Gumption.

I have been safely back in Shropshire for the last six weeks now after a brilliant and tearful Africana send off. This means snuggling down each night with a duvet, enjoying my wonderful family, staying too long in the bath and watching Made in Chelsea (shudder- I mean from Kambia to MIC, I guess you could call that escapism). Luckily I start a new job next week in a friendly birth centre in South London. Hopefully I will then be spending more time marvelling at the NHS and less time wondering whether Binky is finally going to man up or if Jamie is going to ever give up on Lucy.

However Salone has never been more than a thought away, especially in the last couple of weeks. Ebola finally, tragically, made it's way to Kambia District.

This has meant that the Kambia Appeal volunteers have had to be evacuated. It must be heartbreaking to leave behind close friends and hospital staff in such difficult circumstances, with such mixed emotions. They have handled it brilliantly, and I have no doubt that their hard work, despite all the set backs due to this lethal and persistent virus, will pave the way for future volunteers and has supported the local staff.

Having said this, I know the hospital will be fine.

I know this because despite the immense challenges and difficulties there are some staff members who just refuse to be ground down. Instead they continue to work hard and change things for the better, small small. They have Gumption. 

This is a great word.  It always feels as though it has to be spoken with feeling, as though just by saying it you are making a statement. In The Holiday (hardly the Holy Grail of films, but one I love none the less) Alfred uses it to try and explain the extra something that some women just seem to have. 

My Kambian heroes, however, put a weeping Kate Winslet to shame. They don't have gumption just because they decided to stop crying over a man, it comes from somewhere much deeper than that. It has to, otherwise they would have given up long ago. 

I will talk about three such people who are just a few of some of the incredible characters I met during my time in Kambia. 

I have chosen them firstly because they are women. In a country where to be born a girl means you have often disappointed someone before even taking your first breath, they prove that being female is something to be proud of. A barrier to be beaten down not to change your path. Secondly all three of them regularly do their best to save lives and do so under ridiculous circumstances: low or no pay, continuous long days at work, separated from their families in other villages and often without even the most basic of equipment, such as gloves. Lastly they are leaders, shouting (literally) about problems that others ignore and giving colleagues the boost they need to keep plodding on. 

First up we have Memuna:

     

I am proud to say she became my friend. Working long hours on the female ward, even right up until the day she gave birth, Nurse Memuna has stamina and strength. She got fed up of waiting for facilities to be provided for hand washing, so to keep staff safer she raised the money herself. Nobody has a bad word to say about this kind and funny women. To top it off she volunteered to be one of the nurses who will care for patients with ebola if they need to be isolated in the hospital: Gumption.

Sallamatu also stepped up to the mark and volunteered to be an ebola nurse:   

She is very feisty and now in charge of male ward. Sallamatu would be able to stand up to any old school senior midwife or consultant who tried to reduce her to jelly. In fact it would probably be the other way around. She is teaching in the picture above, something she is very good at. If there is a problem she will not accept it quietly, and would rather lead a riot than settle for second best: Gumption.

Sister Sally:

   

On call 24 hours a day, midwife Sally stubbornly protects what she believes in, and passionately cares about all the women and babies that are in her care. Pop round for a visit to her home in the hospital, and in between looking after her children, the youngest of which she has adopted, she has a steady stream of community members and previous patients asking for her trusted advice. This women is extremely loyal and seems to have unlimited time for the things she is passionate about: Gumption.

The trouble is these incredible women need people coming up the ranks to join and eventually replace them. It is these local heroes that will bring about real change in the long term. When tuition fees to train to be a nurse are so expensive and unpredictable it can be very difficult for enthusiastic, talented,  hospital volunteers (effectively unpaid nurses) to take the next step and get the teaching they deserve and need to work effectively. There are no student loans for them.

This is why we have decided to support these five volunteers in their quest to become qualified nurses. All of them worked incredibly hard, for free, in the hospital, attending Kambia Appeal classes in their own time, competently running wards. They all made the effort to apply to the course. Surprisingly no easy feat due to the politics that surround the process like so many other things in Sierra Leone. They all have young children, often making the sacrifice to leave them with family so they can try and build a better and more secure future for them. Gumption.

It is going to cost up to £20,000 over three years to train them all, but I think that this is possible. It has to be - this training would ensure that Kambia gets new, appropriately trained staff to join the ranks, and would mean stability for the families of Isha, Yaka, Hawa, Francess and Isha.

