess is that this church is on African time, which Is perfectly fine with me because you can never be late if you don’t know what time it starts!!

There was a child playing drums and everyone sang in Krio. There was a lot of singing, clapping and dancing. I sincerely enjoyed it! I saw several people that I recognized. Everyone was very well dressed in their Sunday best, and most of all the mass was in English. The church itself was very nice and the priest was African. I very much enjoyed the mass and it made me realize how much I missed not going last week.

After mass, we went with Dr. Karen and Dr. Tom to one of the Wesleyan churches in a nearby village. When we arrived there were people sitting outside the steps to the main entrance. As we got up to the door, people began to usher the “strangers” to the front. We squeezed our way through a mass of people and found a seat. We sat through 2 and ½ hours of preaching, sermons, and collection baskets with people again dancing in the aisles.

It was a very fun and unique experience, but one that I honestly hope that I never have to go through again. It was so insanely hot that several people had to leave. Dr. Tom even got sick. At one point, I felt I might even lose consciousness.

After church and lunch I enjoyed a nap until Phillip came to get me for a walk to the tailor. I am amazed with what fine work he does. I had two skirts made. Plus, he was in church this morning so I’m not sure when he ever sleeps! The work was phenomenal though and both fit just fine. He is making a matching bag for tomorrow. The may be my new favorite thing to do in SL!!

Shooting Stars

March 17, 2012    Day 9

Tonight on our walk home, Phillip and I saw the most amazing shooting star. It is quite impressive how clear the skies have become now that they have stopped the burning. We were admiring how brightly the stars were shining when at the same moment, we noticed a star begin to move. It appeared to be in slow motion, as in a movie, but as it shot out across the dark black sky, something miraculous happened- it curved upward and made a large swooping motion. We both gasped. It was truly breathtaking. I think it was a sign from God that despite how much I struggle every day to accept the things in life that are occurring all around me, all is how it should be in the world. Sometimes I feel like I am that tiny little star shooting wildly out of control, spinning crazily as the rest of the world sits by and watches- not daring to move. It is a difficult feeling.

Today I covered the peds ward again. A new patient came in respiratory distress. He was less than a year old. I was alone on the floor and by the time I got to him he was boiling hot and shaking all over with a rhythmic twitch to his body. He lay there helpless, his temperature was growing closer to 105 degrees. I had to do something, but there was no doctor. I had to be this child's doctor. I spoke to the nurse. We agreed on the medications and dosages and he quickly began giving them. By the time Dr. Tom returned, the child had almost stopped seizing. It was a scary moment, but later we checked on the child again and he was still stable. I hope he knows someday how much he scared me, but even more how much he taught me. You can't be afraid of what you don't know here- This Is Africa- there's no time.

When we went back to check on the patient, we took photos of the different hospital wards. (I figured out a camera is a great way to make friends!) We stopped by the Alpha unit and visited with the children there. They were so tiny and precious. I hope to be able to spend more time there this week. There's a tiny set of twins there and I had an amazing photo shoot with them. I can't wait to visit again.

I found time (after reorganizing the pharmacy) to go down to the tailor with Bud and Judy today. It was alot of fun to go and pick out the fabrics and decide what I wanted, but it blew my mind  that the fabric cost more than the tailor charged to make each skirt! Each skirt cost ~2 US dollars to make!! I was shocked. I told Phillip we will have to make sure to tip him well. I hope they turn out nicely. If so, I plan to go back weekly.

I'm beginning to slowly have more and more fun here as I grow used to the environment. Tonight we had a huge dinner at the Asher's and ended the evening with a game of Monopoly cards. I really love NOT having a TV!!

No Fair Answer

Friday, March 16, 2012  Day 8

One of the craziest days so far...

We started out the morning in the peds ward. It was very empty (compared to previous days this week) with only 6 patients. Phillip and I split the load between us. My 3 patients were doing really well- one even ready for discharge. We quickly write our notes and meet Dr. Tom in the men's ward. After seeing a few patients we begin to hear a loud screaming sound from the direction of the peds ward that struck everyone around us all at once. It seemed like everyone straightened up and started paying attention. Some even glancing at the open windows to see what was going on, however despite all this, it did not seem to come as a surprise to anyone at all. Dr. Tom looks at us. We had not yet given report from the peds ward. "What is going on over there," he says suspiciously. "Nothing," we reply in agreement, just as confused. "Everything was fine when we left." We began to worry. After losing five other patients already this week and witnessing one yesterday, the sound of the wailing still caught me off guard. I hope it is a sound that, unlike the people here, I never get used to. It seems to be just another noise to them, as if it blends with the sounds of the fire crackling in the distance or the leaves of the palm tree rustling in the wind. People continue on about their ways, sometimes not even noticing at first that anything has even happened. Lorena tells us stories of how the children in school stand automatically at the procession of the body being escorted from the hospital through their school yard. I cannot imagine going through school with the distraction of people wailing all throughout the day as I sat waiting and wondering, "Is it someone I know? Is it my family?" 

Twice today we received new patients on the peds ward...and twice today we heard wailing as the mourning mothers made their way through the crowds weeping in sorrow and flailing themselves about. It is quite the expression of the most undesirable and often indescribable sensation. And these people live with it every day. It is so hard for me to face the sorrow from the loss of my grandmother, but to have that repeated many times over is more than I hope I ever have to experience. 

As the day progressed and the work continued on, we saw improvement. We discharged several people. It is always such a delight for me to write discharge orders for a peds patient. To see them go from fighting to breath to playing and laughing is a miracle every day.

I've learned that with medicine in Africa, you only do half the work and most of the time with less than half the resources...God does the rest. It frustrates me greatly to try to figure out how He decides who will go and who will stay. I know I shouldn't, but I always find myself asking, "what if we'd have done this?" or "maybe we should've tried that?" It's such a hard game to play and the only fair answer is- there is no fair answer- it is all written into part of His greater plan.

Today after clinic, we came back to Bud and Judy's house for dinner. Meredith and Lorena joined us again and we spent the evening chatting with them and sharing our day's work with one another. After a short while, the kids began to collect on our front porch as they often do. They began to yell for us through the window until finally Lorena came out and agreed to sing a song with them. We all ended up sitting on the front step in the cool evening breeze and joining along. It was so much fun to see how excited the children became when singing and dancing. It again amazed me at how a nation filled with such grief and despair could also provide children that are so happy and joyful as if they were completely naive to the fact that death surrounded them.

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.

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...

Kamakwie

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...