Last day, Camel Mountain, Bumbuna Waterfalls and home.

The last day we were up extra early to do a ward round and I was greeted by a beaming Alie giving me the thumbs up. I guess he enjoyed the Nutella, it was the first time he had smiled spontaneously.

We made plans with the local staff for the patients who were staying in: John Kanu, the head nurse, for dressings and Rose , the Irish ward nurse, for the antibiotics and the financial care of the patients who had no money  (there had to be enough for finishing various six week antibiotic regimens for their infected bones).

We set off to the Bumbuna falls, passing through traditionally built villages on roads, which made me appreciate the distance and difficulty the patients who lived far away had faced coming to see us.

Traditionally built houses. Everyone helps change the roof once a year, the house owner just provides the food for the day, and of course helps his neighbour with their roof.

Traditionally built houses. Everyone helps change the roof once a year. The house owner just provides the food for the day and of course helps his neighbour with their roof.

We drove past the Camel Mountain, which someone perhaps a trifle unkindly suggested could be the Turtle Mountain……

Camel Mountain

Camel Mountain

You could tell you were getting closer to the Bumbuna waterfalls because of the fine mist of water coming off it and the noise! We climbed out on some rocks as close as you could come and admired it. A local fisherman was fishing in the quiet pools at the sides but there was no way anyone could swim, canoe, boat or dive through the whirling water masses.

Bumbuna Falls

Bumbuna Falls

Trees hanging on for dear life

Trees hanging on for dear life a little down stream

In Bumbuna (est pop. 4,000 in 2004), the local Catholic priest Father Andrew (also known as Figo, since he had been a good footballer in his younger days and the other father was nicknamed Macca, which I am told is another footballer  and has nothing to do with Paul McCartney, so I sense a theme here), took us to the World Bank-backed Hydro Electrical Dam (http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRREGTOPENERGY/0,,contentMDK:21649802~pagePK:34004173~piPK:34003707~theSitePK:717306,00.html), which supplies electricity to Freetown and Makeni and whoever else is on the National Grid, which unfortunately is far from everyone. In comparison with the falls this was completely silent, including the two spillways into which the excess water, slick as oil, disappeared without a sound. Local guards had a series of check-points on the way and because Father Andrew was known to them we passed without problem until we came to the dam itself where the guard didn’t know him. But Father Andrew has a direct line to the boss of the project and the guard was soon fully informed, saluting him as we walked to the dam.

We stopped at the dam project’s headquarters and since the head contractor and caretaker is Italian, we found ourselves drinking – but of course! –  Cafe Latte, Cappuccino and Espresso, made on the biggest professional coffee machine I have seen for a long time and certainly in the Sierra Leonean jungle.

Amadu climbing a palm tree with a plastic container under the crown tapping palm juice

By the side of the road we saw quite a few palms which were being tapped for palm wine; unfortunately this also kills the palm. The plastic container at the top of the palm under the crown is tapping the palm juice which is fermented. Amadu, our driver, demonstrated how the local boys climb the palm. I wish they wouldn’t,  having seen the results when they fall down. I tried palm wine last time I was in Makeni and I have to admit that it may not become my favourite drink, possibly the taste had something to do with the container in which the medical students brought it: a large white plastic container for petrol. Having never tried again, I couldn’t say.

Our trip was at an end, Rupert’s beard may also have been at an end, depending on the verdict from his family, but at least it is documented here for posterity.

day 2 ????? ?????????????? Day 6 ????? Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14

So once again, I am back in London. With experiences which make me humble and hopefully give me a greater understanding of other people and make me a better doctor. So many people came to see us, in complete confidence that we would do the best thing for them, and of course we tried our best. I hope to have made a little difference for the better and look forward to the day Abdulai Jalloh is fully trained and back at Makeni. The department will be in good hands.

We had a great team, there is a great team there and we will be back.

Advertisements

1 Comment

Filed under Sierra Leone trip

Day 12, last operating day and an inadvertent Nutella theft.

