Charlotte, Jay and I decided to go to the labour ward in the evening as there were 5 woman who were about to give birth. We had dinner by torch light in a shack outside the hospital, and had egg and mayo butties and oranges for less than a pound for all of us! The evenings are buzzing here, despite the lack of electricity, there are still food stalls run by atmospheric candle light and plenty of people having a gossip and having dinner. After dinner, we braced ourselves for an interesting evening in the hospital. The hospital was pitch dark, and eerily quiet, apart from the screams coming from the labour ward. We arrived and the midwives were working by torch light. They were pleased to see us and instructed us which ladies we should assist with. All of the women had severe infections in their wombs, which created a stench in the small, hot, airless room like no other. All of the women were also experiencing their first birth, and some were scared to push, others were tired, after being brought to the hospital already having experienced 2-3 days of labour in their village. Most woman in Sierra Leone also have FGM (female genital mutilation). This is where their vaginas are cut, often very dramatically, leaving scar tissue where there should be elastic tissue. This makes labour very difficult as their vagina opening cannot stretch, making it extremely difficult for the baby to be born. Charlotte’s mother gave birth first, after many hours of pushing and screaming ‘why why why?’ It was a baby girl. The mother wanted a baby boy, so the midwives just told her it was a boy. After the baby is born, it is rubbed dry, has suction to remove any fluid that it may have breathed in, and then has it’s cord cut. Here, they also traditionally rub the baby with oil ‘to keep it warm.’ I’m not sure how effective this process is, as they then wrap it in the wet towel they had originally dried it in, and surprisingly they do not allow the mother to feed her baby straight away, until she has her knickers back on. This is a shame because by the time the mother was ready to feed, she was too tired and so was her baby who was asleep, and breast feeding releases maternal hormones which help reduce bleeding after birth.
The next birth, was by my mother. Due to the FGM, there was no stretching of the vagina, and after hours and hours of labour the woman needed an episiotomy. This is where the vagina is cut to allow for the head to come out. Unfortunately for the mother, this was done with no anaesthetic and the baby was a still birth. Charlotte and I started to resuscitate it, doing chest compressions, but without a mask and bag to help the baby breathe and no other equipment available, we soon stopped. We were absolutely gutted, but didn’t have time to be upset. We saw to the next birth, while the midwife rather unskilfully stitched the episiotomy by torchlight. The next birth, like the previous one needed an episiotomy but fortunately the baby was alive.
It was midnight by the time we had run out of gloves, and there was still one more labour to go. The patient was a 17 year old girl who had been brought in by her parents after being in labour for several hours. She was tired and begged for Jay to stay with her. The midwife was cross that she was not pushing, and the midwife herself was tired and lay on the bed next to her to rest. Charlotte and I decided to go home, there was not much we could do without gloves and we were shattered. We checked the foetal heart rate of the young girls baby and it was strong. Jay decided to stay as when we left she cried and screamed after him. He stayed until she fell asleep and we got a lift in an ambulance back, as the midwives thought it would be dangerous for us to make our own way home.
The next day on the ward round, we saw the young girl in the postnatal ward. She was without a baby, and the midwife said it had been a stillbirth. Another baby who if treated with a simple intervention to assist with the labour such as forceps could have lived. Perhaps with the girl being so young and with a ‘man in Freetown’ like many young girls in the village, it was a blessing in disguise, but it still was a tragedy. To me, this injustice is highlighted to us even more when a few metres away from the midwives working by candle and torchlight is the lassa fever lab, an international research centre funded by the World Health Organisation and in part by the USA Department of Defence who had state of the art facilities. The concept of millennium development goals (MDGs) seems distant and a pisstake when here in rural Sierra Leone, they have seen little funding and do not have the basic facilities.
By Alix
Monday 4 October 2010
Monday 20 September 2010
Thursday 16 September 2010
Dogblog
• Female patient
• Unknown age
• 10 Kg
• Multiparous (multiple pregnancy)
• No fixed abode
• Gave birth to 9 live infants just outside the male general medical ward during muddy tropical storm
• 2 days post delivery 8 survive, still blind but feeding
• Patient is of canine origin
• After long discussions with patient the offspring have been named:
1. Sylvester - brown
2. Chief – brown
3. Leonardo – spotted
4. Giselle – spotted
5. Gollum – white with funny ears
6. Bjorn –very white
7. Boris – very white
8. Peanuts – tan
9. Un-named - deceased
Offers for homes wanted.
