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

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

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

…and cooked!

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