Dear Friends-
How can I be a week behind already…? It is now Monday morning: 22 November…
[And just as a warning, I am now finishing and sending it on 2 December!!]
Greetings in Jesus from faraway but close in love and heart Sierra Leone where I am trying to redeem the time, sitting on the guest house balcony, all my things packed out that go with me, the rest transferred up to “10 Hillside Baptist Church, Dwarzack Farm”, Susan’s address (I’m not there to have to feel the pain of those suitcases on the heads or shoulder of the hill-climbers!), as I await a ride to “the Provinces” as they say here to indicate anything other than Freetown and its sprawling suburbs. Victor has been “ on his way” to pick us up [for hours now- the final tally will be inserted here when he comes and I have to stop this update….(and the final tally is- 3.0 hrs!)] I have heard second-handedly through Susan as his phone lost charge last night in the middle of making plans and he “had no lights” (ie. electricity in the house was off; it comes and goes but is more consistent than previously, an honor ascribed to the current President Ernest Bah Koroma whom everyone I’ve questioned seems to be respecting, as a “man who is trying” within the current government setting).
Let me describe the congestion of this place… Freetown is on a peninsula but with no bypasses that keep anyone from going basically on an angle through the city center to get to any point. Clogging the roads are more and more private vehicles and many public transport taxi and poda-podas . The shared taxi is about $.25 for a route, it often takes 2 or 3 to complete a trip and sometimes very difficult to get one going your same way. There is usually something interesting in the mix of driver and other passengers, especially the ones who try to tell the driver which bypasses down rutty side streets (more like narrow lanes we’d find in someone’s field but lined with a solid row of metal or wooden shacks) he should use. There has been an improvement since I was last here in downtown areas with police enforcing a rule of only 1 passenger that needs be “in the harness” in the front seat and only 3 or 4 in the back. The poda-podas are the even cheaper ride, and, if you recall, are the minivans they stuff with an incredible load of passengers and then adorn with some pithy phrase to cover their particular situation : Mother’s Love; Thanks Be To Jesus (or Allah); You Can’t do Wrong and Be Right, etc. I guess they feel this imparts the blessing that they surely need to keep going; believe me, many of them seem to be doing that in defiance of the impossible, you are always having to swerve around a broken down one by the side of the road, which they are tinkering back together again. As I squeeze into one, I bless God for creating me with a very narrow personal space and usually reassure the squished persons beside me that one advantage of a “traditionally built” person like myself is no bones stick out to poke them… J Then I settle in to be thoroughly entertained, usually stuck in traffic long enough at some point to absorb it quite awhile: the interesting mix of people inside- Muslims with covered heads, moms with the cutest “pikins” to flirt with, school children in a vast array of individual school uniforms and then this conglomeration including me and my accompanying friends. Outside is the same mix intensified by the interest of what they are carrying on their heads, selling along the sidewalk or in the middle of the street, or pushing in wheelbarrows, wheelchairs or hugely loaded wooden carts dodging traffic like everyone else. it is often much quicker still to walk the city streets and we frequently choose that route thru the center of town 1- 2+ miles, from one outskirt taxi area to another beyond the more central grid, but if you are taking the transport on out of town you need to be on-board before you get to the lesser trafficked areas. Walking is also extremely congested- the vehicles coming from ahead and behind you constantly reminding you with their horns to make way and it is amazing there are not more pedestrian casualties, my friends consider me a magnet for oncoming vehicles: I am always being dragged/pushed further aside then anyone else needs for clearance (…if they can catch up with me that is ! J They usually have all my bags so I can just trek with the best of them, until it comes to climbing too steep of a hill…). [One other option, the fastest way of weaving through traffic and complicating/complicated by the maze of all of the above are motorbike transports but they have been strictly banned for me here as it is considered to be taking your life in your hands…] Hailing a taxi/poda-poda would be relatively easy for me except that each of our pronunciation of the street names is so individually dialected that neither side recognizes easily the others destination. [And Susan’s strict limitations hinder also: never enter a taxi with all men, never one that has the back seat full of a man-woman- man configuration, not if the driver looks “wrong”… ??? She makes quite the formidable protective Secret Service force of one and hates to have to give that job to others J] Often the roads are too narrow for all the parking to load and unload and 2 lanes of traffic both but that certainly doesn’t stop people from trying and the congestion grows accordingly. Now they are trying to widen a couple of the major routes to be officially 4-lane (so potentially 5-6…) and that is causing road construction delays on top of all else-… Really there is no way to travel from any one area of the town to another without traffic issues unless it is between midnite and 6am. Sigh, so this is all to remind myself that when I have expected someone for hours and they say they just completed their chores and have heard that the traffic is “dense” or “choked”, I should take disappointments of my anticipations or plans more graciously!!
On Tuesday, 16th Nov, I started this part of the letter:
Another day in Sierra Leone and this has been both an exhilarating and difficult one.
Spent it in the “Cottage Hospital” as it is called, actually Princess Children’s Maternity Hospital (PCMH) which is divided up into 2 sides, pediatrics and OB. This was the hospital right around the corner from where the Anastasis was docked, which was in middle of a strike, deserted by all staff except one national doctor, and where one ward was kept open by Mercy Ship staff, definitely saving several critically ill babies during the time of my initial trip here. It is now in much better repair, though inundated by the newly mandated “Free Health Care for Pregnant Mom’s and Babies” passed this spring by the President. This is definitely seen as another sign of much needed progress toward reducing the grave maternal/child mortality rate (still worst in the world; you have a 1:8 chance of dying in childbirth as a pregnant woman during your life here) but it is also put in place without near enough caregivers to attend to the accompanying increase in women seeking services.
I had a tour started by Gibrill Conteh, a Public Health nurse, who is superintending the children’s side, very pleasant and patient with my many questions but glad to finally land me in the maternity department about 10:30 so he could get back to his busy schedule. It was a Muslim holiday, so Susan and the kids were off school so they had accompanied me to this point and Susan finally decided I was safe at least as long as she left Olive (her daughter) and Peter Sefoe within call for me; they wandered around visiting the wards, Peter asking questions regarding the impact of the free health care mandate, taking notes and acting enough the part that he was quite proud with being asked if he were a journalist! There were 5 or 6 children’s wards we visited: malnutrition, dehydration from malaria or typhoid, some pneumonia, a case of measles and one of TB (the measles isolated, the TB not!). There were 2 abandoned children with family who had dropped them and never returned- who knows, perhaps they died themselves but one at least had give an incorrect address and her handicapped child made the suspicion of intent higher. To see 2 lappa (African printed cloth)-wrapped packages of various size, testified to the extent that some had not survived the disease or treatment. The neonatal unit perhaps fascinated me the most- a couple of incubators, nasal cannula O2 which was pointed out with pride as now having “mixers” giving capability for controlling the % and adding humidity. There was a set of 10 day old twins sharing one incubator born at approximately 28 wks that were looking pretty well as well as a couple other sets of older twins and some singlets- maybe 10 neonates in all. Oh, the simplicity of what they were trying to do so much with!! I think of our options and I am absolutely humbled by the contrast!!
