from orphanage to market...

Weekends. Always a lovely break from the week, and in Sierra Leone, it’s no different. Sleeping in an extra hour, eating breakfast in your pajamas, having plenty of time to wait for the water to heat in the boiler. Little luxuries which make the weekend such a wonderful time.

I didn’t post a blog yesterday because, comparatively to the earlier week, very little happened. I went with Helen to an orphanage run by a Canadian couple out in Regent. We left a little later in the morning, took a taxi to the main bit of Regent and then hiked for a good half hour up to the top of one of the nearby hills. About fifteen or twenty orphans live in the compound set up by this couple after the war. They are there for various reasons, into which I didn’t really pry.

In any case, we arrived there only to find that no one knew of our coming and the proprietress had gone away for the day (which we were expecting) and she had taken the key to the school room with her (which we were not expecting). So we made do for the morning, practicing some basic math and reading from some of the books collected in the house. I worked mostly with two younger girls, Kathy and Kadiatu. Probably kindergarten or first-grade reading and math level. It kind of reminded me of when I student taught the first-grade kids (Emily, Will Donner, Tim Clark, and Miranda) on board the CBM. :)

We had a fun time, but then the kids all went off to do their chores, and Helen determined that it would be next to impossible to get them all back together again with any kind of focus for work. So we left there a little earlier than normal. Helen had contacted the vocational educator at another VVF centre, but she wasn’t available to meet up, so we headed back to the team house. We couldn’t get transport in Regent, so we walked to IMATT, an international co-operative training center for the Sierra Leonean military. It was a good walk, probably another half-hour or so. Then we found a taxi there that would take us to Mamba Roundabout, a ten minute walk from the house. A lot of walking, but it was really nice to get out and about and see some more of the country.

I was really exhausted, and crashed around four, after attempting to read and stay awake. I woke up a short time later, but never really got my energy back. The sun and heat had drained it all away! :)

Today, I enjoyed a leisurely morning and was sitting out in the verandah when an old colleague of Annekoos and Bastiaan came to visit with his four year old daughter, Esther. It was really nice to sit and talk with them. It was really enlightening to hear his opinions on George Bush, Tony Blair, Salone (Sierra Leonean) politics, superstitions, etc. He explained that he loves Tony Blair because he is crafty, and has so much power in his speaking. He told me he hates George Bush because of his pride and how he has stumbled into the Middle East, leaving a “scar,” as he put it. He says that the next president should do everything possible to bring reconciliation. I couldn’t agree more.

I just got back from downtown. I went with Anne, Bas, and Sandra to the fabric street. I bought some really lovely print and batik for a skirt and a shirt-dress. I think the tailor is coming later this week, and I can give it to him.

It was really great to walk around the market. So much life and color concentrated in one place. The markets in Central America were similar, but this was much bigger, and the wares much more diverse. I don’t remember ever seeing pig’s feet in Guatemala! :) It was really fun, though. And it was great to get out of the house for a little while. The other three have been here for so long, and are really knowledgeable about how everything works. It’s so great to have them as a resource, and I’m ruing the day when they will be gone. But until then, I’ll try to learn as much as possible, and if I make some mistakes a long the way, then that is also a way to learn…

I wish that all of you could be here with me, or that I at least could connect your mind and your senses to mine. Sierra Leone is a full sensory of experiences. I haven’t taken many pictures as of yet, because I find them so inadequate to convey every part of that moment. What picture, for example, can tell you about the sounds outside the window which have become so common place – the birds, the wind in the trees, the children’s voices, the clinking of rocks being broken down, the distant techno music, laughter, crying, all at once. How can you know the smell of Sierra Leone? The sort of campfire smell mixed with earth and, oftentimes, rain. I don’t want to lose these moments, because I know that they will all pass by fast, fast. But, I suppose, the nooks and crannies of memory will have to suffice. Man has not learned how to capitalize on that God-given system…

plenty pikin and apple pie...

We opened the door to the house and were instantly greeted with the smell of apple pie. A little out of place in this African setting, but welcome, all the same. It was a nice gift at the end of a long day, to be sure.