Alie, our 12-year-old boy who had the left above knee amputation for severe and life threatening infection of the bone last week, went back to theatre for the last time today and I am really glad to say things look clean and there is some hope he will survive. He is only skin and bone, which was why I got the idea that he would do well with eating the Nutella in the fridge in our guesthouse. I mean, he could do with putting on some weight. I didn’t actually think it belonged to anyone, so took it up to him, and was rewarded with a huge grin. Well….it turns out that Jocasta, our therapist, was feeding her school attenders with it! I can only say it was an honest mistake and I got absolutely soaked in a tropical storm on the way there  and back (much to the other patients’ amusement). I have already emailed the next team about bringing another jar of Nutella out and needless to say the team have been cracking Nutella jokes all night.

Today should also have been a quieter day, with only three operations scheduled, but that changed. 

First there was the little girl with the intestinal Typhoid perforation from last week, who came back for a second look. The general surgeons in the hospital, which included our Dr Abdulai Jalloh, requested my presence as  senior support. I only had to be there as an assistant and as moral supporter; Abdulai was very capable of doing the operation, which turned out to be well worthwhile and she is already better tonight. 

Then there was the student a year down the line from a road traffic accident and a painful right hip, from whom we drained 500 mls of pus ( so he should be feeling a lot better now!) ; the old man with a leg ulcer which looks like an atypical Tuberculous ulcer; and the young mother with a keloid the size of an egg behind her right ear. All got done and are bedded down snugly, thanks to Rose and her nurses.

The little baby with half the scalp missing had her first change of dressing today and it already looking much better. She is not impressed by the bonnet-type dressing she has to wear!

Today was also a day of photographs. I was called into the men’s section as was asked to pose for photographs with one of our patients for a professional photographer and then everyone else as well! So I took photographs as well in both the male and female wards.

Septemeber 20 2013 010Hassan and Muhammed

Benjamin with his now straight wrist

Benjamin with his now straight wrist

I am not quite sure what the hand gesture means, but it caused a great deal of mirth from the other ladies

I am not quite sure what the hand gesture means, but it caused a great deal of mirth from the other ladies

She insisted on being 'snapped' as if talking on the phone

Isatu insisted on being ‘snapped’ as if talking on the phone

Septemeber 20 2013 016

Adama and her wonderful mum who cared for all the other women in the ward and especially for Awa, my Malian patient, who didn’t have anyone female with her and had both her hands bandaged.

Awa from Mali.

Awa from Mali.

I first met Awa when I went with Interplast, now ReSurge International  (http://www.resurge.org/), in Mali in 2010. She had touched an electrical cable and sustained injuries to all her four limbs. An attempt to get her to the States for further surgery failed, so I was most pleased when she agreed to come to Sierra Leone for more treatment. I think I have probably done as much as I can do now and we went through her exercises today with Jocasta and Francis, our therapists, so I hope she will do them.

Tomorrow, we have an early ward round and then we are going to the local waterfalls (well not so local, 90 minutes away, but all is relative), before heading to the airport and sleeping at the Xaverian Father’s mission in Lungi.

1 Comment

Filed under Sierra Leone trip

Day 11, dressings, dressings and dressings! And breadfruit.

We are winding down with the operations now, doing only simple operations which will not need follow-up and intensive care. The next team is coming in October but it is responsible to be able to take care of your own complications, should they arise.

Today a mother brought a baby up from Freetown with his cleft palate and I don’t operate on clefts at home, so I do not them here either. We are lucky to have a paediatric anaesthetist, so at least he had an anaesthetic assessment and I took their phone number (everyone here seems to have a mobile phone) so the right team can call them. The baby is tiny, obviously because he hasn’t been feeding well, though watching his mother feed him now it all seems to be going down the right way. His twin brother looks about twice his size but that is the right size for a nine month old.  

I am struck by the number of lower leg ulcers here from trauma, infections and sometimes snakebites.  Some have been to the native healer, which hasn’t made things better because some of the herbs used are put on hot and actually burn the skin. John Kanu, the head nurse, has a dressing clinic going which is full every day. I am giving him a hand and see him in action, teaching one of the junior nurses. Very impressive.

John Kanu in action in the dressing clinic

John Kanu in action in the dressing clinic

Last time we were here we went to see the Makeni amputee football team. The civil war here was especially known for the maiming by amputation: people were only asked if they wanted a short sleeve or a long sleeve, or short or long trousers: each question marking the site of the amputation done by machetes. One of the local amputees was a patient of ours. He came with an ulcer on his one remaining leg, which of course makes it even worse and the treatment even more imperative. He can’t afford to lose the other leg. He invited us to come and watch the amputee football, played in the park behind the Bishop’s official quarters and offices. It was phenomenal. The energy and the speed was amazing! As was the cheering from everyone!

