Photos

We added some photos!!

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

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?!

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

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

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.

Church

Having asked James whether he went to church, he replied saying ‘have you never been to an African church before?’. We tentatively replied ‘no’ not knowing what we had let ourselves in for.

Church for James in Kenema is the Faith Assembly of God Church, an evangelical, all-singing, all-dancing affair. Whatever we had envisaged, it was triple the atmosphere. It began at 11am with Onward Christian Soldiers (which we missed cos we were late and it turned out to be the only hymn!). Following this there were lots of welcomes, introductions, explanations (it was a special service of thanksgiving to a young adult group) and lots of fanning (no a/c). Then the singing really started, crescendoing from significantly loud to deafening, but it was all good fun. Some of the songs were in Mende (local dialect), Creole (local dialect) and English (West African accent style). We managed to nod along, did some clapping, a few bum wiggles and the odd hum/moan/grunt from Caz as she tried to join in.

An hour later, very hot, we resumed seating for the magical unveiling of the flower-strewn pulpit/lectern. This was a gift in celebration of the young adult group. The ceremony involved various sets of donations from the congregation, for which you received a flower on a pin. After 3 or 4 layers of flower-covered cloth, the pulpit was finally revealed in all its glory. Much thanks was given and it was christened by one of the longest/loudest sermons we have ever heard. With hindsight, perhaps sitting next to the speaker was a mistake. Already 2 ½ hours in to the service, none of us were expecting what followed. The pastor in question was a big man with a booming voice who had come all the way from the sister church in Freetown for this special day. The essence of his talk was about being good Christians which was such a good message that it took half an hour to summarise, having taken 45 minutes already to get to the point. So involved in his lecture he was (some of which he screamed, some he shouted and some he simply spat) that I think he barely noticed the very helpful assistant who mopped up the streaming sweat from his face halfway through. Lots of ‘hallelujah’s, ‘young adults on fire for Jesus’s, ‘make some noise for the Lord’s and praying later, he sat down.

You’d think by this stage everyone would be exhausted and need a Sunday roast, but no. It continued. More messages/announcements/welcomes/thank yous were needed. There was more praying, singing and crying and after 4 hours of devotion we were presented with a sardine sandwich and a coke. Which tasted like heaven.

What more could you need?! It was such a privilege to be part of and we met some lovely people. However next time (strangely we want to go back) we may take a seat cushion, a glucose drip and put ourselves near the door (not the speaker).

First day at the hospital

After a much-needed rest and a very exciting breakfast consisting of spam and onion omlettes and cups of tea, Mohammad picked us up and drove us to the hospital.

James had jumped in the car en route, and in Dr. Khan’s absence, he stepped up to give us the grand tour. We were all impressed with the hospital and felt very welcome. We were introduced to many new faces, all of which greeted us with huge smiles and strong hand shakes. Not to mention; we had the pleasure of meeting the big cheese… the superintendent. Stay tuned to find out his name; we’ll let you know as soon as we find out!!

The lassa fever research lab was especially impressive, and the ophthalmology unit was brand spanking new. We started to realise that the hospital was pretty dependent on external funding. Other departments were obviously lacking resources and patients suffered for it. However on a more positive note, we saw where we could help and all were eager to get stuck in.

We began with an obstetrics ward round with the lovely Dr Jimissa, a man who we knew only via email until now. Needless to say, it was a new experience, and one that lasted a good few hours. The patients had a multitude of problems that required optimum management.

At 1pm we journeyed back to the house on Blama road for lunch. We were spoiled with African cuisine cooked by Mrs Faima. Our lovely host made sure we didn’t work too hard and ate well.

Our supervisor, Dr Khan was still in Freetown at this point, so we thought we should take the opportunity to explore Kenema for the rest of the afternoon,
Only one of us had a watch that had a second hand, a fundamental piece of clinical equipment. Therefore a mission to buy watches came about. Watch number one had a particularly large face with a certain popular American president plastered across it. Watch number one lasted about 9 hours before falling apart. Watch number two lost five minutes each day. Then it joined Alix in the shower and lost 3 hours per day. Useless. Watch number three – a rather convincing bling bling ‘Casio’ is still going strong, but time will tell….

We concluded the day with a first local beer, Star, which is award-winning in Sierra Leone apparently.

On our arrival back to the house for dinner, we were greeted by the man himself, Dr Khan, who had safely arrived from Freetown. He came to give us the low-down for the following day.

By Charlotte

A weekend not wasted

Customs did us one massive favour: they allowed us to have our first entertaining weekend in Freetown. After BMI delays and customs hassles we didn’t arrive at our guesthouse until the early hours of Saturday morning. Having had plenty of sleep and a wander onto the beach in front of us we went into town to do ‘admin’. Phones needed to be unlocked, sim cards needed to be bought, chargers needed to be lost and we needed to witness the mayhem that is Freetown. We drove through a market (see photos) that was so full of people that if a car needed to go somewhere it would just mow people and their stalls down until they moved, and they did.

The only guidebook to Sierra Leone enthusiastically encourages the nightlife in Freetown, so we thought…when in Rome…. We ended up at Roy’s (named after the owners unborn son) with two local boys who were there to look after us. Perusing the drinks menu, Jay spotted a Dimple. No one knew what it was, the locals said it was nice so we ordered a round. There is possibly a worse combination of 2 drinks in the world, but I doubt it. Whiskey and tequila in a deliciously disgusting mix. Say the name Dimple and Alix still shudders. It was not to be repeated. But we weren’t about to let that ruin our night. We played some very sketchy pool before heading to Aces the local hip-hop nightclub – our guidebook describes it as ‘seedier than a pomegranate’ and we’d have to agree. Full of middle-aged white men sleazing onto local girls with the decidedly loose description of hip-hop music in the background. There’s either more business in Sierra Leone than we realised or the NGOs have been here far too long. After confirming that our behinds just didn’t cut it on the dance floor, informing a Dutch guy who worked for the local beer Star brewery that it was not good enough and finding Jay (and what was here name?!?!) we left hip-hop in the hands of the experts.