Today I had the special treat of sitting in with Sandra and Annekoos in the Outpatient Pediatric Clinic which shares a property with the Fistula Centre. It was really, really great for me to get a taste for what a clinic such as that takes to run on a daily basis, and what the work is like, especially since it’s part of my heart to work in such a clinic focusing on maternal-fetal care and well-baby care. I saw lots of babies, lots of young children, and there were a lot of tears. :) But I think that I would cry, too, if I felt crummy and had no other way to express it.

I don’t even remember all of the kids that I saw, but there were a few cases which stood out from among the rest.

One was a three day old baby with a clef lip. Upon giving birth, the mother, one of five wives, was instantly ridiculed and derided by the other women. She packed everything up, I suppose, and headed off almost immediately because she was in Freetown today. She had come to visit her sister, but upon arrival, she found her sister’s house empty. Her sister had gone to Kambia – another town up country, close to Guinea. So she had stayed the night with the neighbor and had come today after someone at another clinic told her about Mercy Ships. The Africa Mercy will be in Sierra Leone in February, and I’m hoping that she will get a surgical spot. Sandra added her to the list of patients she is referring, so we’ll just have to wait and see. It was so sad to see the mother so crushed by the ignorance of the other wives. I can’t even begin to imagine the weight that she has carried since delivery, all the way coming here, believing her child to be completely abnormal, not understanding how this could happen or what it means, blaming herself for doing something wrong during the pregnancy or during delivery…I think that when she left, a lot of that had gone. A beautiful transformation.

The other was a young boy. Really sweet, quiet, and very intelligent-looking, he had come in for various complaints of unknown origin. He came with his father, whose love and deep concern for his son was written all over his features. It wasn’t very long before the father told us that the boy had lost his mother about ten months ago. And suddenly, the pain was there, the uncertainty of suddenly being a single parent with two children, having to do things you’ve never had to do before. And now one is sick, and you’ve never had to sort out the medicines. And you look at the boy, and you wonder how many times he has cried himself to sleep at night.

Here, now, in my room again, I am surrounded by the exuberant sounds of the community around me. I hear the children calling to one another, a mom calling for her son, and men talking business across the road. The clouds roll in to bring more rain, and the room grows dark, only illuminated by my computer screen. My life is so incredibly far from that of the mothers and fathers and children that I saw come through the clinic today. But for a moment, here and there, I understood, and I shared a bit of their life…

freetown, hiv, surgery, and the bible...

so this was supposed to have gone up yesterday, but for some reason it didn't come through:

Today, as is quickly becoming the norm, was a full day.

This morning was Gladi-gladi. It was so special to see all the women dressed to the nines, so happy to be going home. The other women were so excited for them, and you could see in their faces the hope for their gladi-gladi when they (oh, we can only pray!) go home dry as well. The bonds forged between the girls – most of whom thought before coming that they were the only ones with this problem – will last a lifetime. It’s kind of weird to think that you’ll be a part (in the background mostly) of such a life-changing event. I think that’s what draws me to midwifery – the moments that I’ll get to be a part of.

After the singing and dancing was done, Harriet and I headed into Freetown with one of the patients. Her fistula surgery had failed inexplicably, and so she had gone in for HIV testing. She is positive. So we were just taking her in for a follow up exam and to renew her ARV prescription. Freetown is a sight to behold, and I’ll probably have to save a full description for a later date, because it is late, and morning isn’t coming any later. J

We went to Connaught Hospital, a government-run center which was rebuilt after the war by the World Bank, as Harriet informed me. The grounds were beautiful, even if getting through the gate was a bit of a challenge. I only got a peek into one of the wards: a huge, long empty room almost like a two-story warehouse made out of concrete in which all the beds are separated by curtains. The nurses stay at the end and essentially are there to dispense medication, monitor vitals, and contact the doctor in an emergency. As a patient, you must bring your sheets, food, kerosene if you’re going to have surgery (to fuel the generator), and a caregiver – usually a family member who will help you with your daily care.

