Work

It is time to write about work. I have been avoiding it but think I can do so no longer. It may not be for the faint hearted amongst you. I work short hours; I usually get to the hospital about 9am, sometimes later and leave by 3. Today I left about 1.30 as I had had enough. No-one chases me and I am deciding my own work. My mission (should I choose to accept it; oh no, I have already) is to increase the capacity of the staff in maternity and to provide on the job training. So I spent the last 2 weeks observing and just trying to understand what is going on. I don't think I have succeeded in that, but maybe it will come with time. My main concern is the maternity ward, as the ante natal clinic runs fairly well. The Mat ward has anyone on it who is pregnant, in labour, delivered or what ever. So today we have 12 out of 13 beds full with cases from abortion (illegal here), to post natals of about 3 weeks. We have very little equipment. I saw that baby checks were not being carried out and so I started training staff how to do them and in the first 2 days we picked up one septic baby and one with birth asphyxia. The first one got the only suitable size cannula for his IV, so when the 2nd one needed an IV line we had problems. Then we found one in my office, but the dr. missed the vein first so had to use the same one again. Then I saw the following day that the cannula was in the baby's foot; it must have been the same one as we had no others. I read before I came out here that medical care for mothers and babies is free. Let me tell you it is not. They pay for their paper notes when they come in, they pay for equipment and drugs. A few drugs are supplied by the hospital but they run out quickly. So the babies only got some of their antibiotics as the parents could not pay for the full course and this is bad practice as regards resistance to anti biotics. They both improved. The delivery room is terrible; high hard tables in an unclean room. Everything is unclean. There is one bottle of 'soap' in the delivery room and we wash our hands with chorine water. There is nothing to dry them on. None of the toilets flush or have soap. The patients go outside to the loo. We have electricity only when the generator is one (for operations) so it goes without saying there are no CTGs or drug pumps or anything like that. I have not yet seen a birth here (pain relief only for CS) so that will be interesting. The reason I left early today was that we had a 21 year old in who had delivered her first twin on 11th Nov. in the afternoon in a maternal and child health post out in a village somewhere. She came in with someone in a uniform of sorts who had done the delivery (so I think not an untrained trad. birth attendent) but the second twin was not yet born. What followed was not good. The baby will certainly be dead. Why leave her for nearly 2 days before coming in??? She was transferred out just before I left to another local (and better) hospital. Still with the baby unborn. My aim is to get some organisation into the ward before I can do anything else. It is run by unqualified staff and the odd student, while the midwife in charge is elsewhere (often asleep). They do not allocate staff to patients, so 'care' is extremely haphazard. Drugs don't get given, sutures not removed etc.etc. They have wonderful staffing levels; 10 staff for 13 patients (excluding me) but they all move about the ward together like a shoal of fish. The consequence is that no-one has any responsibility. There are other things; labours of 6 days resulting in ruptured uterii, eclamptic fits. It's all good learning!

My weekend

Was the last post a bit negative? This will be more positive, I promise. I will describe to you my last weekend as I can't quite get round to telling you yet about work. I have also neglected to tell you about my house mates: Kiki who is a Dutch nurse and is staying here until she can go to her placement about 15miles away, Annette who is a nurse tutor at the Northern Poly here in Makeni (from the Philipines) and Celine from Canada, who does the same job as Annette. So that's us.