Sunday morning we woke to a Spam and mayonnaise breakfast. Attempting to order a taxi to the beach, we got quoted $200. Even 20 miles on dirt and moguled roads isn’t worth $200 so we headed into town to find James. Sunday was football day. We went to a local premiership play-off match between Kingtom and St John’s, and what an experience it was. Sat on seating made from branches we ate peanuts from a lady’s head and watched the fiercely contested match. At half time it was still 0-0. Then the riot police arrived. Armed with visors, gas masks and tear gas guns, they were there to escort the referees off the pitch and protect them during the break. I don’t know if we felt safer that they were here or more concerned that they were necessary. Second half underway, a football or two in the face, St John’s scored much to the jubilation of the crowd. Goal etiquette is to run onto the pitch cheering wildly, hug every player and wait to be beaten off the pitch by the men with sticks (and a santa hat). These weren’t riot police, these were purely men with sticks for the sole purpose of beating people off the pitch. Match resumed, a riled Kingtom fought back with an equaliser. Received by the other half of the supporters running onto the pitch in celebration. The match ended 1-1 with a re-play scheduled for the following day. How anyone can score at all is impressive on a dirt pitch with chalk outlines, random bits of pavement in the middle and the odd drain cover just for you to trip over and dogs running on the pitch. Referees escorted off once more, it became clear why the riot police were necessary with the very boisterous crowd.

Excited that our first local event had gone smoothly, independence was the order of the day. Breaking from the set plan, sending our driver home to have a rest, we got into a taxi to a local eatery. For us, the journey was a bargain at £1.50, for the driver who may have lost a fuel tank, an exhaust and other extraneous items, it may have been a very expensive trip down a bumpy road to Lacs Villa. Halfway through a delicious meal, coming somewhere from beyond the pitch black trees next to us we heard massive cheering and celebrations. Someone’s birthday perhaps?? Thinking nothing of it, we paid up, got into a taxi (with markedly better suspension) and headed home. On the way the taxi man explained that Sierra Leone were playing Egypt in the African Cup of Nations. Egypt being reigning champions were tough competition for Salone, who despite huge support rarely do well. Sunday was a big day in Salone history. Taking the lead in the second half, Egypt equalised just before the end, but this didn’t dampen the celebrations for the best Salone result in six years. En route to our guesthouse, the car could go no further due to the human road block of revellers. Vouvousela in Jamie’s ear, thumping on the car and screaming had to be witnessed before we were allowed to continue. It made English fans look tame, Sierra Leoneans certainly know how to party.

Customs

5 days, 3 ferry crossings, 24 hours in a truck, 7 dimples, 1 very seedy nightclub and a bucketload of sweat later, we arrived in Kenema. Despite all our best efforts to do everything above board, use appropriate channels and help from James (from the Lassa Fever unit in Kenema), customs were not expecting our arrival with 6 big boxes of donations. After our initial attempt to get them through on Friday afternoon (everyone had gone home) we returned to the customs office bright-eyed on Monday morning at 9am. We were met with a very adept paper-shuffling lady who had no record of our documents. So we trotted to the other side of town to the government building to get the documents re-printed. Returning to customs, the paper-shuffling lady (miraculously) found our documents in front of her….but the relevant man who could stamp these was now in a meeting with the IMF.

Fortunately, across the road we bumped into our supervisor Dr Khan (having a pedicure, yes he’s male) who made an energetic phone call for all the salon to hear. Bureaucracy in progress, we became concerned about ferry crossing timings. Freetown’s international airport (the location of our goods) is situated across a massive estuary from the main city. To drive around takes 6 hours, so the only way to get there is across the water. There are several boat related options but as the FCO says ‘none is without risk’. However, general local consensus is that the big car ferries are the least risky of all options, even if they do sink and don’t have life jackets. The ferries leave from the airport in time with the flights so there are only a few a day; our plan was to take the 2pm ferry across, leaving Dr Khan sorting things out at the mainland end, by the time we had arrived at the airport, a phone call would have been made and we would return with our booty on the 5.30pm ferry. It was optimistic.

We arrived at the airport to find that a phone call is not enough, in fact we needed the document in all its glory, with stamps. Dr Khan (who had the letter now with stamp on the mainland) had a plan. He managed to find a local lad who would take our letter to the airport via a fast (but more risky) route of a ‘speedboat’. So we raced back to the ferry terminal with Mohammed our rebel-escapee super-driver to meet this lad off the boat. Stamped document in hand, 4.15pm on the clock, we were smiling. Proudly presenting the prized document to the officials at the airport, the big cheese in the chair said ‘I will see to action this very quickly’, put the paper to one side and continued paper-shuffling. After some frustrated looks, the man granted us our special boxes and at 5.35pm we again raced back to the ferry terminal in the hope that it was late (which considering African time, was a valid hope). Sadly when we got to the gate the guard simply said ‘9 o’clock’.

In true British style we had decided it was very much beer o’clock while we waited 3 hours to board the last ferry of the day. Monsoon rains hit just as we needed to walk down the ramp, but we were in high spirits as we had our boxes and a 6 hour car journey with 7 people in 5 seats to look forward to. Mohammed valiantly drove through the night so that we could finally sleep at our Mama’s house in Kenema. After a big welcome from the whole family (and tea) we went to bed.