All in all, it was a really interesting experience. More about it later, yeah?

Okay…so I’m running out of time, so I’ll just give the basics and hopefully fill in over the weekend or something when I’ve a bit more time.

After we got back from Freetown, I hung about the ward a bit while I waited for the doctors to finish the day’s second surgery. Then I scrubbed in for the third and last of the day, which was really fascinating. I hadn’t done so well with surgery during clinical, so I was a bit nervous, but everything went off without a hitch. I was so interested that I didn’t have a second to think about possibly being a bit woozy. I think I had a better face mask on, as well, which helped me from getting overheated and dizzy.

The surgery went really well, and I spent the rest of the afternoon with the doctors in the screening room, having a look at potential patients and following up with current ones. Then the (work) day was over, and I joined up with the doctor’s again to walk home along the beach. The breeze was absolutely gorgeous and the sound of waves was an absolutely perfect ending to the day. On the way, we passed a football (soccer) match which was a bit unique. All of the players only had one leg. Victims of the war, they had all banded together to form a football team, and they were actually in training to go the amputee world football cup in Turkey next month or so. They were all so great – some of the friendliest people I have met here so far, although most are really friendly in general. One of them told me that they play every Saturday in the same place from 8-10 am. Perhaps I’ll be able to go over and watch them a bit more. I’m sure I need to learn a thing or two before I try to do this intramural soccer thing in the fall! J

Then back to the house, a quick rinse-off in the shower, dinner, and then out again for Bible study. I went with Sandra and Bas to an inter-NGO Bible study that’s held here every other week. It was really great to meet all different sorts of people, mostly from the US, although a few from the UK, the Netherlands, and one from South Korea. All involved in different sorts of work. It was really neat. But, alas, there will have to be more about that later. My walk and Bible study took all the time that I usually take to write away, although I gladly gave it over to do something a bit different!

Tomorrow, I think that I’ll be spending a good bit of the day in the pediatric outpatient clinic with Sandra and Annekoos. More stories tomorrow, to be sure!

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…

first day...

It’s five thirty, and I am home for the night. One of the staff wasn’t feeling very well, so I came home early with her. My first day of work is done.

It at 4 am when a massive storm woke me up to the sound of roaring. Hurricane-like winds were ripping over the roof above me as sheets of rain lashed the windows and flickers of lightening revealed millisecond images of outside. Back to sleep and then up at 6 to make the 7:10 transport to the clinic. The morning started with rounds with the ex-pat medical team to get report from the circulating nurses – all Sierra Leonean nationals. So I got a tour of the ward and quick introduction to the face of VVF. Nearly fifty women all with the look of hope mixed with fear, silently wishing every moment that this will work.

You see, not everyone who comes to the clinic walks away continent and dry. Many, in fact, will leave without finding success. Their fistula may be repaired (or it may not be), but the many other complications that follow such a traumatic injury leave them still severely incontinent. The question every morning: “Is she dry?” One can almost tell without asking which patients are dry, which are still wet, and which are awaiting surgery simply by their faces.

After a quick walk about the ward, we all came together in the children’s clinic attached to the Fistula Centre for a few moments of praise and prayer, staff and patients together. After that I teamed up with Helen, ringleader for the education and training programs we provide to the women recovering and waiting. After chatting for a bit about the program, her vision, etc., we got ready for the morning session: numeracy.

The first plan for the ACFC was to teach literacy for the women who came through the doors, but the reality is that it’s nearly impossible to teach several years of education in two weeks. Helen told me that it’s often a huge feat for these women to learn how to hold a pencil properly. So, she said, we start with numbers. After all, most of them are subsistence farmers so being able to add and subtract may very well be much more useful.

We counted on our fingers and practiced identifying numbers on flashcards. They all had it down pretty well. Then while Helen worked with them on a simple worksheet meant to develop fine motor skills for writing, I took about five girls over to the side. These girls had been identified as being literate, or at least had had some formal education. We worked on a worksheet in which they finished the following sentences:

My name is…
I come from…
I get this piss problem for…
I like this hospital because…
I want to….when I get home.

