Work 2

So back to work. I have not written about that for some time so it's about time I picked it up again.
Do I have a typical day at work? Probably not, but I will try to describe one.
I get up about 7 and walk to work, about 10 minutes away, past the local people washing at the public tap and the (semi) naked children, past the fish market and into the main road where I dodge the traffic and all the kids shouting "oporto" (white person) at me. I sometimes give them a regal wave. When I get to work I am usually very hot and sit in the office for about 15 minutes drinking water. We buy packets of it; there is no safe drinking water in the hospital. There is not really any water at all. I therefore want to avoid using the loo there. Then I steel myself and go to the maternity ward where I do a bed round and make notes about the patients. Some of the staff - or most of them - have no idea why I want to write notes about the patients and cannot understand why I find it helpful to know about the patients. Hmm. We have only had one maternal death this month; she had an antepartum haemorrhage, they wanted 3 units of blood to transfuse but they could only get one and she bled again and so died. They get the blood from relatives. We have now got a system for notifying maternal deaths and this is just starting up now. The 2005 figures were 2100:100,000 maternities against a UK figure of 9:100,000. I have been trying to organise the maternity ward but to no avail. I tried to get them doing a proper handover and write notes about the patients but it did not work out. Literacy is a problem here and I found they were unable to pick out the relevant details, so that foundered. I tried to get a system of named staff caring for named patients, which seems so obvious to me, but this proved impossible. I have also tried to instigate daily baby checks, again this has not worked out. The babies do not get checked over when they are born nor on a daily basis, as they would at home. I tried this back in November and it failed then. Someone said that they don't bother about babies here because so many die before they are 5 but maybe, just maybe, some of them would survive if anyone did bother about them. Silly idea of mine. Most of our babies are at the lower end of the normal birthweight range, most likely because of maternal anaemia. This is due to malnutrition and/or malaria. Less than 2.5kg is low birthweight and we have lots about 2.6 or so and we have had some about 1.7kg. Needless to say there is no neonatal care unit. How could there be? No electricity! So, after a while of reading about the drugs and care not given, I go back to the office and write stuff.
In order to feel I am achieving something, I have started some teaching sessions for anyone who is interested. This is actually what I am supposed to be doing: it is called 'capacity building'. They are about maternity/midwifery but open to anyone as the staff rotate around the hospital in 6 month batches. So twice on Mondays I hope some people will show up and they have so far. I did last Monday's session on pre-eclampsia and eclampsia and had 8 to the first session at 11am and 5 to the 3pm show, so not too bad. Only 2 from maternity though. Next Monday's sessions willl be on antepartum haemorrhage. Apt, I think.
The other things is that the new Midwifery school opened here a couple of weeks ago with a lot of razzmatazz. I am also working there, teaching anatomy and physiology which is great because I have to learn it before I can teach it! I did learn it once for exams but really have forgotten so much, but the best way to learn something is by teaching it. We have electricity and ceiling fans and a staff room with a fridge and a skills lab with lots of models and teaching aids ... Can you guess where I would rather work? They do have big classes here and I have 73 in one class. I had thought it would be more daunting than it actually is standing up in front of that lot, but I a manage. They are all nurses who are on a 2 year midwifery course and they have lots of experience already. They all recognise me when I am out, of course, as we white people stick out like sore thumbs, and so I am forever pretending I know who they are when I don't. I think they probably know that.
I seldom work more than a 6 hour day, which is the norm here. 8 hour days are called 'white people's hours', but it is very hot here, don't forget. I walk home from the hospital and get an ocada (motorbike taxi) back from the school. And then I have a very exciting evening in the bar with whatever other expats turn up! We get our cat Ginger some meat or fish on the way home, grab an ocada and go home and are often in bed about 10. How's that for an exciting life?

NOISE

OHMYGODITISSONOISYHERE!

I will stop shouting now. There is a bit of a lull in the noise level. Before I came I had an idea that it would be peaceful over here, I would be bathed in lovely bird song and the sound of the wind rustling through the trees. Fat chance. I have never heard such a racket in my life!