One day I hope that some of them will rub off on me, but for now I, and other volunteers they inspired, are going to try and raise the money they need to change their world.

If you want to help and can spare some cash, please follow the link below.
www.bmycharity.com/SupportKambiaNurses 

It's Only Lassa

A few weird and wonderful things have happened in the past month or so.

Weird was the excitement of developing Tumbu Fly larvae in my ankle. This happens when the fly lays eggs in your clothes while they dry, which then burrow into your skin when you put them on. A maggot then grows under your skin getting bigger and fatter thanks to your juicy flesh.

I have to admit we were all grossly excited about this, and I cringed as a little head poked itself of my ankle after I had put on some vaseline (I suppose the equivalent of smoking it out). We were so excited that the only concern was that it hadn’t grown any bigger, therefore ruling out the option of a youtube video. Next time I must do better.

Wonderful was the arrival of the first rains, starting surprisingly early in March. It was comforting to hear the hammering of the rain on the tin roof again. Unfortunately, as Samuel warned, the rain “washes the sun”. I think that the fact that there is now never a moment when my face isn’t dripping with sweat proves this theory.

Also the arrival of the mangoes! They are incredibly delicious, and add some much needed variety to our diet. I do feel though that I would not risk my life for their taste. Several boys disagree with this however, not willing to wait for them to ripen when they can be easily shaken or hooked down by bamboo sticks, instead climbing high into the sky, balancing on precarious branches, many of which crash down later throughout the day (the branches, luckily not the boys... yet).

Another great day was a casual trip to the border to see a community health clinic and visit our friends. This led to a trip over the river border to pop into Guinea and see the border village. Who needs visas when you can just smile and talk badly in French? This woman was the friendliest person I have ever met.

Unfortunately not all new developments are good. Dare I mention the E word?! Ebola is in Guinea, and sadly as we are the direct route between Guinea and our capital Freetown, as well as being the first hospital over the border, this is not an idle threat to us.

We have discussed contingency plans of course, the most sensible being Josie’s suggestion of hiding in a bucket. No chance of a bodily fluid splash then.

Another option is to run away to the beach, perhaps slightly more appealing.

Sadly the reality is actually that we have been taken out of clinical contact. Extremely frustrating (if understandable on the Kambia Appeal’s part). It was hard to look our friends in the eye, and say you cannot help them, and yet they cannot leave and have to continue working, often without being paid, with not enough gloves and in some cases not even anywhere to wash their hands. Amazingly the staff were incredibly understanding, only saying how much they appreciate our efforts.

 I think it is safe to say that I wouldn’t be so gracious in their shoes. My respect for the unique staff of Kambia Hospital is increasing daily.

We had a scare last week, when we were told there was a suspected case 10 minutes from us (this would mean we would have to be evacuated home). Luckily it was only Lassa, another horrific viral haemorrhagic disease, but this time with only a 20% mortality rate rather than 90%! Yay! I hope this is the only time in my life I will be celebrating a Lassa diagnosis.

We have been finding other ways to stay sane/ keep busy. 

Here are a few examples:

1)      Drinking many suspicious plastic sachets of ginger rum.

2)      Taking out frustration on mud and transforming it into bricks.

 

3)      Trying to cook on a charcoal fire (with many furry and feathered friends to keep us company).

 

4)      Taking a sweepstake on the amount of time it would take for our fence to finally be repaired. Good news – I won a whole 30,000Le (about £5).

5)      Being slightly awestruck at the sporting day talents of the local secondary school. Also laughed the loud speaker booming out a harsh ten minute long scolding for the tiny 5 year old scout who couldn’t lower the flag properly. Poor boy (but pretty funny)!!

Hopefully I will be UK bound in a few weeks time, unless Ebola has it’s wicked way with Kambia, in which case it may be sooner. Let’s hope I have a little longer left of sweating to go.

Angel Delight, KFC and a Malnutrition Ward

I have been meaning to write this for a couple of months now but it is becoming much harder to know where to start. The trouble is life here is tragic and cruel, and to write about it is to trivialise it in some ways. But at the same time life here is also very colourful, rich and incredibly fun. The more friendships I make and the more politics I discover I realise both how fabulous it is to have the privilege to live here, if only for a while, yet also how hard it is to know how some things will ever improve. 