(by the way, we weren’t being vulgar with the whole piss thing – it’s quite a common word here. Harriet, the ex-pat nurse manager told me that the bladder is commonly called the “piss bag”)

The answers were remarkable. One girl who didn’t look any older than myself had been suffering from her fistula for ten years. Another, slightly older, fifteen. What did all of them want to do when they got home? Go back to school. “I want to continue to further my education,” one girl wrote. Her name is Jinnah, and she has stolen my heart. A large number of them want to be nurses, which also made me (and the nurses there) very happy. J

Then it was lunch time: cassava and rice. I didn’t actually eat it as I had brought some food from the house, but it certainly had an interesting smell. Helen said that she likes every lunch they serve at the Centre except for Monday’s, so I have a feeling I didn’t miss much. I suppose I should try it, though, before I go.

I spent the early part of the afternoon making up some simple booklets for the women to practice their numbers by writing and coloring. Then it was craft time. We made pom-poms, and all of the girls loved them. They ended up mostly as necklaces, although several found a clever way to fasten them into their hair. Absolutely amazing. J Fine-fine, I would say (which essentially means, “soooo good!” in Krio). Then they would smile or laugh. I love them all.

The rest of the afternoon was spent on getting some materials prepped for tomorrow. The girls are going to color in name tags to go above their beds - add some pizzazz to the wards and help them see better the letters in their names. Then it was nearly five o’clock, and I headed home!

A pretty fun-filled first day. Exciting and informative and interesting and engaging and challenging and so many things, really. I talked with Terri, my supervisor, for a bit during lunch, and we talked about getting to rotate about the Clinic this first week to get comfortable and adjusted and familiar with everything going on, then looking at going out to do follow-up stuff starting next week. So tomorrow, I’ll probably help Helen a bit, but I’m to shadow Harriet and see what her day looks like! I can’t wait…

lists and lessons

Where do I even begin?

In forty-eight hours I have

• traveled across six time zones
• flew back across one
• spent fifteen hours on planes
• spent nine hours in London Gatwick airport (four too many)
• elbowed several individuals in order to grab my bags off the carousel in Lungi
• whizzed along Sierra Leonean roads by dark
• inched along Sierra Leonean roads by day
• rode a ferry across the river, watching Sierra Leonean soap operas and music videos
• unpacked in my new room
• met my housemates (all lovely :D)
• had tea at the Aberdeen West African Fistula Centre (with a tour of the grounds)
• ate a traditional Scottish meal
• watched a good movie
• found myself quite a bit at home…

Every minute I want to pinch myself to see if I’m really here – on Lumley Road, Freetown, Sierra Leone. But more than anything else, I need to pinch myself because it feels so comfortable. I feel as though I have come home. I know that there are days to come when I am frustrated, exasperated, and confused beyond all belief, but for today, for this moment, I am home.

The compound where I am staying is near the bottom of a very steep hill, traversed by an extremely pot-holed dirt road. Through the metal gates, guarded by a national group, I stay in the main house, behind which there are a few more houses with apartments surrounding a little covered portico. In the house, I am on the top floor, down the end of the hall next to the bathroom. B3.

We run the generator from 18:30 to 7:30 on weekdays, 10:00 on weekends. Internet is available during those hours in the common room downstairs. Downstairs also is the kitchen, the laundry, and the supply closet.

A fairly simple house with some subtle nuances: When there isn’t power, the water isn’t heated (as I forgot until shortly before I turned on the tap for my shower this morning). One rubbish bin is for rubbish to be burned, the other is for things which can’t be burned. This trash, when thrown out, will be gone through by some of the people on the street, so nothing which may be dangerous should be thrown out there. Showers and toilet flushes are to be kept to bare minimum as it is scarce. Refrigerators should only be opened sparingly during the day in order to conserve the cool inside. Be nice to the cats because they help to control the pest population.