In the Labour Ward there were several nurses on duty, they had had no laboring moms until just the half hour between 10-10:30am before I arrived within which 3 had walked sounds familiar to us OB nurses , we call it “feast or famine’ syndrome… 2 were laboring actively, one had been in labor she said some 24 hours previous and was not progressing so well. There was some interest in me being there, very little interest in the patients- the standard is for evaluations of progress and fetal well-being and maternal BP to occur every 4 hours: if they are obviously delivering, well then, no need to do any of the above… just let it happen. I made the rounds of the 3 patients frequently, practiced with the ear trumpet for heart-tones and finally got a little the hang of it- a cone shaped metal or hard plastic body narrows at approximately 6 inches into a little disc with a hole in it to which you place your ear. You would find the same place you would with electronic Doppler or ultrasound transducer to auscultate the baby’s heartrate- it picks up a whisper-y quiet sound/vibration you have to listen carefully for and compare with maternal pulse rate. The water was broke by the midwife for at least one of the active ones and we had meconium stained fluid (I think I only saw one birth without). The 2 active patients were started on Pitocin (or they say here: Syntocin) running “slow drip” which was very unmonitored and scary as all get out to me!! No one is really paying attention to the amount of contractions a woman is having but the patients are very aware of the connection, begging for it in some settings, disconnecting it if they decide they have too much… well, it’s a different world!! I am really not sure that I would not have preferred to be ignored than suffer the care of the midwives there when they finally did get to the point of delivery and were deemed worthy of receiving a little attention to get the job done… It was decided that I was not to watch but to deliver the back to back patients, they were not impressed that I would not cut an episiotomy on the prim-ip so did it for me. The sad tradition to us of female circumcision/genitalia mutilation is the norm here with very few exceptions so there is probably truly a need in many cases but it was cut straight laterally and I was busy doing the second delivery so didn’t see them stitch it up. Both deliveries were uncomplicated except for the meconium fluid of the one. One way or the other, the babe gets a swipe of the mouth with a piece of gauze, wrapped in a piece of lappa or item of the patients clothes that hasn’t already been used for an underpad for the mom, they provide none of that, a plastic piece under the patient that they rather act as if is the patients fault if it gets soiled. Somehow, the way that the midwives grabbed the closest piece of clothing/fabric (and these women had not come dressed in their worst clothing of course- dress is chosen carefully for the occasion here), and crammed it under them, will always portray the amount of disrespect they showed in the whole manner in which they gave their care or lack of it… Of course, no family member was allowed with them- “we have to be able to do our work…” (Having them leave the room for 5 minutes every 4 hours would have usually accomplished that as far as the nursing interaction went!!) Anyway, as it’s been since time began, usually God has arranged that nature will prevail despite great discomfort in childbirth and so both moms did very well, with babes born within 12 minutes of each other, both rather husky boys weighing in at 3.2 and 3.4 kilos. Both babies were Juniors- the first son in each family; Hawa delivered first, Baby Mohamed they thought and then Philip was the baby of Hannah, though they actually don’t announce the name until the next week naming ceremony. Assigned apgars were 9 @ 1min and they don’t assign a 5 min one as I guess they have stopped watching them by then… The families did come in a little to see the babies and of course, we had to take pictures, which we promised to try to get developed so I could share with them. I tried to get both kiddos, identified by their mom’s name on a piece of adhesive tape on their wrist and who were eagerly sucking on their fists, into their mom’s for breastfeeding within the first hour- the one mom did, the other refused but did at about 2 hours after she had had a good nap, woke up needing to be cleaned up and we finally chose to use a diaper out of the new pack she had: how strange it is to have almost nothing that is disposable available! So much that we take for granted!!
In the meantime, Isha, the pt who had been laboring a long time before she came in, was still laboring and without much progress and irregular uterine activity. As quickly as they had started the Pitocin on the active ladies, I was wondering why not on her… Well, they had told me before to be very careful with her care and what extra precautions they would be taking at time of delivery, as she was HIV positive, now they said that any intervention was going to be contra-indicated in her condition. The afternoon shift came in, about 4pm though they were due at 3p- but were apparently not expected any before that as “it was a holiday”. I got soft drinks for the departing /arriving nurses after I ran down the kids who were babysitting my bag with all my items in it ”. Both post-partum patients and their babies had by now been transferred to the other ward with much thanks for me and my promise to come back and see them as I could. Isha was crying miserably and begging for “a drip, but this seemed to move no one but me, and one of the new nurses settled down on a bench in the main admitting area and proceeded to take a nap while the other did charting. Then in came a transport pt for “obstructed labor” who was completely dilated but whose baby’s head had not descended at all. She was seen relatively quickly by the attending OB (there are 3 in the entire country, all operating from here because this is the official transfer hospital, with their services extend by med students) and consented for a Cesarean which thankfully are now are available without question if considered necessary. At this time, the sleeping nurse from the bench in the middle of the room where all the activity was taking place was awakened by literally shaking her shoulder, and rather disgusted to be expected to participate, took her down to the OR in a wheelchair... I had quickly done a check on Isha and there had been no apparent change in 3 hours which I reported to the charge midwife and she sent down a message to the attending doctor with the nurse going into surgery and so she did bring back an order to start an Oxytocin drip. I didn’t see this as going anywhere very quickly, was quite exhausted by all the day’s conflicts and so decided to go on home.
There had been many parades passing on the street all day and little transport available, so the kids and I decided to walk to the central point to get a taxi. We hadn’t been down the street very far, till the people standing outside a house we were passing, hailed us and insisted that we stay stepped back a slight bit from the street on their entryway, as “Bad boys, rough boys were coming”. I didn’t know what credence to give this but the kids took it in as a valid concern and sure enough another parade was coming that way and there were some pretty rough characters partying their way with it, and we drew enough attention surrounded by our “concerned citizens”, including a visit from one of the traditional “devils”, this one faceless and the entire suit covered with whiskey labels flapping like fringe. We probably halted there about 15 mins and then took a little different alternative route of f the main street and ended up walking 2 routes till we got a taxi on direct to the guesthouse.
Let me describe the congestion of this place… Freetown is on a peninsula but with no bypasses that keep anyone from going basically on an angle through the city center to get to any point. Clogging the roads are more and more private vehicles and many public transport taxi and poda-podas . The shared taxi is about $.25 for a route, it often takes 2 or 3 to complete a trip and sometimes very difficult to get one going your same way. There is usually something interesting in the mix of driver and other passengers, especially the ones who try to tell the driver which bypasses down rutty side streets (more like narrow lanes we’d find in someone’s field but lined with a solid row of metal or wooden shacks) he should use. There has been an improvement since I was last here in downtown areas with police enforcing a rule of only 1 passenger that needs be “in the harness” in the front seat and only 3 or 4 in the back. The poda-podas are the even cheaper ride, and, if you recall, are the minivans they stuff with an incredible load of passengers and then adorn with some pithy phrase to cover their particular situation : Mother’s Love; Thanks Be To Jesus (or Allah); You Can’t do Wrong and Be Right, etc. I guess they feel this imparts the blessing that they surely need to keep going; believe me, many of them seem to be doing that in defiance of the impossible, you are always having to swerve around a broken down one by the side of the road, which they are tinkering back together again. As I squeeze into one, I bless God for creating me with a very narrow personal space and usually reassure the squished persons beside me that one advantage of a “traditionally built” person like myself is no bones stick out to poke them… J Then I settle in to be thoroughly entertained, usually stuck in traffic long enough at some point to absorb it quite awhile: the interesting mix of people inside- Muslims with covered heads, moms with the cutest “pikins” to flirt with, school children in a vast array of individual school uniforms and then this conglomeration including me and my accompanying friends. Outside is the same mix intensified by the interest of what they are carrying on their heads, selling along the sidewalk or in the middle of the street, or pushing in wheelbarrows, wheelchairs or hugely loaded wooden carts dodging traffic like everyone else. it is often much quicker still to walk the city streets and we frequently choose that route thru the center of town 1- 2+ miles, from one outskirt taxi area to another beyond the more central grid, but if you are taking the transport on out of town you need to be on-board before you get to the lesser trafficked areas. Walking is also extremely congested- the vehicles coming from ahead and behind you constantly reminding you with their horns to make way and it is amazing there are not more pedestrian casualties, my friends consider me a magnet for oncoming vehicles: I am always being dragged/pushed further aside then anyone else needs for clearance (…if they can catch up with me that is ! J They usually have all my bags so I can just trek with the best of them, until it comes to climbing too steep of a hill…). [One other option, the fastest way of weaving through traffic and complicating/complicated by the maze of all of the above are motorbike transports but they have been strictly banned for me here as it is considered to be taking your life in your hands…] Hailing a taxi/poda-poda would be relatively easy for me except that each of our pronunciation of the street names is so individually dialected that neither side recognizes easily the others destination. [And Susan’s strict limitations hinder also: never enter a taxi with all men, never one that has the back seat full of a man-woman- man configuration, not if the driver looks “wrong”… ??? She makes quite the formidable protective Secret Service force of one and hates to have to give that job to others J] Often the roads are too narrow for all the parking to load and unload and 2 lanes of traffic both but that certainly doesn’t stop people from trying and the congestion grows accordingly. Now they are trying to widen a couple of the major routes to be officially 4-lane (so potentially 5-6…) and that is causing road construction delays on top of all else-… Really there is no way to travel from any one area of the town to another without traffic issues unless it is between midnite and 6am. Sigh, so this is all to remind myself that when I have expected someone for hours and they say they just completed their chores and have heard that the traffic is “dense” or “choked”, I should take disappointments of my anticipations or plans more graciously!!