By Caz
• Unknown age
• 10 Kg
• Multiparous (multiple pregnancy)
• No fixed abode
• Gave birth to 9 live infants just outside the male general medical ward during muddy tropical storm
• 2 days post delivery 8 survive, still blind but feeding
• Patient is of canine origin
• After long discussions with patient the offspring have been named:
1. Sylvester - brown
2. Chief – brown
3. Leonardo – spotted
4. Giselle – spotted
5. Gollum – white with funny ears
6. Bjorn –very white
7. Boris – very white
8. Peanuts – tan
9. Un-named - deceased
Offers for homes wanted.
By Caz
Interesting cases we have seen....1
The man with the largest scrotum in the world
The debate for this patient for much of the day was whether his scrotum was the size of a large cantaloupe or a small watermelon.
Still unsure as to its melon classification, we decided we had better get a second opinion. Our initial impressions were large scrotum due to…massive swelling of the scrotum…?? Dr Khan on the other hand had a more scientific way of putting it. It turns out he had elephantiasis (worms blocking all his lymph vessels) creating, you guessed it, the largest scrotum in the world! Who said 4 years at med school was wasted?!
The debate for this patient for much of the day was whether his scrotum was the size of a large cantaloupe or a small watermelon.
Still unsure as to its melon classification, we decided we had better get a second opinion. Our initial impressions were large scrotum due to…massive swelling of the scrotum…?? Dr Khan on the other hand had a more scientific way of putting it. It turns out he had elephantiasis (worms blocking all his lymph vessels) creating, you guessed it, the largest scrotum in the world! Who said 4 years at med school was wasted?!
A week of mayhem
We are writing a week later about last week as we have been so busy we haven’t had a chance to get to the computer. We’ve been on the maternity ward, and seen half the babies die. The nurses are good, and work hard, but it is a controversy that in the country with the highest maternal mortality in the world, in a referral hospital there is only 1 obstetrician. He works hard, trying to prioritise patients but when Charlotte and I came across a 19 year old woman with an obstructed labour, where the head was stuck in the pelvis, the doctor was resting and didn’t answer his phone for several hours. Without a c-section this young mother would have died. Luckily the doctor came and performed a c-section, but this was complicated by bleeding after the operation. She was v. close to dying on the operating table, she was in haemorragic shock and was dying. The doctor opened her up again and managed to do a B-Lynch procedure which basically works by pulling the womb tight like a drawstring bag to stop the bleeding. This second procedure was done with no anaesthetic, but luckily she was in such severe shock, she didn’t seem to be in pain. After 6 hours in surgery, we left at 10.30pm to go home, and were pleased that she was alive and well in the morning with her baby. However, a few days later her baby died. This is just one example of what happens everyday on the maternity ward. Sorry about all the doom and gloom, Charlotte and I delivered twins!! They were girls and the midwives called them Charlotte and Alix!! We were more excited than the mother, who wept that she couldn’t afford to have 2 girls. Oops sorry, was trying to end on a good note. It’s hard to find happy endings here.
Baby Resus Sierra Leone Style
1. Swing the baby upside down
2. Shake it upside down until it probably gets a brain haemorrhage.
3. If unsuccessful, hold upside down by the ankles and tap the feet. This is called the ‘pepper pot technique.’
4. Suction.
5. Suction.
6. Suction.
7. Repeat steps 1-6.
8. Repeat steps 1-6.
9. Wrap up and hand over to relatives for 50% chance of survival.
There is no oxygen, there is no incubator, there is no way to secure the airway and nurses don’t listen to their heartbeat or lungs as they don’t have a stethoscope, the mothers who have c-sections cannot feed their babies for several hours because they are off their face on ketamine from the surgery.
By Alix
Baby Resus Sierra Leone Style
1. Swing the baby upside down
2. Shake it upside down until it probably gets a brain haemorrhage.
3. If unsuccessful, hold upside down by the ankles and tap the feet. This is called the ‘pepper pot technique.’
4. Suction.
5. Suction.
6. Suction.
7. Repeat steps 1-6.
8. Repeat steps 1-6.
9. Wrap up and hand over to relatives for 50% chance of survival.
There is no oxygen, there is no incubator, there is no way to secure the airway and nurses don’t listen to their heartbeat or lungs as they don’t have a stethoscope, the mothers who have c-sections cannot feed their babies for several hours because they are off their face on ketamine from the surgery.