As I am constantly being told by the wise staff, small small is how it will happen.

So a few things that have happened:

Our wonderful Dr Small left but only after making us pancakes and being given many gifts of Africana outfits and a delicious chicken called KFC .

The beautiful new malnutrition ward opened which is the culmination of many people’s hard work. This is both a victory and a sad reminder of the fact that this kind of ward is needed in the first place.

It puts my chocolate and roast dinner cravings into perspective. (Also makes our cupboards stocked with UK goodies seem ever so slightly selfish...)

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We had a party fuelled Christmas and New Year including a riverside rave, a botched but fairly successful attempt at mulled wine (while pretending it was cold), countless Christmas films and cocktails and surfing on the beach. Not quite the sacrificial Christmas I had perhaps been envisaging pre departure, but we did end up welcoming a special Christmas Eve baby into the world. Never just pop in to say hi...

Then it was all change. With the departure of Hannah and Martin we then got to welcome several new faces. With them came copious amounts of angel delight - the closest thing to ice cream here and heaven on a spoon. My standards have slipped but I have no shame in saying that when I return home butterscotch angel delight will always be on my shopping list.

So as for the hospital, what do I say? 

There have been clear steps forward which are incredibly exciting. I really enjoy (and find very frustrating) the never ending hilarity of the work ethic here: I have recently discovered that it is much easier to persuade people to do work with you if you sing when you ask... “Let’s do this blooood presssureeeeeeee, what could beeeeeeee more fuuuuunnnn!!”. Also the community feel of the team, particularly in the evening when all staff members seem to congregate on the ward in their satin pyjamas.

This can’t deflect from the terrible reality of caring for a young women overnight, who has several children already, watching her uterus rupture, knowing there is nothing you can do about it until morning (by which time it may be too late). 

Or take away the frustration of suddenly not being able to hear yet another baby inside its mother due to the lack of effective monitoring allowing us to spot the moment of decline. And is it even right to take someone into life threatening surgery (because that is what it is here) to save a baby? However precious that little person is, how can you weigh up the perhaps small chance of preserving life when the mother may die leaving her family behind to fend for themselves?

Not enough blood, not enough skills, not enough motivation, incentive or morale, never enough money and certainly not enough resources or equipment.

And yet so much can be done with words, kindness and skilled hands. This is why it is never worth giving up. And one day, all this will change. I hope that I will come back in the future to Kambia, perhaps on a family holiday, to go to a thriving beach packed with tourists, drive through a fantastic infrastructure with ethical and growing local business, brilliant sanitation and agriculture, not having to worry because if I get sick I can  go the hospital with full faith in their care and facilities.

This will happen, but how many have to die first?

I will never forget the women and babies who would be alive if only they had been born a couple of decades later, or somewhere else not so far from here.

A Christmas Miracle

So the past few weeks have been a huge challenge and a big lesson in patience, for many different reasons. Hannah has told me that a previous volunteer passed on that Kambia meant “Come and be patient”.  Her boyfriend then later corrected her:

“No Hannah – it means come and endure.”

Sam also pointed out the other day that we are in the country with the third worst health indicators in the world, in its worst district used as a dumping ground for the staff that no one else in the country wants, where even volunteers avoid  and no money is invested. This perhaps shed a little light on why we were so frustrated.

The best words of wisdom came from Lucy, Hannah’s lovely friend who came to stay:

“However bad your day has been it is not as bad as Jack Bauer’s.”

We have been obsessively watching 24, an old series where Jack has to deal with his wife and daughter being kidnapped and save America along the way.  For a moment I did wonder whether the death toll of our day is higher, although after counting both up we thankfully came to the conclusion that no, Jack wins by a large margin.

There has been big excitement over the past few weeks ...

The road is being surfaced in tarmac AND our first shop has officially opened... a garage!!!! There is no stock yet but that is a minor detail. It may mean that 2014 will bring a daily opportunity to buy chocolate. Very important for morale and bribery.  

 

 

 

 

 

The grand opening of our new shop and garage

 There are also now solar street lights, which gives children light to do their homework at night, provides more of a social life and makes walking around at night feel very safe.