These are the first of many lessons – some of which will become like a second nature before I leave here nearly two months from now. Others, I’m sure, will continue to surprise me every time I encounter their teacher…

(p.s. as far as pictures go...i'm trying to get some uploaded for everyone to see, but i'm having a bit of trouble, so bear with me! :D)

ready to go

my bags are packed, i'm ready to go...

a couple of summers ago, my best friend spent the summer working on board the m/v anastasis in spain. shortly before she left, she played some of the songs that she had selected at her "mix tape" of sorts for that summer and its many pending adventures. we drove back from tyler with the windows down blaring the peter, paul, and mary hit "leaving on a jet plane." i've found myself humming that tune often this past week as i have rushed from here to there preparing as much as possible for what lies ahead of me in the next few months.

i've made countless lists, checked through them multiple times, crossed and recrossed items from them, and have been to wal-mart more times than i would like to admit. there always was that one thing that i had forgotten... but i had gotten an early start on monday (thanks to my mom) when we packed my bags for the most part.

so by the time that i got to today, i really had nothing to do. which was weird, because i almost always have something to do. :) then it hit me - like a two-by-four between the eyes - i had spent my whole week preparing physically: getting my yellow-fever vaccination, beginning my doxycycline anti-malarial regimen, purchasing last-minute items, yet surprisingly (and yet not so) i did not feel ready. apprehension and stress still gripped my heart and twisted my stomach. there were still so many questions for which i did not have answers! i realized how very little i had done to prepare myself mentally and spiritually for what lies ahead.

because, you see, far before i ever thought of tickets and visas and internships and advanced study grants and budgets and institutional review boards God had called my heart to sierra leone - to this time, this place, and its people. in the middle of everything, i had let go of that truth. today i reclaimed it, and with it came the rush of joy and excitement which threatened to sweep me away.

writing this now, as my house beginst to quiet down for the night, and i sit on my bed for one last evening in a while, i realize what a gift today truly has been. i sat in the garden reading and doing crossword puzzles and glorying the beautiful day. i laughed so hard i wept - literally! not just teared up, but tears streaming - with my family during dinner. we bonded over a ridiculous game of 90's trivial pursuit, and for a moment i truly regretted that i would be leaving tomorrow. not because i wasn't so extremely excited, but because i realized how very far i would be (again) from those that i love so very dearly. my quiet baby brother who is turning into a man before my very eyes and whose sheepish grin melts my heart. my mother who is truly one of my dearest and closest friends. my father who continues to challenge and grow me every day with infinite love. my sister whose new friendship is truly an unexpected blessing - like finding that there is one more delicious morsel left in the cookie jar. i will miss them all.

but then i feel that tingly, bubbling sensation in the bottom of my stomach, and suddenly it's a little harder to breath. it's not the fear and apprehension of a few days ago. it's sheer excitement and bated expectation.

the music on my itunes shuffles to the next song, and i hear the plaintive strumming of a guitar: my bag's are packed, i'm ready to go...

second star to the right and straight on 'til morning

wow. as i write this, my backpack sits in the living room next to my suitcase - ready to go. i really do feel as though i'm off to neverland as opposed to freetown, sierra leone. almost my whole life i've been asking to do things to which i received the now familiar response, "not yet...you're not old enough." when i asked to go to sierra leone for two months this summer and heard, "sure, why not" i almost fell over.

suddenly, i find myself pushing against a wall that no longer stands in my way, and i'm just now stumbling forward to keep from falling on my face as i adjust to this new freedom of adulthood.

in the meantime, my last week is full of the little things: today i go to get my yellow fever shot, friday i start my doxycycline. the days seem to pass so slowly, and yet i can't believe june 3rd is almost here. my thoughts are full of conjectures - what stories will i hold within me two months from now when i again sit on my parents bed and write on this blog? what relationships will i have made? how will i have changed?

and in between now and then - what adventures will fill my time? who knows, really?

but it's in the questions and the conjecture that there begins to grow that little seed of sheer excitement - the kind that makes your stomach flutter and your palms sweat - that puts the touch of a smile in the corners of your mouth as you walk through life so completely overwhelmed by the goodness of God