By Alix
Freetime in Freetown
Charlotte and I set our alarm clock at 4.30am to get the bus from Kenema to Freetown on Sunday morning. Although it was early, we thought we had had a lucky escape from a 4 hour church service. However, as soon as we were on the bus, there was a pastor, giving a sermon. Then after our 6-hour bus ride on the government bus, we hopped on the ferry to cross the estuary to pick up our friend Rosie who was arriving in Freetown that day to join us on our elective. The ferry (A rusty, slow moving, hulk of a ship) ride took an hour and we were instructed to clap for Jesus during this time. Meanwhile around us, there were babies crying, dirty nappies being thrown overboard, people selling mussels, lobsters, watches, pants, cheeseballs; you name it you can buy it. We managed to pick up Rosie from the airport, but couldn’t face the ferry ride. There were other options, such as a helicopter (US$60), Tourist speedboat ($40) or local speedboat (£2). We chose the local speed boat, where we were directed onto the beach, followed by a swarm of locals, and were told at first it was $100. After a good barter we paid the local price and were shown the boat; a wooden boat, with faded paint that could probably seat 10. We agreed to get on and were suddenly picked up off the ground by some of the guys. We screamed and shouted with not much dignity. We were put back down on the sand and told that we couldn’t step in the water as it had salt in it and that it was poisonous. The boat was 2 steps away from the beach and with pleads of independence that we can get on ourselves, we were once again scooped up and dropped in the boat, and then asked what the tip was. Cheeky bastards. However once the boat got going, it took 10 minutes and was awesome!! We got back to Freetown, checked into the YMCA and went for a Chinese. The next day involved getting money out. The ATMS do not have VISA and we had run out of cash, it took over an hour to get some sort of VISA transfer, which cost about £30 to do, but there wasn’t any other choice. Money sorted, we decided to go to a Chimpanzee Sanctuary, which was only 8km from Central Freetown. After 15 minutes of discussing directions to the sanctuary and agreeing on a fair price, we were on our way, in possibly the worst car we have ever been in. No windows, boot door wouldn’t close, the floor felt like it was going to cave in, and our asses were getting v. hot on the seats in the back. Although only 8km, it was a bumpy ride which took 45 minutes, with a very grumpy driver who apparently did not actually know where we were going and no longer wanted to drive us. We drove though the hills, past the US embassy and the IMATT (Army training with UK Army officers) in the posh part of town and then we were in the jungle (or what an English bumpkin would describe a jungle, not sure if its actually a jungle).
The Chimpanzee Sanctuary was fantastic. There were 100 chimps that had been rescued from the domestic market, some were pets, some were used in industries such as welding and some were used as entertainment. Willie (hehe) showed us round, he knew every chimp by name and called to them in Chimp language (we did have to stifle giggles) and we saw them being fed their dinner, fart a little, groom each other, which included one of the chimps inserting a finger into another chimps ass. After our tour, we got back in our taxi with our grumpy driver, and crawled back to Freetown, with the car feeling as if it was going to collapse in a heap. We had a quick dinner with the most delicious fish I’ve ever tasted and some plantain and rice. I tried to ask what type of fish it was, several times. She just answered ‘grilled.’
On arrival back in our hostel there were cockroaches in our bed, including in our pillowcase and PJs. Gross. We managed to change rooms but felt very itchy all night. Again we set our alarm for 4.30 to get on the bus back to Kenema. 6 hours later, we arrived back in Kenema. It felt like arriving home, our friends/colleagues from the UK met us back at our house, and the family gave us a warm reception. After a delicious dinner of BBQ chicken like no other, we were back at work in the hospital that afternoon.
Back at the hospital, we found one of our patients on the general ward had died of heart failure. Charlotte and I were put back to hard work, starting with clerking a patient in a critical condition with cerebral oedema post giving birth to a stillborn baby. If we were in the UK, we would have called intensive care and got her transferred to the specialist ward as an emergency. Unfortunately here, we could only give her drugs to reduce her blood pressure and reduce her cerebral oedema, but we had little equipment to monitor her. We went home at 7.30 after seeing several other patients, including a C-section. We worried all night that our critically ill patient would have died in the night, and we were relieved to see her this morning, although there had been little improvement.