Annette had some friends going to Bo, which is another city (town really) some distance away, I don't know how far, but when there is a ride, it's a good idea to take it. So we met up in Makeni: Father Edgar (priest), two Marias who live in Yele (part way to Bo) and me. Oh, we also had a chicken in the truck (live). We had a fun journey to Yele to see the lovely house there where the Marias live - facing the river in a lovely setting - and then we all went off to Bo on these roads that are like nothing on earth! Full of pot holes that even a 4 wheel drive found difficult to negotiate. We met an 'unofficial' road block - a tree across the road - which is how some people earn money here. Edgar got out to pay and pointed to me, the man smiled and waved. He was apparently telling him it was my birthday (it wasn't) and he let us off cheaper. Then we stopped to buy some massive grapefruit at the road side. These cost 100 Le each (6000 = 1 pound sterling) and again there was pointing and smiling. It was my birthday again! I said to Edgar: "for a priest you tell an awful lot of lies" and they all roared with laughter. And that was what the whole trip was like; lots of laughter. Philipinos like to laugh and eat and are great company. So we arrived in Bo and went to where we were going to stay, but after a couple of hours I was offered the chance to ride home again that night with Edgar and the 2 Marias as far as Yele, so I took it. The alternative was to get the poda poda (rickety old bus) back the following day. We dropped off the Marias and Edgar and I continued on the bumpy roads. We found the road blocked by a truck at one stage and just managed to squeeze past it. The front wheel had fallen off. No maintenance here, you see. There was a man lying on the bonnet and I thought he was dead, but no. It seems that is what they do: the truck breaks down and you sleep on the bonnet till help comes. Help was not us, in this case as we drove on. It was a journey Father E described as the night I drove through Sierra Leone with a crazy priest and he wasn't wrong.

The sky here is wonderful at night; no mains electricity means no light polution so you can really see the stars and it is wonderful.

Also good: twice last week I got motor bike taxis (how we get around in Makeni) and when the driver found I was English said how wonderful being colonized by us was and we are all family. I joined the public library when I got here. On my second visit, the motor bike taxe drove me straight up the front garden right to the front door and the library man said to me "hello Anne". I have never been remembered by name in a UK library before. But then I have probably never been the only white library member before either!

Everyday life in SL

So still no photos and I am sorry about that but I will try very hard to get some up soon.

I am now in Makeni, having arrived here nearly 3 weeks ago now. It was a nice journey up here in a decent vehicle (don't get many trips in that so we enjoy them when we do travel in it). The country is really beautiful, very lush and verdant with mountains (or big hills maybe). The human georgraphy is not so great! Makeni has city status but if you come from somewhere like London, it's just a town. I live in a detached single storey house in a compound: ie it is surrounded by a wall with a locked gate. There is razor wire atop the wall and spikes on the gate. In Sierra Leoneon terms, it is a good house; we have four bedrooms with the master having an en-suite bathroom and verandah and study. The other bedrooms share a bathroom. We have a kitchen, dining area and sitting room. There is also accomodation for servants out in the back yard. We live much better than our neighbours over the road (shanty type dwellings) but don't think of my housing in western terms! Maintainance is not a readily understood concept over here. You build something and then that's it! You leave it to its own devices. So our loo has not been flushing (buckets again! Where would we be without them?), the 'shower' is a trickle, we have no mains electricity in common with the rest of this town, so no fridge/freezer, tv etc etc. It makes life boring.

To those of you I told I wanted a simpler life: I was wrong. It is not simpler but just difficult in a different way. We buy rice, for instance, loose and this means you have to pick through it to get out the stones and insects! It took me about 45 minutes to work through a bowl for 4 last week. The shops are not what you would consider shops for the most part. There are a few Lebanese supermarkets (not much stuff in them) and the rest is stalls by the side of the road or bits for sale on people's verandahs. I didn't recognise some of them as shops at first. The food here is very limited and the cost is going up all the time. That is ok for me but not if one onion costs about a quarter of your daily income, as it does for most locals. Life is hard here; I can and will come back but not everyone can. I am so glad I was born in the developed world.

Transport is a nightmare. We (the Brits) left a railway behind which was dismantled. I don't know why. Hardly any of the vehicles on the road are road worthy. When one of my house mates and I came back from Freetown last week we paid for the middle row of a 3 row vehicle. The driver got 2 men in the passenger seat and four in the row behind us!

I don't want anyone to think I am not ok: I am. It is just all quite strange and I have so much to learn. Time is doing very odd things; I really feel I have been here at least 3 months or so and can't believe I was in the UK a month back. I will try to write about work next time; that's a whole different ball game!