On Tuesday, 16th Nov, I started this part of the letter:
Another day in Sierra Leone and this has been both an exhilarating and difficult one.
Spent it in the “Cottage Hospital” as it is called, actually Princess Children’s Maternity Hospital (PCMH) which is divided up into 2 sides, pediatrics and OB. This was the hospital right around the corner from where the Anastasis was docked, which was in middle of a strike, deserted by all staff except one national doctor, and where one ward was kept open by Mercy Ship staff, definitely saving several critically ill babies during the time of my initial trip here. It is now in much better repair, though inundated by the newly mandated “Free Health Care for Pregnant Mom’s and Babies” passed this spring by the President. This is definitely seen as another sign of much needed progress toward reducing the grave maternal/child mortality rate (still worst in the world; you have a 1:8 chance of dying in childbirth as a pregnant woman during your life here) but it is also put in place without near enough caregivers to attend to the accompanying increase in women seeking services.
I had a tour started by Gibrill Conteh, a Public Health nurse, who is superintending the children’s side, very pleasant and patient with my many questions but glad to finally land me in the maternity department about 10:30 so he could get back to his busy schedule. It was a Muslim holiday, so Susan and the kids were off school so they had accompanied me to this point and Susan finally decided I was safe at least as long as she left Olive (her daughter) and Peter Sefoe within call for me; they wandered around visiting the wards, Peter asking questions regarding the impact of the free health care mandate, taking notes and acting enough the part that he was quite proud with being asked if he were a journalist! There were 5 or 6 children’s wards we visited: malnutrition, dehydration from malaria or typhoid, some pneumonia, a case of measles and one of TB (the measles isolated, the TB not!). There were 2 abandoned children with family who had dropped them and never returned- who knows, perhaps they died themselves but one at least had give an incorrect address and her handicapped child made the suspicion of intent higher. To see 2 lappa (African printed cloth)-wrapped packages of various size, testified to the extent that some had not survived the disease or treatment. The neonatal unit perhaps fascinated me the most- a couple of incubators, nasal cannula O2 which was pointed out with pride as now having “mixers” giving capability for controlling the % and adding humidity. There was a set of 10 day old twins sharing one incubator born at approximately 28 wks that were looking pretty well as well as a couple other sets of older twins and some singlets- maybe 10 neonates in all. Oh, the simplicity of what they were trying to do so much with!! I think of our options and I am absolutely humbled by the contrast!!
In the Labour Ward there were several nurses on duty, they had had no laboring moms until just the half hour between 10-10:30am before I arrived within which 3 had walked sounds familiar to us OB nurses , we call it “feast or famine’ syndrome… 2 were laboring actively, one had been in labor she said some 24 hours previous and was not progressing so well. There was some interest in me being there, very little interest in the patients- the standard is for evaluations of progress and fetal well-being and maternal BP to occur every 4 hours: if they are obviously delivering, well then, no need to do any of the above… just let it happen. I made the rounds of the 3 patients frequently, practiced with the ear trumpet for heart-tones and finally got a little the hang of it- a cone shaped metal or hard plastic body narrows at approximately 6 inches into a little disc with a hole in it to which you place your ear. You would find the same place you would with electronic Doppler or ultrasound transducer to auscultate the baby’s heartrate- it picks up a whisper-y quiet sound/vibration you have to listen carefully for and compare with maternal pulse rate. The water was broke by the midwife for at least one of the active ones and we had meconium stained fluid (I think I only saw one birth without). The 2 active patients were started on Pitocin (or they say here: Syntocin) running “slow drip” which was very unmonitored and scary as all get out to me!! No one is really paying attention to the amount of contractions a woman is having but the patients are very aware of the connection, begging for it in some settings, disconnecting it if they decide they have too much… well, it’s a different world!! I am really not sure that I would not have preferred to be ignored than suffer the care of the midwives there when they finally did get to the point of delivery and were deemed worthy of receiving a little attention to get the job done… It was decided that I was not to watch but to deliver the back to back patients, they were not impressed that I would not cut an episiotomy on the prim-ip so did it for me. The sad tradition to us of female circumcision/genitalia mutilation is the norm here with very few exceptions so there is probably truly a need in many cases but it was cut straight laterally and I was busy doing the second delivery so didn’t see them stitch it up. Both deliveries were uncomplicated except for the meconium fluid of the one. One way or the other, the babe gets a swipe of the mouth with a piece of gauze, wrapped in a piece of lappa or item of the patients clothes that hasn’t already been used for an underpad for the mom, they provide none of that, a plastic piece under the patient that they rather act as if is the patients fault if it gets soiled. Somehow, the way that the midwives grabbed the closest piece of clothing/fabric (and these women had not come dressed in their worst clothing of course- dress is chosen carefully for the occasion here), and crammed it under them, will always portray the amount of disrespect they showed in the whole manner in which they gave their care or lack of it… Of course, no family member was allowed with them- “we have to be able to do our work…” (Having them leave the room for 5 minutes every 4 hours would have usually accomplished that as far as the nursing interaction went!!) Anyway, as it’s been since time began, usually God has arranged that nature will prevail despite great discomfort in childbirth and so both moms did very well, with babes born within 12 minutes of each other, both rather husky boys weighing in at 3.2 and 3.4 kilos. Both babies were Juniors- the first son in each family; Hawa delivered first, Baby Mohamed they thought and then Philip was the baby of Hannah, though they actually don’t announce the name until the next week naming ceremony. Assigned apgars were 9 @ 1min and they don’t assign a 5 min one as I guess they have stopped watching them by then… The families did come in a little to see the babies and of course, we had to take pictures, which we promised to try to get developed so I could share with them. I tried to get both kiddos, identified by their mom’s name on a piece of adhesive tape on their wrist and who were eagerly sucking on their fists, into their mom’s for breastfeeding within the first hour- the one mom did, the other refused but did at about 2 hours after she had had a good nap, woke up needing to be cleaned up and we finally chose to use a diaper out of the new pack she had: how strange it is to have almost nothing that is disposable available! So much that we take for granted!!