 

 

 

Tarmac in progress with solar street lights above

Not only does the tarmac mean that the dust is massively reduced, decreasing the need for showers and antibiotics for respiratory infections, but it might just mean Kambia will start to develop, bringing with it job opportunities.  Unfortunately it will also bring traffic and the motorbikes that give us lifts have already sped up, increasing everyone’s daily chance of death/ mutilation.

So I could write about the amount of babies who die daily unnecessarily here, or the women who have died through the incompetence of the staff or lack of resources, and my frustration that despite my best efforts this still, and will continue to, happen regularly. But instead I am going to write about my favourite ever (work) baby. Baby Sheko.

He was born a couple of weeks ago now, on a day that followed a particularly bad few days. His mother came in with yet another ruptured uterus, with palpable fetal parts. There was no doctor, but luckily Alhasson, a brilliant CHO, was willing to do the caesarean. I heard a fetal heartrate, but just put it down to my lack of experience using a pinard, rather than the battery operated dopplers.   Just in case I might be right, I insisted on going to theatre on my own, knowing that resuscitating with someone else would mean a diplomatic battle and wasted time (“just a bit more suction... lets swing the baby from it’s ankles... why are you bothering to dry it... lets go straight to chest compressions?”). 

I was determined that that day I would forget about long term benefits and just try to do the right thing for one family. After pushing for sterilisation (which has to be agreed to by the husband, many of whom think that their wife is less important than another son), we were in theatre, ready to go.   At least some of us were.  Another hours wait went by for the various members of staff to turn up at work and the operation started, after the compulsory prayer. Considering you have a maximum of 30 minutes for the baby to be out in the UK when it is an emergency caesarean, these couple of hours drove me insane, and I gave up all hope of a live baby.

BUT... you guessed it, baby Sheka came out of the abdomen, as the uterus had opened so much he was no longer inside it, and gave a gasp!! Alhassan and I were so excited that we almost forgot to clamp the cord, but sure enough after a few minutes of resus (to a chorus of “what are you doing, give it suction, swing it, smack it”) he cried!! As anyone with any experience of obstetrics or midwifery will know, this was perhaps the closest thing to a miracle I have ever seen.

Beautiful Baby Sheko survived and thrived, with a mum well enough to feed him a few hours later. Happy day!

Baby Sheko, with permission from his lovely mother

We have also had Christmas to keep us going. The staff are definitely in party mode, and with cooler nights we have been to two hospital parties the last couple of weeks. This involves every member of the hospital, so patients are left with the night staff popping over to check on patients occasionally, perhaps bringing a few of them back along. It also means no one goes to work the next day. It has done wonders for our street cred however. Not only are they amazed that white people dance, but I have now been asked to give Konnie, a VNA, dance lessons. With my history of dancing like an enthusiastic crab I think this will be by far my proudest moment and biggest achievement in Salone. I cannot believe that I, a distinctly unsmooth white girl has been asked for moves from a beautiful African women. Score!

Hannah and I glammed up, Africana style

We watched our first Christmas film yesterday, while sweating, underneath our makeshift decorations. It was The Holiday, and as Sam pointed out, the first film the boys haven’t been interested in.  As soon as they realised it was more romance than violence they soon drifted away. Not surprising considering we found out recently that the retribution of choice for the increasing number of thieves around Christmas is an injection of acid into the stomach. Not for anyone they know of course...  I certainly felt warm and fuzzy following our dose of Christmas spirit, although that might have been the sun and dehydration.   My wonderful family have also made me a beautiful advent calendar, with a gorgeous treat each day.  It has meant whatever my day in hospital has been like, I have always come home to a smile. Thank you!

I have to say though I hope our Christmas dinner will not consist of another of Abraham’s star catches.  Groundpig (rat) is a grand cause for a roasted celebration here!

Abraham and Rat

I am keeping my fingers crossed for a few more Christmas Miracles and wishing everyone a very Merry Christmas and a Happy New Year. 

From One Born Every Minute to One Dies Every Minute

So I thought I would be able to sit down and keep a daily record of my time here - how wrong I was! Mainly because I have already had more fun in my first three weeks than I expected to have in my whole 6 months here. 

Who would have thought that I wound find myself in a tropical paradise last weekend, watching a safely distanced sea tornado with good company. Wasn't I supposed to be trying to save lives rather than sunning myself?!

