Friday, 17 December 2010

Exams - everything is so last minute

The set 2 have just sat their end of first study block exams. They had 5 days of exams testing their knowledge on a variety of subjects - antenatal care, drug calculations, anatomy and physiology, fundamentals of midwifery, ICT to name but a few subjects.
All the 5 midwifery tutors who taught components of the training were required to set the exam paper based on the subject they had taught.
An exam chair was appointed and one other person to assist. The exam chair was another VSO - she had not set exams before and neither had the person who was appointed to assist the exam chair.
All the questions were given to the exam chair - all hand written - even though they were asked to send it by email. This was to make the exam question selection and formatting of the exam paper easier.
It turnes out that the tutors could not or where unable to send emails. This needs addressing - the students are having ICT lessons and many of them are learning fast!
The exam chair was given several reasons why emails could not be sent - including not knowing how the log off.
The exam chair felt really overwhelmed with having to choose exam questions and type and format into an exam paper for each subject.
I spent time together with the exam chair - the whole of the weekend just prior to the exam week typing up exam questions, choosing the questions from a selection the tutors had written and checking spellings, grammar before the final copy was approved.
The exam papers where shrouded in secrecy in case the questions were leaked. So much so the exam chair was asked to organise a trip to Freetown (not an easy journey) to get the papers photocopied. This was however done locally due to the practicalities.
The exams were due to start last Monday at 9.00. I was concerned that the photocopying would not be ready in time.
I was told by one of the tutors that when they sat some exams recently they had to sit and wait for the professor to arrive with the exam papers - he arrived so late they sat the exam that day in the dark - using torches!!!
I really wanted the Midwifery School in Makeni to do better than that!
I hope when set 1 come to sit their end of second block exams - many lessons will have been learn from this late preparation.
Amazingly - all the exams went smoothly and the correct exams where taken on the correct day at the correct time.
Then the marking had to be done - MCQ x 66, essay questions x 66 and for me an additional paper for an 'assessment' mark x 66!!!
They are all done and recorded - but how the questions were answered is another blog story!!!
The set 2 students are now out on their first clinical placement.

Thursday, 11 November 2010

My weekly timetable - including The Government Hospital Makeni

There are now 2 sets of student midwives in the School of Midwifery Makeni. The first set started in January 2010 and the second set started in September 2010. Both groups are currently in school so the timetable currently doubles up - there are now twice as many classes to teach.
I teach Monday, Tuesday, Thursday and Friday. I have a non teaching day on Wednesday so I have taken it upon myself to attach myself to the Government Hospital Makeni. Partly because it helps me close the gap between teaching and clinical work so my teaching may reflect the context in which I am working. Some of the other reasons are that the hospital is within walking distance of the school and partly to try and set an example to the others who teach within the midwifery school - that to attach themselves to a hospital/peripheral health unit is beneficial to their knowledge and relationships with trained staff.
There are 2 other volunteers based at the government hospital. They have a very tough assignment and I join them on Wednesdays where the 3 of us do a ward round - I join the maternity department round.
When we arrive at the maternity department my experience has been that all the staff, patients, relatives and a few others who don't seem to be attached to anyone within the maternity department have plastic beach chairs lined up like a cinema and are watching a large television.
These televisions are new to the hospital - even though basic essential equipment is lacking.
The 3 of us announce that we are going to see all the patients - many people remove themselves very quickly from the ward, some staff appear annoyed with us for disturbing their television viewing, and some patients just look relieved that the noise of the load television has stopped. If you are lucky the plastic beach chairs are moved out of the way so the patients may be seen.
The type of clinical conditions I have seen here in Sierra Leone I have not seen in the UK.
Women with advanced HIV - because they were not tested during pregnancy. The test is offered to all pregnant women but many do not want it done for fear of stigmatisation and rejection by their families and communities. HIV is known as 'Slim's disease'. Therefore perhaps many women who die of HIV have 'Slim's disease' on their death certificates. So perhaps the AIDS problem is misdiagnosed and maybe a bigger problem than the statistics tell us. Apparently 2% of the Sierra Leonian population have HIV - these are official government statistics.
I have seen women transferred in from the peripheral health centres and health posts who have been in labour for 3-4 days. These mothers and babies often have very poor outcomes. Often the babies have died in utero and are either macerated or fresh stillbirths. Some babies have such elongated heads as a result of trying to pass through the birth canal. I have never seen such mishapen heads from birth until I came to Sierra Leone - but in the UK we do not allow women to labour (active labour) for 3-4 days.
There is such basic equipment here and the student midwives have informed me that in some of their units there is not enough equipment for the births. Sometimes the instruments are not sterilised between births. The equipment is rinsed under the tap - the water is not drinkable - it comes from a well source.
Women in labour are not offered or given any pain relief. I have not seen any Pethidine or Meptid let alone any entonox. There are however epidurals for c sections.
On the postnatal/antenatal ward there is a mix of all sorts of clinical conditions. Women who have birthed stillborn babies next to someone in the next bed with twins. I have witnessed a woman with severe eclampsia on Magnesium Sulphate - fitting - who was then put in an ambulance (no paramedics) with just a driver and a relative - to be sent to a hospital 3 hours away - I never managed to find out the outcome of this woman.
Immediate post operative women are put in the open ward with all the noise of babies, relatives, the television and the other patients. Many of these c section women have been transferred very late on in their labour, have travelled a long way to get to the government hospital with a very poor infastructure to even get there and they are exhausted.
Many of the women I have seen have severe eclampsia and c section is often not the first choice here in terms of care and management.
There is however a scanner - which was I understand until recently - stored in a cupboard. It was certainly good enough to confirm an intra uterine death at 26 weeks - classic Spalding's sign - the woman had not felt the baby move for 3 days. There are no induction of labour drugs - this woman will have to wait for nature to take its course - sometimes up to 2 weeks - many of these women abscond and their outcome is unknown as there is poor follow up. Bladder catheters are used to dilate the cervix in some instances - the balloon is filled up with water to stretch the cervix in the hope that labour will progress.
I can't help but feel shocked with what I see.
1:8 women die of childbirth 1:5 children do not reach their 5th birthday - there is now free health care for pregnant women, lactating women and children up to the age of 5. The demand now for free health care is higher than what can be provided. There is currently a lack of trained midwives and doctors - a poor infastructure and although traditional birth attendants are not to be encouraged to work in the provences - what choice do women in Sierra Leone really have.