In the meantime, Isha, the pt who had been laboring a long time before she came in, was still laboring and without much progress and irregular uterine activity. As quickly as they had started the Pitocin on the active ladies, I was wondering why not on her… Well, they had told me before to be very careful with her care and what extra precautions they would be taking at time of delivery, as she was HIV positive, now they said that any intervention was going to be contra-indicated in her condition. The afternoon shift came in, about 4pm though they were due at 3p- but were apparently not expected any before that as “it was a holiday”. I got soft drinks for the departing /arriving nurses after I ran down the kids who were babysitting my bag with all my items in it ”. Both post-partum patients and their babies had by now been transferred to the other ward with much thanks for me and my promise to come back and see them as I could. Isha was crying miserably and begging for “a drip, but this seemed to move no one but me, and one of the new nurses settled down on a bench in the main admitting area and proceeded to take a nap while the other did charting. Then in came a transport pt for “obstructed labor” who was completely dilated but whose baby’s head had not descended at all. She was seen relatively quickly by the attending OB (there are 3 in the entire country, all operating from here because this is the official transfer hospital, with their services extend by med students) and consented for a Cesarean which thankfully are now are available without question if considered necessary. At this time, the sleeping nurse from the bench in the middle of the room where all the activity was taking place was awakened by literally shaking her shoulder, and rather disgusted to be expected to participate, took her down to the OR in a wheelchair... I had quickly done a check on Isha and there had been no apparent change in 3 hours which I reported to the charge midwife and she sent down a message to the attending doctor with the nurse going into surgery and so she did bring back an order to start an Oxytocin drip. I didn’t see this as going anywhere very quickly, was quite exhausted by all the day’s conflicts and so decided to go on home.
There had been many parades passing on the street all day and little transport available, so the kids and I decided to walk to the central point to get a taxi. We hadn’t been down the street very far, till the people standing outside a house we were passing, hailed us and insisted that we stay stepped back a slight bit from the street on their entryway, as “Bad boys, rough boys were coming”. I didn’t know what credence to give this but the kids took it in as a valid concern and sure enough another parade was coming that way and there were some pretty rough characters partying their way with it, and we drew enough attention surrounded by our “concerned citizens”, including a visit from one of the traditional “devils”, this one faceless and the entire suit covered with whiskey labels flapping like fringe. We probably halted there about 15 mins and then took a little different alternative route of f the main street and ended up walking 2 routes till we got a taxi on direct to the guesthouse.
My days are running all together, but I’m pretty sure this was the night that Victor brought 2 of his friends, and mine after the past 2 trips, by the guesthouse in the evening for a little- Sunny and Jeff are both from Nigeria like Vic is and obviously have a special camaraderie. (and their own Ibo dialect that Susan scolded them profusely for using in others company- which I thought kind of funny ‘cause when they get to speaking Krio fast it is still difficult for me to catch; riding that Sunday eve to the beach, I felt quite cheated of the fun as they all hee-hawed over some comedy spoof on the public radio!) Jeff and his wife Yvonne were married while I was here the last time and have a daughter, Precious; Sunny in the time between my trips and they also with a “girl-child”, Princess. We shared Susan’s good cooking and they didn’t stay so long…
Wednesday, Susan was off to school and so Dominick and Olive accompanied me to the hospital where Dominick stayed awhile and then went on to other errands, while after awhile she sent out an SOS for Peter to keep her company again. I was there by about 9 and it was an entirely different day- no sleeping today on the job, for every available space was taken up by a nursing, midwife or med student! There must have been 12 of them in all, seemed to be alternating somewhat at times, but most trying to crowd in for anything happening in any of the room. I’ve lost a little track, but I think there were 5 patients when I arrived. One was post-delivery by several hours and had had some increased bleeding, 3 had been transferred in from various other clinics or perhaps home (stories didn’t always match depending), with prolonged or “obstructed labour” as they call it and awaiting evaluation. And then, there still was Isha, laboring with no significant changes after a long night, whom I would have expected to have been delivered by Cesarean by at least 10pm of the night before! I had felt rather guilty the afternoon before for leaving her, but trusted that the augmentation would work for her or an alternative delivery would be provided, even as it was for others. Well, no- I was told, she had “not cooperated”, pulled her infusion line out of her IV lock site during the night and was demanding “operation” but still had not made much progress and so that sounded like a very justified thing to me… “How was the baby?” I asked and met with a shrug- “Well, if it is a problem, who is to blame?” Obviously, my answer would have been the opposite of theirs! Thankfully, when the attending doctor came in to evaluate, one of the younger nurses countered the information the older nurse was giving the MD- “She is just not trying; she still needs be made to try…”-with a vehement “How can someone just stop everything? She has had a long try and still there is nothing changing!!” Thank goodness someone took her part- there had been meconium from the day before, can’t imagine there was not a maternal temp, though who can tell from the profuse sweating, definitely dehydration after 3 days without any but a little mainline Pitocin; she went to OR as the first of the women waiting, begged me to go, which I wanted to do anyway, (this didn’t seem to phase the midwives) and then clung to me for the spinal anesthesia procedure. Of course, her blood pressure dropped, her IV was positional and thankfully they didn’t take too long getting the baby out- but he was a very limp, non-breathing male. One of the midwives had came to the OR to receive the babe, so he was carried to a warmer (not on!), heartrate was about 90 and dropping, and as I grabbed for the apparently much used ambu bag (no O2 attached), the nurse stopped me- “No, wait a minute!” while she attempted to stimulate and then just blew 2 or 3 forceful breaths into the opened mouth. No response, heartrate still going down and I was done waiting to see what they would do next! - I bagged with some difficulty in getting chest movement, adjusted, gave the bag to the other midwife who had been doing a few intermittent chest compressions and started regular ones with fervent prayers answered as pulse steadily increased and breathing efforts started, with that subtle return of tone that we know is the sign of hope again. He then went to the minimal observation status that they all get but the crisis was passed and he didn’t seem to expect any more attention than this… I won’t ever know what the sequence of events would have been if I hadn’t have taken over because I couldn’t wait and see- I only pray that this little boy won’t be infected with the HIV/AIDS. This babe had a huge caput (head misshapen from efforts to fit down the birth canal- showing that it was not something that time would have accomplished anything but another sad addition to the poor fetal statistics). There were 3 C-sections in a row after that, all women that had been transferred in after their labor had failed to bring progress, all exhausted and thankful for the option. I attended the second one, again as labor support I thought, but there was no hesitancy on the physician’s part in moving right into the procedure and suddenly he was asking, “Who is the nurse to receive this baby?” and suddenly the most likely option was me. Such thick meconium (a true knot in this cord!) and just the tiny little bulb syringe (“sucker”) to use, and me with 3 larger ones in my suitcase at the guesthouse… I would have probably gone to the third one, too, but there was much ado when I returned and a footling breech delivery in progress but the mom completely out of control, surrounded by students and having very spaced contractions. No IV yet, and here was a place for augmentation for sure! The mom was making very weak, completely uncoordinated pushing efforts and there is nothing to me so difficult to be patient with as in a breech presentation, you are so desperate to see that head emerge, but their midwives would have had infinitely more experience than we at it, the med students left it to them but followed my lead in assisting to increase indogenous Pitocin flow, while I got up on the bed behind the woman, getting her into position and coaching/insisting on concentrating to push and finally we saw the obvious turning that accompanies the descent process and shortly, with much more dram, there was our, thankfully, little girl! She needed a little assist, but stimulation accomplished a weak cry and she finally ended up by herself on a stretcher with an adult O2 mask laying in front of her face for a couple of hours and gradually pinked up… I finally found a dry lappa for