I will tell you about a typical 24 hour cycle. The quietest bit is usually from about 2 to 5.30am and that is not guaranteed. Around 5.30 the call to prayer is broadcast from the main mosque, then a smaller mosque joins in and, not to be outdone, the churches' bells start ringing. The call to prayer goes on for about half an hour. Why can't they get an alarm clock instead? Then our neighbours start their morning chores while it is still cool; lighting fires, chopping wood (maybe not in that order) and calling to each other. Whispering is unknown. Then everyone is up and about. The children cry and people argue and sometimes there is music, too. So I walk to work and along the road am passed by countless noisy vehicles with non-functioning exhausts, cranky engines and I don't know what. The local mobile phone companies like to drive trucks through the town playing music at a volume only possible in Africa, I suspect, aided and abetted by the generator to power it. All speakers must be at least the size of a wardrobe. I believe this may be enshrined in law here. The hospital is for sick people but they don't need peace and quiet, no no. They would probably think they had died and gone to hell. So the noise level continues unabated and in the evening there are the televised football matches (usually Manchester Utd. against whoever). There is a house near us where you can go to watch them and I am told you can't get a sheet of paper between the men crammed in there watching. I don't need to tell you that I can sit in my house and listen to the dulcet tones of whoever the English commentators are, do I? Then the music starts - always distorted - don't forget the size of the speakers, and sometimes they seem to have competitions to see who can play it the loudest. The time of day matters not one jot. You want to play it full volume at 4 or 7 am? Fine. As the electricity is provided by generator we have that added to the mix and, of course, we contribute to that ourselves as we like some light in the evenings. We also need it to pump the water from the well to the tank. We normally turn it off around 10 pm. So sometimes it gets quietish around midnight but then the dogs start!

IF YOU COME TO SIERRA LEONE BRING EARPLUGS.

Christmas

Was it really Christmas? I don't think so as it was far too hot and my Christmases so far have been dull and rainy. But that is in England and I'm in Sierra Leone, so it makes sense. It just felt so odd. We had none of the relentless pre-Christmas commercialism that you get back home. I did not see a single Christmas card or wrapping paper or anything at all. I got one Christmas card from a fellow Brit who had been back home and come back with cards and crackers. I saw 3 Christmas trees; one outside the Lebanese supermarket in Bo, one at Magbenthe hospital and one here in the Wusum hotel, whose internet cafe I am using at the moment.

I went on Christmas eve to the beach at a place called River no. 2 (imaginative, no?) not far from Freetown. The photos above are of River no. 2 and I have just added them (May 2010). I got myself and my rucksack to Magbenthe hospital on a motor bike taxi before 8 in the morning but we didn't leave until about 11. I do like to be punctual! I went with Matt, who is currently taking care of the farm his father manages about 40 mins. outside Makeni, Natasha, a Dutch midwife from Magbenthe hospital and Ellenoor a Dutch physio also from Magbenthe and her boyfriend Desmond. We were a motley crew: a Sierra Leoneon, 2 Dutch, one South African and British me. Matt and Natasha and I were not too keen on the accomodation at River no. 2. If you have the Bradt guide book, it sounds much better than it is and, for $50 per room per night, it is not worth it. However, the location is great and the food was not bad. We spent the night of Christmas Eve on the beach with a bottle of wine, a bonfire and looking up at the stars. I am sure we saw a Christmas tree up there ...

On Christmas day we went the few miles over the usual cratered road to Franco's where Suzie and Bernhard were staying and I had my lobster on the beach that I had so long wanted at Christmas. Well, almost on the beach; actually on a terrace overlooking the beach. It was a lovely day and we had Suzie's Christmas crackers and wore out paper hats. How British! Boxing day was similar but minus lobster, then back to Makeni on 27th. So that was it; no presents either given or received, no mad last minute Christmas shopping or anything. Just being lazy. And eating lobster.

New Year was quiet and back in Makeni. Nothing much else to say really. I did miss my girls, but as it did not seem like Christmas at all that was bearable.

A Happy new year to you all and I shall be home this year! Before you know it!!