Thursday, 28 October 2010

Weekend in Kabala

I have only been to Freetown from my base in Makeni about 3 times. Mainly this is due to transport and more recently - accomodation.
Last weekend 4 of us went to Kabala which is north of Freetown - about 200 miles although it takes about 6 hours to travel from Freetown to Kabala.
One of the 4 of us managed to arrange transport via a works truck - of course we had to pay for fuel and for the drivers time.
It took 2 and a half hours to travel from Makeni to Kabala - about 135 miles.
The road was rough and bumpy but was not as bad as I thought it would be. The tarmac was very pot holed in places and the edges of the road were non existant. Often we drove on the wrong side of the road to avoid pot holes that were filled with water and so the driver would not have known how deep the holes were.
We arrived at another colleagues house in Kabala - she had booked the 4 of us into a guest house - the best one in Kabala!! Bed but no breakfast. It was basic and had 2 double beds in 2 bedrooms, a small sitting room and a toilet, sink and wet room style shower. When I brushed my teeth I did not notice that there was no goose neck attached to the sink - so my spit that went into the sink sprayed out onto my feet! We slept 2 to a bed - I wondered how clean the bed was. The pillow case had black mildew on it and the sheets smelt sweaty not to mention moist - but that could have been from my sweat. There was electricity from 7pm - midnight - so we put the fan on that was in the room.
We went for a walk in Kabala the afternoon we arrived. It was a beautiful day - bright, sunny and certainly a lot cooler than what we have come to expect in Makeni. We stopped at a small cafe and had groundnut soup - a very typical meal made with goat meat and loads of rice. We also had some bottled fanta.
We walked to the town - a lot more airy and spacious than Makeni - if you think of Makeni as a diluted Freetown and Kabala a diluted version of Makeni. There was certainly less traffic and very few houses had compounds.
It was great to get out and have some really fresh air.
Some of the group went to the cafe for some drinks later - but I went to bed early - I was shattered!
The next day the 4 of us and our 2 colleagues plus a local guide all walked up the big hill - Wara Wara - I think that is what it is called - I've left my guide book at home! It was a steep climb and the others walked up it like mountain goats. Our guide made us some walking sticks - this helped with getting past the rubble as the incline was steep.
I did not make it to the summit and neither did one other - we chose to wait just at the base of the summit - it would not have been too far to have completed the journey - but I was flagging. We waited for the others to complete the climb then they returned so we all walked down together.
We met a family who live on the hill. Apparently during the civil war many people took to the hill to escape from the rebels. There was evidence of crops/managed land for growing produce. The house was just so basic with no electricity and water other than what was collected from a stream.
I spoke with one of the boys who lived there - he travels up and down the hill to get to and from school every day. I asked him about the last baby that was born in the family - he told me that a local traditional birth attendant came to the house to help his mother as she could not walk down the hill in labour. She was lucky and so too was the baby - but this type of midwifery is common as the infastructure is one of the problems, not to mention lack of trained staff and midwifery 'waiting houses'.
We walked down the hill but my hips were showing signs of strain - one of our colleagues walked with me - and I was very grateful for that - I could not hold on with my feet and the steep angle - I was fine once we had reached the bottom.
We went back to our colleagues house and I poured water on my feet - the best feeling in the world! I also had no socks - which did not help - only a few blisters!!
We had a cab ordered for us to take us back to Makeni - a 9 seater Renault estate car. We paid for 7 seats so we had comfort in the 2 back seats between the 4 of us. The boot was full and the driver picked up 2 passengers who both sat in the front seat. One of the other passengers had a live chicken in a bag and by the time we arrived to Makeni - it had pecked its way out of the bag. I was sitting in front of the chicken and every now and then I could hear it rustling - but it was squashed in by a suitcase.
That day we also visited the maternity hospital in Kabala - it was I understand run by Dutch personal - but 2 years ago they pulled out and left it to be managed by locals - overseen by the government.
I was impressed as the hospital was clean - it smelt of cleaning fluids, the women looked well cared for, the beds were not covered in blood and there were 2 wards - one for newly birthed and one for c. section women. The operating theatre and birth room also looked cared for - this was certainly a surprise - not what I was expecting. The grounds of the hospital were spotless - well done to them.
More about the Government Hospital Makeni in my next blog.