By Alix
The Chimpanzee Sanctuary was fantastic. There were 100 chimps that had been rescued from the domestic market, some were pets, some were used in industries such as welding and some were used as entertainment. Willie (hehe) showed us round, he knew every chimp by name and called to them in Chimp language (we did have to stifle giggles) and we saw them being fed their dinner, fart a little, groom each other, which included one of the chimps inserting a finger into another chimps ass. After our tour, we got back in our taxi with our grumpy driver, and crawled back to Freetown, with the car feeling as if it was going to collapse in a heap. We had a quick dinner with the most delicious fish I’ve ever tasted and some plantain and rice. I tried to ask what type of fish it was, several times. She just answered ‘grilled.’
On arrival back in our hostel there were cockroaches in our bed, including in our pillowcase and PJs. Gross. We managed to change rooms but felt very itchy all night. Again we set our alarm for 4.30 to get on the bus back to Kenema. 6 hours later, we arrived back in Kenema. It felt like arriving home, our friends/colleagues from the UK met us back at our house, and the family gave us a warm reception. After a delicious dinner of BBQ chicken like no other, we were back at work in the hospital that afternoon.
Back at the hospital, we found one of our patients on the general ward had died of heart failure. Charlotte and I were put back to hard work, starting with clerking a patient in a critical condition with cerebral oedema post giving birth to a stillborn baby. If we were in the UK, we would have called intensive care and got her transferred to the specialist ward as an emergency. Unfortunately here, we could only give her drugs to reduce her blood pressure and reduce her cerebral oedema, but we had little equipment to monitor her. We went home at 7.30 after seeing several other patients, including a C-section. We worried all night that our critically ill patient would have died in the night, and we were relieved to see her this morning, although there had been little improvement.
By Alix
Kenema
Some claim it to be the second largest town in Sierra Leone, some the third, either way it’s semantics because it’s not a big place. Or so we thought.
On Sunday Mrs Faima’s son Emanuel (on leave from the army) gave us the tour of the town. He’s a quiet but very well informed gent and showed us to the far borders of the city. So thorough was this tour that we saw the water and electricity supply for the whole area (which was broken). The main road to Kenema from Freetown is tarmaced (financed by an Italian company), as is the road through the middle of town, but after that it’s dirt tracks all the way.
We began with a trip through a European looking park, which the Catholic mission had planted. It was beautiful and serene and much appreciated by the locals. It had long sweeping lawns and palm trees, reminiscent of a colonial lodge (probably the only place like this in Sierra Leone). Inside the park we located the town’s tennis court (lacking in fencing, could be an interesting game).
The tour was such a novel experience, not only for us, but for the locals in the suburbs that we felt like royalty with all the vigorous hand waving that we had to do. Half way through we visited the old airstrip. This was much used in its colonial heyday and during the war, but now is the spot to find palm wine (home brew) from small huts along the edge.
Having been introduced to the whole of Kenema we concluded our tour at the local power station. If retro-cool could affect a power station, this is it. Straight out of the 60s, it was proudly shown off by its workers as the bees-knees in electricity distribution. Imagining that we’d see hydroelectricity in action, or at the very least a water wheel, we bounded into the control room to find this was the only ‘safe zone’ of the whole building and we saw nothing more that dials (reading zero). Apparently there are rooms even the workers can’t enter.
In all seriousness, Kenema has got into all our hearts and we feel welcome everywhere. There’s no animosity to the ‘pumuis’ (white people); even when Jay got called ‘white monkey’ they were grinning their heads off. It’s nice to be in a place that is so grounded after such recent unrest. The war isn’t taboo to talk about, everyone was affected and has their own story to tell, but life goes on. And what leaps in development they have made. There is evidence of the total destruction that occurred all over, but it is alongside modern development. Considering it is 2nd to the bottom on the human development index, we are all massively impressed by Sierra Leone, and Kenema in particular.
After the excitement of the power station we ended up in Capitol (the restaurant part). Looking through the extensive Lebanese menu we made our choices only to find out that the Lebanese chef was on holiday. Rather that telling us this information at the beginning, we went through the whole menu asking ‘what is this exactly?’ to the reply ‘no, we no have’. Hummus it was.
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