Bureu Beach

It already seems another world ago that I arrived in Kambia. After setting off piled high with gloves and treats in a Redcar train on Halloween, I ended up in a crammed and temperamental car bouncing my way through a dramatic storm. Torrents of rain created lakes in the bumpy pot hole filled road, with lightning illuminating the dramatically flat landscape fringed with palm trees. This appealed to my romantic side, as though some one actually cared that yet another "Oporto" had arrived in Sierra Leone!

Soaked and smelly after 29 hours of nervous travel I finally got to meet my wonderful new Kambian family. Hannah, Sam and Martin who I would be working with in the hospital, then Charles, Abbas, Santigie, Almamy and Abraham who are in charge of the base, security and extremely important things like food. Despite images of dire shacks my hut and the base seemed very hospitable, helped by a kind donated candle and welcome poster. No serial killers living here with me then (or very friendly ones). 

Luckily it was the weekend, so my first couple of days were spent wandering around the red dust roads, meeting many very friendly neighbours and being dramatically introduced at one of the colourful local churches (the attraction being the networking,singing and dancing - making me feel decidedly white and unsoulful).

Outside our base

I also purchased a very colourful bucket at the even more colourful market, which I was told would be invaluable. So far I have seen many being carried on heads and find it slightly surreal washing in the same looking bucket that the bloody delivery instruments are sterilised in! 

All this to put off my first day at the hospital. Still it finally came so when I realised I had no way of escape save a 4 hour motorbike ride, meaning probable death or mutilation, I made my way in.

Perhaps the easiest way to describe it is by telling you what surprised me the most:


Number 1: The rats (and chickens, dogs, goats...) freely running throughout the ward, no doubt enjoying the blood and urine stains covering most surfaces.

Number 2: The warm welcome of an over worked, non paid and under valued work force.

Number 3: However hot it is, you should dress smartly. My scrubs didn't really cut it next to the sister's flamboyant tailor made outfit and matching hairpiece.

Number 4: The lack of job doing. Why would you bother to give drugs or care for someone when you could be lying on a bed giving yourself metronidazole for period pain? Or watching a film?! (especially when you come in for free).

Number 5: The normality of death. In my first week I saw more dead babies than live ones, a breech delivery, 3 eclamptic (fitting) women and 2 ruptured uteruses. Considering some midwifes won't see this in their career, it's safe to say I was a little overwhelmed.

Tragically one mother also passed away, although I feel her story is not something to share on here. It made all those books I had been reading in preparation so much closer to home. Matching faces to the glum mortality figures of this beautiful country is something I never wanted to do. I couldn't help but make the comparison between the fact one mother dies in childbirth around the world every minute, yet In the UK with our glorious NHS one beautiful baby is born every minute. 

What I wouldn't give for an emergency buzzer... 

I have quickly understood the importance of educating women and girls especially about the importance of family planning. It is very hard when faced with huge challenges in the hospital to try and find a way to sloooooowly change some of the problems, while being aware that this may not be possible, and understanding that more time means more deaths. Therefore it seems much simpler to stop a lot of the problems from ever appearing! This is something we are trying to get more involved in.

I never guessed that one day I would be helping to teach sex education to an all girls school, cringing my way through questions about wet dreams and "mummy and daddy business", then the next pushing the broken down "ambulance" containing two women in desperate need of a cesarean, to try and find a hospital with a Doctor. They now however both seem of equal urgency.

With Lamin trying to explain "wet dreams"

Luckily we managed to get to a hospital which was just an excruciatingly bumpy hour and a half away (we did not have to push it all the way or I would have been in the ambulance too), banishing my panicked thoughts of a 4 hour journey to Freetown turning up with two dead babies and two dead mums.  

I have to admit I did wonder for a few seconds whether a road side attempt at a section with my paper scissors and travel sewing kit was an option.

Overall life here is good.  We have just come back from a very long and entertaining matriculation ceremony for Charles Abbas and Santigie (we of course, sweat dripping from us, late, were ushered up onto the stage leaving no chance of an early escape), complete with two squawking chickens given to the college as a gift.  We have access to plenty of cheap plastic sachets of gin and coffee rum and we even managed to do a kind of bonfire night, although no one stood around the bonfire for long in 90% humidity. 

For now, I am taking a leaf out of Salones's book and "telling God tenki",

keeping all my fingers and toes crossed for a few more births than deaths this next week. 

 My African lappa dress for the matriculation