Sunday, 10 October 2010

Death - Part of Everyday in Sierra Leone

Death seems to be part of everyday here in Sierra Leone - over the past couple of weeks there seem to be accounts of people dying perhaps uneccessarily.
We had some plumbing done recently in our house in Sierra Leone - the plumber had lost his 26 year old daughter 3 weeks ago. She had a dental extraction done by a dental quack. She apparently was unwell 5 days later and died from chest pain. There are no dentists here in Makeni and only a few in Freetown. I cant recall the exact number but I can remember being very surprised at how few there were.
At the local government hospital an aneasthetic nurses wife complained of a headache last Sunday whilst preparing vegetables for her 3 children. Her husband the aneasthetic nurse went to watch the football at a local bar and returned to find his wife dead. She was 36 years old. Apparently at the funeral last week - her father said he had now buried 6 out of his 9 children.
Recently I was given an account of a child being admitted to the children's ward. This child had been admitted very late on with whatever the condition was - but there was no cannula to insert the necessary treatment - although treatment was administered via an alternative route - there was also a lack of the appropriate drugs required. This child died.
There was a death due to Lasser fever recently in one of the local hospitals - the staff involved in the patients care required specialist monitoring incase they had contracted this fatal disease. One person I believe had tested positive but has been able to recieve appropriate treatment - but others are still being monitored closely.
At the government hospital last week - another VSOer and myself came across a woman who was 34 weeks pregnant. She had had 2 fits and was on a recognised pre-eclampsia treatment. But there was no surgeon working on that Friday when we saw her - and unlikely to be one available on the Saturday or Sunday. The fetal heart was 140 bpm and the mother's own pulse was 100 bpm. She was potentially going to have another fit - perhaps with a poor outcome for either the baby, herself or indeed both. I was with another VSOer and a referal to another hospital was made - however the receiving hospital have a policy of patients paying - I will follow up the outcome next week.
One of the student midwives lost her daughter in childbirth on the second day of her midwifery course. Her daughter died of a post partum heamorrhage. The child survived. The student midwife continues with her studies - this is how it is here in Sierra Leone.