her, too. Then at some time in this mix came in a patient with a very large belly, looking like possibly twins but just positioning somewhat skew, she had labored for some 18 hrs now and had given up- demanding a CS, crying that she would pay (In other words if the free-care was going to deny her what she thought she needed). She truly was a bit of a challenge, in and out of bed, sometimes rolling on the floor, continually wailing- (I gonna die, I gonna die…) and removing the Pitocin infusion as soon as it got her UC’s back to a little better pattern… She dilated but the baby remained high with her completely refusing to push- “Help me I beg, I can not do this, I am too tired, I go die…!!” Calling all her relatives in to give away her children. At one point as she wailed her “I go die…” litany, I tapped her forehead to counter each one with “Bad thot, bad thot, bad thot- you go be fine… “ and she cheered up for just a couple of minutes, thanked me and then in came another family member and the theme returned with extra emphasis. Anyway, the OB doctors evaluated and decided to try a vacuum attempt, done in the OR. As soon as we headed that way, she cheered up, as soon as I saw the literal vacuum glass jar with the metal attachment, I wasn’t sure I could handle being there for it but observation being my goal, and the pt quite delighted to have me there, I was game to stay but as a very happy ending, the MD who checked on fetal position did some manual manipulation of doubtless a posterior presentation and suddenly she was pushing on her own with a fine, medium size baby in about 3 pushes! Hallelujah!! But that was it for my day- it was about 6 pm and I was exhausted! Junior Thoronka had came to assist seeing me home, Vic was done and ready to spend the evening together but would have been counter-productive for him to come through traffic that direction, so we walked to where he had his car parked while he is working presently in an intern position at a bank here (unpaid for as long as they can manage to get you to accept it in that status- so he is applying several other places, too; hoping for the option of competitive offers to use for leverage, and in the meantime really is working hard, but thankfully and fruitfully he feels as he learns application of what he has worked so hard to master). Jeff was with him, the rest of us crowded in and we went on to the guesthouse, where politeness would have demanded I should have at least gone in to say “hello” to Susan, but seriously didn’t know if I had energy left to negotiate one flight of stairs (my own: “I weak, I weak…” situation ;0) and the beach outing Vic had planned, picking up dinner for us to take sounded so good!! That I just sat in the car waiting for it to start again and take me to “my centering place”- the ocean I love here! He’d brought barbequed chicken and jollof rice which is one of my favorites from the Delightful Café, which still has delightful food but poor internet connection… We reminisced and relaxed and then closed the evening with ice-cream for a treat from a store in the “strip mall” by the China Town Restaurant. There is each time more building of tourist-catering shops, restaurants and lodging in this beautiful, but more and more crowded beachfront area with some of the new guesthouses quite elaborate but priced for the European/ American tourist, so not an option for me while I am here. (Could you really tell someone you hadn’t enough money to pay for the meds they had been prescribed but unable to get yet due to “finances”while you were paying 4x that daily for luxury?) Anyway, once again I was relaxed and blessed by that time shared with such a dear friend.
The following day, Vic’s friend, Jeff was in charge of me and we travelled to the outskirts of town, slowly due to traffic, where he hiked me up a hill (I asked the wrong question: instead of “Is it far?” should have been, “Is it steep?” and it was for a hot afternoon!) His wife is a pretty young woman, Yvonne, expecting their 2nd child and meeting her again with the pretty lighter-skinned, green eyed Precious, was very nice- though the little 15 mo old didn’t see that she and I had anything too in common, and was still hiding from me when I left. She served us a very good meal of fish, rice and yams, and then we took some pictures, including their view over the bay inlet through the little tree created islands that always remind me of Florida Everglade area, toured the landladies house above theirs on our way out, and made it safely down the hill with only one slip for me just when I was remarking how I didn’t think I could ever make it climbing these hills in flip-flops as most of them do, I tripped and fell to one knee but with just a minor scrape, hardly a bruise.
Then Jeff took me on to the Tamba-family at the polio camp and it was very good to see their smiling faces! My little girls are growing up so much: Sia continues to be maturing into a quieter demeanor than she had on the historic day she dragged me in to meet her parents, the little sister who was to become “my Kumba” and newborn baby sister Finda, who is now 7 years old, and quite outgoing and mischievous! Tamba still struggles with the burdens of raising a family, getting a business established and Mabinty, his wife, has health problems that need further evaluation, so it seems that no matter what has been done, the needs are still accumulative and I hardly know how to address this in a consistent matte. I guess I need to do more reading of books like Gary Miller’s, even as I have discussed with him the micro-loan-type projects, it has been difficult for me to implement that in the fullest sense (probably because I am so lack-daisical at applying business principles in my own life!!) We didn’t stay so long this time, but hope to get out for a little outing with the family some time before I go.
Jeff delivered me all the way back to the guesthouse and I was ready to wash-up and enjoy the family atmosphere with my friends there for awhile before bedtime but had received an invitation for a Sierra Leone Midwife Association meeting where they were confirming their new officers and it was within walking distance from the guesthouse, Susan was eager to go and I had bought the t-shirt to get us in. So, we went and gave a show of support: the part that interested me the most in the actual meeting and hearing them recite the midwives pledge/creed
(Which I was sure some of them were perjuring themselves by saying!) was over, but we supported by buying some food and hanging around a little and then back to the guesthouse and to bed.
I’m sure Friday began with a visit from Peter and Mrs. Sefoe’s good breakfast. Then it was a day that Junior Thoronka and I went into town for a little shopping for Salamatu’s cloth that I am hoping she can dye and then make into bags for me to bring home for gifts and some potentially to sell. The one which she gave to me last trip has been my very favorite, and a most durable one, loaded heavily, and still with me everywhere here on this trip, usually commandeered by one of the bodyguards. It is very difficult for me to evaluate what the true dangers would be here anymore than any other place where you would travel; I personally feel comfortable and perhaps that makes them even that much more protective…
Jr and I went from town on to the school sporting event that each school has once a year and makes a big thing out of; they divide into House’s who each wear a different color of top and then do relays, different length track events and have a generally athletic time of fun and competition. I was soon invited to the tent where the faculty was and announcing and record keeping was being kept and made some little and big friends who fed me and even better furnished me with cold drinks as I had forgotten my water and am always parched here. I was soon informed I would be in charge of judging an interesting competition called “Ready for School”. The four houses- red, green, blue and yellow had a competitor who arrived with a backpack and a school uniform and sitting on chairs with a chair to use as a dressing table they proceeded to get ready for school in front of us. They washed their feet, put on socks and shoes, changed everything down to their underwear, keeping themselves protected by a towel as they shifted from one outfit to the other, tightening everything down, shining and primping a little bit and then taking out their books they carefully sauntered (I would have thought it was so as not to get their shoes and socks dusty except I have been behind far too many of them in town and it is their one and must be the “cool” speed…) down to the end to be judged on neatness and completeness. It really wasn’t about speed, which was good as the green candidate was late and had already been disqualified by the time she arrived but hadn’t heard this, but her hurriedness didn’t help and I had to place her last anyway. Sure enough, the most nonchalant but still the fastest to get through and the “coolest” of the saunterers really did look the most put together- there is one like that in every class, isn’t there? I got to award the trophies also for a couple of the events, so how useful it is to have someone visiting around that is obvious to spot! It actually was a lot of fun and then we had an interesting close to the evening in Jr offering to deliver the cutest little baby girl back from her baby-sitter to her mother along the poda-poda route, so did I get the stares as I walked off with this little pikin who cuddled with me all along the way that was this time all too short and sure enough, there was her mom waiting for her at one of the stops we made. Made me think again about finding one that’s needing a mommy to snuggle with!! Home again to the guesthouse and I believe Vic might have been by again… Perhaps it was Alie that night…
