Fighting fires and fistulas...

Today was a bit of a different day.

For one, it started earlier. I woke up at five-thirty to turn the boiler in the bathroom on so that I could have some hot water for my shower. Half and hour later, I jumped in. Showers here are a bit different than at home. Water’s a luxury, so it’s on to get wet, off to soap up, on to rinse. Growing up we called them ‘ship showers’ because we did the same thing in order to conserve water when it was limited on board – during sails, for example.

I left again with the medical team, looking forward to my day shadowing Harriet, the ex-pat nurse and fire-fighter, as I came to see. First fire of the day: one of the nurses called in sick – malaria, again. That one handled, we went about on ward rounds to get report from the night nurses. It was just like being in clinical! Only there were only us and about six other nurses for the fifty-odd patients. Granted, usually these girls’ only medical complaint is the VVF, generally much healthier and mobile than the patients we get in US hospitals.

Next we worked up the discharge cards and papers. Each patient takes with them a copy of their OR notes, in case they see someone else in the future, discharge instructions, and a laminated card with their patient information and the phone number of the clinic. That meant taking everyone’s picture or “snap.” Each girl would stand there, as stoic as the day, but once they saw their face in the back of the digital camera, they would nearly die laughing. I couldn’t help but laugh as well, which only made them laugh more. J

After discharge cards, Harriet ran off to deal with a few more things, including a patient who had come from up country, but who was refusing treatment and therefore needed transport back home. Meanwhile, I sorted through supplies and got everything in a more orderly fashion. One of my most favorite things to do!

Then it was “chop” time. I found myself with a huge bowl full of steaming rice and black-eyed peas cooked with chicken. It tasted quite good, I think. It was kind of hard to tell after the first few bites because the pepper in it had singed all of my taste buds.

After lunch we did a few other things, like teaching one of the women Kegal exercises (pelvic floor muscle-strengthening techniques to increase sphincter control and hopefully improve stress incontinence). That was a sad case. One of the sweetest girls, someone who really struck me yesterday, Fatmata, was fully repaired but was still wet. Another of the patients, being discharged tomorrow, is going home wet. She had a fistula from her bladder and her rectum. The one from her rectum has been repaired and the bladder one has been attempted, but there’s nothing else that we can do. Tomorrow will be a difficult gladi-gladi day for her, I’m sure.

“Gladi” is the Krio word for happy, and in Krio, instead of saying “very” anything, you just repeat it twice. So if you’re very happy, yu gladi-gladi. Gladi-gladi day is when all the women leaving the clinic get their new dresses, headdresses, and we have a big celebration for their home-going. I may actually miss it, though, because I’m going tomorrow with Harriet to the government hospital here in Freetown to follow up with a patient that we have in the Centre who just found out she’s HIV positive. I’m sure that will be quite the eye-opener.

Later in the afternoon, after tea with Harriet and Terri, I got to pop into the screening room to see the girls examined for the first time to determine if they are suitable for surgery and whether the fistula will be a hard or easy one to fix. It was quite a lot of fun to hang around the surgeons and the translator and see the other side of it. I was invited to pop my fingers in for a feel of the fistula, but I didn’t quite want to just at the moment. The lady, who had had three fingers inside her already, hardly looked like she would welcome a fourth. It was really tempting though. I only hope I’ll get another chance.

It was absolutely horrifying to see the histories for some of the girls. Six deliveries and no living children. Ten deliveries and two living children. All of them in labor the last time for at least four days, most of them for seven. Seven days. That’s a week. That means starting contractions now and passing a stillborn child next Tuesday. That’s absolutely ridiculous. I still can’t get over it.

I should probably go, though. Dinner’s about to be served…fish and chips with apple pie (like mince pie but with apples, yeah?) read the note to our cook on the posted menu this morning…