Makeni's Amputee Football team

Makeni’s amputee football team

We have eaten well, cared for by Usman our cook, who also presented me with my first breadfruit. It really tastes like bread, and very delicious bread too. He makes little chips, which are very hard to stop eating.

Breadfruit in the natural state

Breadfruit in the natural state
...and cooked!

…and cooked!

Leave a comment

Filed under Sierra Leone trip

Day 9 and 10. More work!

No internet yesterday. The days are busy and operating lists full. Invariably someone turns up who needs an urgent operation, like the eight-month-old baby who had an intravenous line inserted in her scalp (common practice in babies) in the government hospital, but who turned up today with half her scalp missing. She obviously went on the list immediately and has now got a clean wound. I hope the amazing healing powers of babies will do the rest … and a little bit of help with dressings.

Many things have changed since I was here two years ago and all for the better. Better organisation, better nursing, but the supply chain is still the same. We try not to be wasteful whilst doing the best for the patients and not cutting corners.

A patient of mine very kindly thought of the team before we left and furnished me with loads of nut and chocolate bars and organic nutrients. They’ve all gone. They were lovely and kept our energy up! It is lovely to see how the patients share their food, one of the mothers to a small girl with osteomyelitis is especially kind and helpful; she even helped in the dressing clinic today.

I spent most of the day in the dressing clinic with one of the local nurses, changing dressings on ulcers, which seem to be endemic here. We dress them, discuss them and I hope she will remember when I have gone what to do and document.

Martyn Webster, the head of ReSurge Africa (http://www.resurgeafrica.org/), reminded me to say that Sierra Leone is also a beautiful country, home to pygmy hippos (which are mostly out at night in the northern regions, notoriously shy), and sandy beaches.

It certainly is.

Beautiful Sandy Sierra Leonean beaches.

Beautiful Sandy Sierra Leonean beaches.

2 Comments

Filed under Sierra Leone trip

Day 8 and an amputation

We had to amputate Alie’s leg today. Alie is a 12-year-old boy who fell from climbing a palm tree months ago. He presented very sick on Monday, he was very unwell with an infection in the bone of the left leg, the whole left leg.  We got him three pints of blood from his brothers. He got a bit better and we have been seeing how he got on because the decision to do an above knee amputation in a child is not an easy one. We have been talking to him and speaking to his family and the operation was done today. He will feel better, I am sure, but it may still kill him. He is skin and bone. He hasn’t got any parents but is taken in by an auntie and his brothers are with him.

We see a lot of osteomyelitis, infected bones after open fractures, and even from closed ones. The native healers put on hot herbs, the skin breaks down and not only do they now have a non-union of a broken bone but they have an ulcer on top of it and an infection. It is very hard to get the message across that people should use traditional medicine when the provision of traditional medicine is poor. There is one hospital in Freetown which treats acute injuries but the majority of injures we see are old non-unions, infected non-unions.

I would like to get a lower limb orthopaedic team out here on a regular basis, perhaps a retired orthopaedic surgeon to stay here for six months.

Waiting for more rain, -a tree on the inside of the compound

Waiting for more rain, a tree on the inside of the compound

Leave a comment

Filed under Sierra Leone trip

Day 7, Sunday chicken coconut roulette and mass

There is a palm tree in the little garden in the middle of the compound and as we sit in the shade reading this morning, a large coconut without warning drops to the ground. I quite readily believe that it could kill you, which makes me wonder why one of the chickens seems to like sunning itself under the tree, some kind of weird chicken Russian coconut roulette perhaps, or maybe it is trying to show off to the other chicken. We are counting on spatchcock later.

I give the tree a wide berth from now one, as many of the coconuts still attached look remarkably large and ripe.

I go to mass with Rose this morning in the hospital chapel next door. I haven’t been for years. The choir is good and our physiotherapist Francis is also there. I am happy that I have taken the clothes I had made out of the local cloth here last time with me and that I am wearing them, as everyone is in their Sunday best. The collection boxes are divided into one for women and one for men, one of the best examples of ‘nudging’ I have seen for a long time. Nudging is when you get people to do what you want them to do without asking them directly, in this case I suspect the collections are increased a little as a result of competition between the sexes. Genius.