Then on Saturday, I spent quite a bit of time at the computer in Eric’s office where he oversees computer classes and consigned work for clients and where Peter Sefoe sometimes assists also. Saturday night, Vic came by a little later than usual and tired, all of us we ate together some of Susan or Princess’s good cooking. I had had a more restful day and was eager for some time out, so even though I could have been contented with a walk around the neighborhood, he decided we would go out again “for ice cream” which means the beach area and we started through the still rather heavy traffic. He takes his driving very seriously and it is a continual challenge to outguess the other vehicles. We were enjoying some light visiting; I well know the rules are to be sure he can concentrate on the traffic but it slipped into a little variance on cultural differences suddenly and just at that time there was a stopped poda-poda in the middle of our side of the road, no lights visible and as he quickly swerved to avoid it, a motorbike from behind also went to pass us both and we glanced it enough to throw it out of control! I will never forget the horror of seeing it teeter at the roadside, the passenger fall off into the far side of the road and then it careen on to spill on the ditch on our side beyond the stopped vehicle where the driver was catapulted off, the bike laying on its side. With an anguished, “See, now you know why I tell you we can’t talk in the car…?!!” and an unquestionable command- “Do not get out of the car!” which I knew trumped even my weak- “But I am a nurse…“ as he dashed to see the extent of the injuries. There was an immediately huge crowd in attendance, around the site of the bike and driver, the other young girl had immediately got up and went to see also to the driver and the next thing was the door opening with a bystander carrying the driver who was unconscious, and she (it surprisingly was a young Muslim girl who had been driving the bike: with what amount of experience I never found out) and her sister were being taken to the hospital by Vic and I, accompanied by the man who had suddenly became an advocate for “my young sisters”, with as far as we could tell, only by virtue of having been there to see the incident. I really couldn’t examine the patient, her pulse was a little weak and not at all rapid, she moaned a few times to her sister’s plea of “Talk to me sister, please.” And then to continue the prayers that had started at the moment of the incident was all that seemed possible and the most needed. Seemed to take a very long time to find the hospital Victor had specifically chosen for his experience with it having swift treatment and skilled practitioners; believe me, I wasn’t talking much, Victor was handling the whole thing very well, reassuring the sister of our concern and assisting her to inform the parents of what had happened. The one girl started out by insisting- “Take us to the police station!” but Victor was adamant in repeating, “Life comes first!” and later we talked about the complications that police involvement might have brought to the situation, especially if they saw myself as part of the picture that could be manipulated to advantage for them. The man with us was fairly neutral as a witness in our discussion: the girls were at fault “the most” for coming up from behind to pass without indication, but “You could have probably seen them if you were watching closer…”- how I repented for my probable part in this deficit! The hospital did receive us well, the young lady was able to walk in without assistance and her complaint was of pain to the center of her chest. I snuck in a quick keychain light check of her pupils and they were equally reactive, which was my greatest relief as I had been afraid she may have hit the wall with her head on her final slide. She had no signs of anything fractured in her collarbone/chest/rib area, no obvious bruising even, and her vital signs were fine. I am sure she had had the wind knocked out of her on impact and was probably scared to death about the consequences of the accident in general. They started an IV, added a painkiller to the drip and let it infuse freely. In the meantime, the sister’s road scrapes on her hand, elbow, and knees were cleaned and dressed and she was given an injection for pain also. Only after all of this, did the nurse in charge, who had seemed to be a competent man, turn to me and say- “And now, we must talk about the bill…” I had rather dreaded this part and felt a bit more vulnerable because Victor had left the room for a little, but just simply asked the Lord for grace and said, “I will be glad to pay what is fair for the treatment but I will not pay more just because I am a white woman.” “No” he said, “I can tell you and your friend are trying to do the right thing and are full of compassion so you will pay only the usual.” That was 50,000 Leones, approximately $12.50 US. There was some antibiotics and pain meds also that made it another $10 or so, we left them with transport money, the brother having arrived, and exchanged phone numbers before we went ahead and left. (Victor has checked in a couple of times subsequently, and there seems to be full resolution of all to this time, but I am so sorry it all had to happen and just thank the good Lord it was no worse for anyone!!)
Victor said he didn’t think this should “cheat us” out of our ice-cream, and I was certainly feeling the need of a de-briefing, so we backtracked to the original plan and, though we decided we had better not spend the diminished funds on non-necessary, we had a little chicken and rice he had brought when he had came that evening, so we ate that and rejoiced together that the Lord had so graciously spared us all a far greater tragedy to mar the memory of my trip. And, he certainly had a good point to prove his requests as not have meant to be harsh, but it is just a very critical thing to drive in such unpredictable environment and he felt very bad, even embarrassed for not having “trafficated” better. (An apt word seeming to fit an origin here as “driving through complicated traffic”, I guess!) How greatly we gave thanks for God’s protection!!!
Somehow, now 2 weeks behind, I am getting a little clouded- have far more to share and to give you a little happier preview of the nursing side of this- I finished much of this last mail as I awaited the births 2 days in a row of babies at my favorite clinic at Bo again, the Massah Memorial Maternity one along with my dear midwife/friend/mentor Sister Theresa… A much happier experience and details will be your way one of these days… have also had time in Makeni with the dear ones there and oh, there is so much to tell with time going so fast!!
My life and adventures are exciting right now, but no more important I want to emphasize then all that He is working within your own. I know every day there are things in your life very significant and blessings/protections perhaps far more than we even realize from moment to moment. May He continue His loving care over us all!
Keep me in your prayers as I do each of you! [Please forgive my mistakes in this (besides it’s great length!!!) it comes to you unedited and thus in need of your grace, as we all are dependent on HIs!!]
Wednesday, Susan was off to school and so Dominick and Olive accompanied me to the hospital where Dominick stayed awhile and then went on to other errands, while after awhile she sent out an SOS for Peter to keep her company again. I was there by about 9 and it was an entirely different day- no sleeping today on the job, for every available space was taken up by a nursing, midwife or med student! There must have been 12 of them in all, seemed to be alternating somewhat at times, but most trying to crowd in for anything happening in any of the room. I’ve lost a little track, but I think there were 5 patients when I arrived. One was post-delivery by several hours and had had some increased bleeding, 3 had been transferred in from various other clinics or perhaps home (stories didn’t always match depending), with prolonged or “obstructed labour” as they call it and awaiting evaluation. And then, there still was Isha, laboring with no significant changes after a long night, whom I would have expected to have been delivered by Cesarean by at least 10pm of the night before! I had felt rather guilty the afternoon before for leaving her, but trusted that the augmentation would work for her or an alternative delivery would be provided, even as it was for others. Well, no- I was told, she had “not cooperated”, pulled her infusion line out of her IV lock site during the night and was demanding “operation” but still had not made much progress and so that sounded like a very justified thing to me… “How was the baby?” I asked and met with a shrug- “Well, if it is a problem, who is to blame?” Obviously, my answer would have been the opposite of theirs! Thankfully, when the attending doctor came in to evaluate, one of the younger nurses countered the information the older nurse was giving the MD- “She is just not trying; she still needs be made to try…”-with a vehement “How can someone just stop everything? She has had a long try and still there is nothing changing!!” Thank goodness someone took her part- there had been meconium from the day before, can’t imagine there was not a maternal temp, though who can tell from the profuse sweating, definitely dehydration after 3 days without any but a little mainline Pitocin; she went to OR as the first of the women waiting, begged me to go, which I wanted to do anyway, (this didn’t seem to phase the midwives) and then clung to me for the spinal anesthesia procedure. Of course, her blood pressure dropped, her IV was positional and thankfully they didn’t take too long getting the baby out- but he was a very limp, non-breathing male. One of the midwives had came to the OR to receive the babe, so he was carried to a warmer (not on!), heartrate was about 90 and dropping, and as I grabbed for the apparently much used ambu bag (no O2 attached), the nurse stopped me- “No, wait a minute!” while she attempted to stimulate and then just blew 2 or 3 forceful breaths into the opened mouth. No response, heartrate still going down and I was done waiting to see what they would do next! - I bagged with some difficulty in getting chest movement, adjusted, gave the bag to the other midwife who had been doing a few intermittent chest compressions and started regular ones with fervent prayers answered as pulse steadily increased and breathing efforts started, with that subtle return of tone that we know is the sign of hope again. He then went to the minimal observation status that they all get but the crisis was passed and he didn’t seem to expect any more attention than this… I won’t ever know what the sequence of events would have been if I hadn’t have taken over because I couldn’t wait and see- I only pray that this little boy won’t be infected with the HIV/AIDS. This babe had a huge caput (head misshapen from efforts to fit down the birth canal- showing that it was not something that time would have accomplished anything but another sad addition to the poor fetal statistics). There were 3 C-sections in a row after that, all women that had been transferred in after their labor had failed to bring progress, all exhausted and thankful for the option. I attended the second one, again as labor support I thought, but there was no hesitancy on the physician’s part in moving right into the procedure and suddenly he was asking, “Who is the nurse to receive this baby?” and suddenly the most likely option was me. Such thick meconium (a true knot in this cord!) and just the tiny little bulb syringe (“sucker”) to use, and me with 3 larger ones in my suitcase at the guesthouse… I would have probably gone to the third one, too, but there was much ado when I returned and a footling breech delivery in progress but the mom completely out of control, surrounded by students and having very spaced contractions. No IV yet, and here was a place for augmentation for sure! The mom was making very weak, completely uncoordinated pushing efforts and there is nothing to me so difficult to be patient with as in a breech presentation, you are so desperate to see that head emerge, but their midwives would have had infinitely more experience than we at it, the med students left it to them but followed my lead in assisting to increase indogenous Pitocin flow, while I got up on the bed behind the woman, getting her into position and coaching/insisting on concentrating to push and finally we saw the obvious turning that accompanies the descent process and shortly, with much more dram, there was our, thankfully, little girl! She needed a little assist, but stimulation accomplished a weak cry and she finally ended up by herself on a stretcher with an adult O2 mask laying in front of her face for a couple of hours and gradually pinked up… I finally found a dry lappa for her, too. Then at some time in this mix came in a patient with a very large belly, looking like possibly twins but just positioning somewhat skew, she had labored for some 18 hrs now and had given up- demanding a CS, crying that she would pay (In other words if the free-care was going to deny her what she thought she needed). She truly was a bit of a challenge, in and out of bed, sometimes rolling on the floor, continually wailing- (I gonna die, I gonna die…) and removing the Pitocin infusion as soon as it got her UC’s back to a little better pattern… She dilated but the baby remained high with her completely refusing to push- “Help me I beg, I can not do this, I am too tired, I go die…!!” Calling all her relatives in to give away her children. At one point as she wailed her “I go die…” litany, I tapped her forehead to counter each one with “Bad thot, bad thot, bad thot- you go be fine… “ and she cheered up for just a couple of minutes, thanked me and then in came another family member and the theme returned with extra emphasis. Anyway, the OB doctors evaluated and decided to try a vacuum attempt, done in the OR. As soon as we headed that way, she cheered up, as soon as I saw the literal vacuum glass jar with the metal attachment, I wasn’t sure I could handle being there for it but observation being my goal, and the pt quite delighted to have me there, I was game to stay but as a very happy ending, the MD who checked on fetal position did some manual manipulation of doubtless a posterior presentation and suddenly she was pushing on her own with a fine, medium size baby in about 3 pushes! Hallelujah!! But that was it for my day- it was about 6 pm and I was exhausted! Junior Thoronka had came to assist seeing me home, Vic was done and ready to spend the evening together but would have been counter-productive for him to come through traffic that direction, so we walked to where he had his car parked while he is working presently in an intern position at a bank here (unpaid for as long as they can manage to get you to accept it in that status- so he is applying several other places, too; hoping for the option of competitive offers to use for leverage, and in the meantime really is working hard, but thankfully and fruitfully he feels as he learns application of what he has worked so hard to master). Jeff was with him, the rest of us crowded in and we went on to the guesthouse, where politeness would have demanded I should have at least gone in to say “hello” to Susan, but seriously didn’t know if I had energy left to negotiate one flight of stairs (my own: “I weak, I weak…” situation ;0) and the beach outing Vic had planned, picking up dinner for us to take sounded so good!! That I just sat in the car waiting for it to start again and take me to “my centering place”- the ocean I love here! He’d brought barbequed chicken and jollof rice which is one of my favorites from the Delightful Café, which still has delightful food but poor internet connection… We reminisced and relaxed and then closed the evening with ice-cream for a treat from a store in the “strip mall” by the China Town Restaurant. There is each time more building of tourist-catering shops, restaurants and lodging in this beautiful, but more and more crowded beachfront area with some of the new guesthouses quite elaborate but priced for the European/ American tourist, so not an option for me while I am here. (Could you really tell someone you hadn’t enough money to pay for the meds they had been prescribed but unable to get yet due to “finances”while you were paying 4x that daily for luxury?) Anyway, once again I was relaxed and blessed by that time shared with such a dear friend.
The following day, Vic’s friend, Jeff was in charge of me and we travelled to the outskirts of town, slowly due to traffic, where he hiked me up a hill (I asked the wrong question: instead of “Is it far?” should have been, “Is it steep?” and it was for a hot afternoon!) His wife is a pretty young woman, Yvonne, expecting their 2nd child and meeting her again with the pretty lighter-skinned, green eyed Precious, was very nice- though the little 15 mo old didn’t see that she and I had anything too in common, and was still hiding from me when I left. She served us a very good meal of fish, rice and yams, and then we took some pictures, including their view over the bay inlet through the little tree created islands that always remind me of Florida Everglade area, toured the landladies house above theirs on our way out, and made it safely down the hill with only one slip for me just when I was remarking how I didn’t think I could ever make it climbing these hills in flip-flops as most of them do, I tripped and fell to one knee but with just a minor scrape, hardly a bruise.
Then Jeff took me on to the Tamba-family at the polio camp and it was very good to see their smiling faces! My little girls are growing up so much: Sia continues to be maturing into a quieter demeanor than she had on the historic day she dragged me in to meet her parents, the little sister who was to become “my Kumba” and newborn baby sister Finda, who is now 7 years old, and quite outgoing and mischievous! Tamba still struggles with the burdens of raising a family, getting a business established and Mabinty, his wife, has health problems that need further evaluation, so it seems that no matter what has been done, the needs are still accumulative and I hardly know how to address this in a consistent matte. I guess I need to do more reading of books like Gary Miller’s, even as I have discussed with him the micro-loan-type projects, it has been difficult for me to implement that in the fullest sense (probably because I am so lack-daisical at applying business principles in my own life!!) We didn’t stay so long this time, but hope to get out for a little outing with the family some time before I go.
Jeff delivered me all the way back to the guesthouse and I was ready to wash-up and enjoy the family atmosphere with my friends there for awhile before bedtime but had received an invitation for a Sierra Leone Midwife Association meeting where they were confirming their new officers and it was within walking distance from the guesthouse, Susan was eager to go and I had bought the t-shirt to get us in. So, we went and gave a show of support: the part that interested me the most in the actual meeting and hearing them recite the midwives pledge/creed
(Which I was sure some of them were perjuring themselves by saying!) was over, but we supported by buying some food and hanging around a little and then back to the guesthouse and to bed.