Nudging in the finest form, donation boxes for women and men

Nudging in the finest form, donation boxes for women and men

Our patients in the hospital are all well, including the little girl who had the emergency operation for a perforated bowel last week. Everyone on the general ward still pays for their medicine and sometimes the medicine just isn’t available. We are using the medication I was donated from the Wellington and the Edgware Community Hospital, so our patients do not need to pay and any surplus will of course go to the general side.

I am here with Rupert Eckersley, a consultant orthopaedic surgeon from Chelsea and Westminster. He was my boss in the hand unit when I worked at C&W as a registrar (2003) and later a great colleague when I was a consultant in the same unit (2004-2010). He came with me the last time we visited Makeni in 2011 and is the British Society for Surgery of the Hand’s president in 2016, so I hope to count on their continued support! (He is saying yes). He is also growing a beard so I am taking daily photographs to document the progress.

Rupert in clinic day 5

Rupert in clinic day 5, beard day 6

Dannie Seddon and Rhys Jones, the team anaesthetists, have returned from a well earned one night away to celebrate Dannie’s birthday at the seaside. They are flat out on a daily basis here apart from trying to arrange training for Maclean, the local nurse anaesthetist turned medical student, and fixing the anaesthetic machine with the leak.

Not quite sure what  is going on here, but resolve to keep well clear of the anaesthetic department disputes when they are brandishing  long sticks.....

Not quite sure what is going on here, but resolve to keep well clear of the anaesthetic department disputes when they are brandishing long sticks…..

A couple of the local boys have adopted Jocasta and when she is not working at the hospital she helps them with their homework.

Jocasta's private school

Jocasta’s private school

Leave a comment

Filed under Sierra Leone trip

Day 6, Saturday and trying out a Moser light

Ward round in the morning finds all our patients are well. The other patients in the female bay with my Malian patient take care of her and feed her (both her hands have been operated on and are in bandages) when the cook brings her food.

John Kanu kindly lends me the theatre log book where all the operations from the different teams are logged, so I can see what they have been doing so we have some sort of statistics. I also have to write our own operations from last week in it. I have from November 2011 until today to catch up on, but slowly I transcribe it onto my computer, perhaps a task I can finish tomorrow. In fact I can definitely finish it tomorrow, as I am definitely not going to finish it today.

I told our cook Usman about the Moser light – a plastic bottle, half out and half through the roof, filled with water and a little bleach which acts as a light bulb inside dark houses in daylight hours. A genius idea. Usman is game, so we go to his house and make one and try it out in the outside kitchen – I don’t want to make a hole in his roof in the rainy season! It is still brighter than the surroundings and he says he will try it inside.

Everyone gets stuck in making hte Moser light

Everyone gets stuck in making the Moser light

The light in te outside kitchen

The light in the outside kitchen (it is the bright blue square under the roof by the pole)

I go for a walk with Rose, our resident Irish nurse, who is funded by ReSurge Africa and the Voluntary Missionary Movement and has been at the Holy Spirit Hospital for a year and is staying another. She is on the wards and works with the local nurses to increase their knowledge and skills. We get a little lost in town, but are soon pointed the right way when we ask for directions.

Rose at teh nurses' desk in teh ward.

Rose at the nurses’ desk in the ward.

One of the many mosques in town. We hear the Muezzin call to prayer in the mornings, shortly followed by the singing at mass from the next door church

One of the many mosques in town.     We hear the Muezzin call to prayer in the mornings, shortly followed by the singing at mass from the next door church.

The last member of the ReSurge team is Jocasta, a hand therapist originally from Australia, but was in London when she got interested in Makeni. I have worked with Jocasta both in the NHS and in the private sector and know her to be totally laid back. People didn’t know she was coming back for another six months so when we arrived on Sunday there was double joy from our welcoming committee seeing her back.

we are not sure what Jocasta has in the suitcase, but think it might be next years' budget.

We are not sure what Jocasta has in the suitcase, but think it might be next year’s budget.

We are half way through our time here and though I can see so many things have changed for the better since last time, there is still so much more to do. I know everyone here works really hard every day and I am sure that John Kanu is exhausted by the time we leave. Patrick Turay, the hospital director, has made solid plans for the expansion of the hospital and I am sure everything will only get better and better.

Leave a comment

Filed under Sierra Leone trip