I’m sure Friday began with a visit from Peter and Mrs. Sefoe’s good breakfast. Then it was a day that Junior Thoronka and I went into town for a little shopping for Salamatu’s cloth that I am hoping she can dye and then make into bags for me to bring home for gifts and some potentially to sell. The one which she gave to me last trip has been my very favorite, and a most durable one, loaded heavily, and still with me everywhere here on this trip, usually commandeered by one of the bodyguards. It is very difficult for me to evaluate what the true dangers would be here anymore than any other place where you would travel; I personally feel comfortable and perhaps that makes them even that much more protective…
Jr and I went from town on to the school sporting event that each school has once a year and makes a big thing out of; they divide into House’s who each wear a different color of top and then do relays, different length track events and have a generally athletic time of fun and competition. I was soon invited to the tent where the faculty was and announcing and record keeping was being kept and made some little and big friends who fed me and even better furnished me with cold drinks as I had forgotten my water and am always parched here. I was soon informed I would be in charge of judging an interesting competition called “Ready for School”. The four houses- red, green, blue and yellow had a competitor who arrived with a backpack and a school uniform and sitting on chairs with a chair to use as a dressing table they proceeded to get ready for school in front of us. They washed their feet, put on socks and shoes, changed everything down to their underwear, keeping themselves protected by a towel as they shifted from one outfit to the other, tightening everything down, shining and primping a little bit and then taking out their books they carefully sauntered (I would have thought it was so as not to get their shoes and socks dusty except I have been behind far too many of them in town and it is their one and must be the “cool” speed…) down to the end to be judged on neatness and completeness. It really wasn’t about speed, which was good as the green candidate was late and had already been disqualified by the time she arrived but hadn’t heard this, but her hurriedness didn’t help and I had to place her last anyway. Sure enough, the most nonchalant but still the fastest to get through and the “coolest” of the saunterers really did look the most put together- there is one like that in every class, isn’t there? I got to award the trophies also for a couple of the events, so how useful it is to have someone visiting around that is obvious to spot! It actually was a lot of fun and then we had an interesting close to the evening in Jr offering to deliver the cutest little baby girl back from her baby-sitter to her mother along the poda-poda route, so did I get the stares as I walked off with this little pikin who cuddled with me all along the way that was this time all too short and sure enough, there was her mom waiting for her at one of the stops we made. Made me think again about finding one that’s needing a mommy to snuggle with!! Home again to the guesthouse and I believe Vic might have been by again… Perhaps it was Alie that night…
Then on Saturday, I spent quite a bit of time at the computer in Eric’s office where he oversees computer classes and consigned work for clients and where Peter Sefoe sometimes assists also. Saturday night, Vic came by a little later than usual and tired, all of us we ate together some of Susan or Princess’s good cooking. I had had a more restful day and was eager for some time out, so even though I could have been contented with a walk around the neighborhood, he decided we would go out again “for ice cream” which means the beach area and we started through the still rather heavy traffic. He takes his driving very seriously and it is a continual challenge to outguess the other vehicles. We were enjoying some light visiting; I well know the rules are to be sure he can concentrate on the traffic but it slipped into a little variance on cultural differences suddenly and just at that time there was a stopped poda-poda in the middle of our side of the road, no lights visible and as he quickly swerved to avoid it, a motorbike from behind also went to pass us both and we glanced it enough to throw it out of control! I will never forget the horror of seeing it teeter at the roadside, the passenger fall off into the far side of the road and then it careen on to spill on the ditch on our side beyond the stopped vehicle where the driver was catapulted off, the bike laying on its side. With an anguished, “See, now you know why I tell you we can’t talk in the car…?!!” and an unquestionable command- “Do not get out of the car!” which I knew trumped even my weak- “But I am a nurse…“ as he dashed to see the extent of the injuries. There was an immediately huge crowd in attendance, around the site of the bike and driver, the other young girl had immediately got up and went to see also to the driver and the next thing was the door opening with a bystander carrying the driver who was unconscious, and she (it surprisingly was a young Muslim girl who had been driving the bike: with what amount of experience I never found out) and her sister were being taken to the hospital by Vic and I, accompanied by the man who had suddenly became an advocate for “my young sisters”, with as far as we could tell, only by virtue of having been there to see the incident. I really couldn’t examine the patient, her pulse was a little weak and not at all rapid, she moaned a few times to her sister’s plea of “Talk to me sister, please.” And then to continue the prayers that had started at the moment of the incident was all that seemed possible and the most needed. Seemed to take a very long time to find the hospital Victor had specifically chosen for his experience with it having swift treatment and skilled practitioners; believe me, I wasn’t talking much, Victor was handling the whole thing very well, reassuring the sister of our concern and assisting her to inform the parents of what had happened. The one girl started out by insisting- “Take us to the police station!” but Victor was adamant in repeating, “Life comes first!” and later we talked about the complications that police involvement might have brought to the situation, especially if they saw myself as part of the picture that could be manipulated to advantage for them. The man with us was fairly neutral as a witness in our discussion: the girls were at fault “the most” for coming up from behind to pass without indication, but “You could have probably seen them if you were watching closer…”- how I repented for my probable part in this deficit! The hospital did receive us well, the young lady was able to walk in without assistance and her complaint was of pain to the center of her chest. I snuck in a quick keychain light check of her pupils and they were equally reactive, which was my greatest relief as I had been afraid she may have hit the wall with her head on her final slide. She had no signs of anything fractured in her collarbone/chest/rib area, no obvious bruising even, and her vital signs were fine. I am sure she had had the wind knocked out of her on impact and was probably scared to death about the consequences of the accident in general. They started an IV, added a painkiller to the drip and let it infuse freely. In the meantime, the sister’s road scrapes on her hand, elbow, and knees were cleaned and dressed and she was given an injection for pain also. Only after all of this, did the nurse in charge, who had seemed to be a competent man, turn to me and say- “And now, we must talk about the bill…” I had rather dreaded this part and felt a bit more vulnerable because Victor had left the room for a little, but just simply asked the Lord for grace and said, “I will be glad to pay what is fair for the treatment but I will not pay more just because I am a white woman.” “No” he said, “I can tell you and your friend are trying to do the right thing and are full of compassion so you will pay only the usual.” That was 50,000 Leones, approximately $12.50 US. There was some antibiotics and pain meds also that made it another $10 or so, we left them with transport money, the brother having arrived, and exchanged phone numbers before we went ahead and left. (Victor has checked in a couple of times subsequently, and there seems to be full resolution of all to this time, but I am so sorry it all had to happen and just thank the good Lord it was no worse for anyone!!)
Victor said he didn’t think this should “cheat us” out of our ice-cream, and I was certainly feeling the need of a de-briefing, so we backtracked to the original plan and, though we decided we had better not spend the diminished funds on non-necessary, we had a little chicken and rice he had brought when he had came that evening, so we ate that and rejoiced together that the Lord had so graciously spared us all a far greater tragedy to mar the memory of my trip. And, he certainly had a good point to prove his requests as not have meant to be harsh, but it is just a very critical thing to drive in such unpredictable environment and he felt very bad, even embarrassed for not having “trafficated” better. (An apt word seeming to fit an origin here as “driving through complicated traffic”, I guess!) How greatly we gave thanks for God’s protection!!!
Somehow, now 2 weeks behind, I am getting a little clouded- have far more to share and to give you a little happier preview of the nursing side of this- I finished much of this last mail as I awaited the births 2 days in a row of babies at my favorite clinic at Bo again, the Massah Memorial Maternity one along with my dear midwife/friend/mentor Sister Theresa… A much happier experience and details will be your way one of these days… have also had time in Makeni with the dear ones there and oh, there is so much to tell with time going so fast!!
My life and adventures are exciting right now, but no more important I want to emphasize then all that He is working within your own. I know every day there are things in your life very significant and blessings/protections perhaps far more than we even realize from moment to moment. May He continue His loving care over us all!
Keep me in your prayers as I do each of you! [Please forgive my mistakes in this (besides it’s great length!!!) it comes to you unedited and thus in need of your grace, as we all are dependent on HIs!!]
In Him, Christine
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