Tuesday, 5 October 2010

Things are Improving

Since I have returned from UK last month I have noticed several improvements within the School of Midwifery Makeni.
Despite the obvious lack of money - we have a new generator at the school this means the electricity supply is much more powerful even though it needs to be cut off at lunch time to rest it. The internet although dial up is still working reliably. The 16 computers in the library are for the student midwives - only 2 of the new student midwives have ever touched a computer before - but they are all willing to learn.
The 3 returned Sierra Leonian midwifery tutors have just completed their tutor training in Nigeria. Also we have another VSO midwifery tutor. This brings the department up to 5 tutors plus the Head of School - she can now concentrate on some of her administrative duties.
There are some changes regarding student welfare, storage of lesson plans, twice monthly academic meetings, curriculum development meetings,weekly all staff meetings, use of printed student and staff information which is now posted in strategic places.
This is just a small part of the sustainable organisation of the new school that is happening.
The school now has a motorbike and a truck - which makes life easier for transporting students, although a larger veichle or small minibus is also required considering the numbers of students.
Some student midwives are receiving sponsorships and this helps with funding their education and clinical placements. Much more of this initiative is required.
We still struggle without a photocopier as the engineer who came to fix it did not know what the problem was.
Printing notes for lessons is sometimes slow and currently due to the size of class -the use of powerpoint presentations is prohibitive.
A decision was made to open up the internet in the library to the general public as a means of income generation. However it was pointed out that without specific anti virus protection the computers would almost certainly be open to abuse - even if not deliberately. This has been highlighted and hopefully a sustainable solution will be found. The staff at the school were not aware of the possible issues around contamination from the use of memory sticks, accessing porn, corruption and violent websites.
The library is currently being catalogued by one of the staff into subject headings with a system of identifying each book so that book loans will be a possibility soon.
When I think back to April when I first started - things have improved and will I hope continue so as to provide the midwives Sierra Leone needs to reduce the unacceptable high maternal and infant death rates.

Sunday, 19 September 2010

My First Week Back in Sierra Leone

I have been back in Sierra Leone for just over a week and back in Makeni a week. The plane flight was uneventful and it was my first time on an airbus. It meant we had to refuel in Malaga because of the head winds and the fullnes of the flight/luggage.
I was met by a really great friend at the heliport with a taxi and I returned to the safety and comfort of her flat in Freetown. 2 of my Makeni - up country - friends were waiting for me in the flat - so it was all a bit of a surprise and wonderful to see them all.
The 2 up country friends and another friend had arranged for a lift up to Makeni on the Sunday - somehow the messages got lost in translation but we were asked to get over to Lungi - the airport side of Freetown where our lift would meet us.
We got on the very old transport ferry - it looked like what the Isle of Wight ferries may look like in 100 years time!! We boarded and waited for what seemed like ages - apparently it waits until it is full then goes across the large estury which took one and a half hours from boarding to dismounting. We were entertained (if you can call it that) by some dwarfs doing a singing and dancing routine and a hat was passed round for a collection.
There were DVD's of the trial of Charles Taylor amongst others and lots of load african music to which even the small children danced to - what a sense of rhythm they have!
We met our lift - but the journey took 6 hours back to Makeni. The road north of Freetown is a mud track with many pot holes. The driver was obviously tired and was asked not to try and overtake other veichles once we had joined the tarmac road at Port Loko. It was dark and he could really not see ahead of him. Two of us said if he tried to overtake again we would ask to be dropped off at the roadside. We trailed a long veichle and a truck with its flashers on. It was a long veichle belonging to a road digging company that had a mechanical problem. We were so releived to reach the sign saying Makeni. We stopped off at the supermarket (if you can call it that) and bought a few provisions.
My room remained the same - just a few dead bugs on the floor. The house I live in was as before.
The next day was a work day but I had to get some money, top up my mobile phone, negotiate a motorbike and get my internet reinstated.
My internet had been cut off whilst I was away in Europe - I was really frustrated as I could not contact people back home. I went back to the shop 3 times to get it sorted out - really frustrating. One evening when I was reduced to tears of frustration - a kind VSO colleague lent me her internet stick. She and another VSO colleague were up country for a 2 day conference being held for all VSOers at the Maternity School Makeni.
I am so dependent on internet - I just can believe what a nerd I really am!
I found I slotted back in to life in Makeni as though I had never been away - when I think of the steep learning curve I had when I first arrived - it was as if I had never been away.
I have met up with several of my aquaintences - some have moved on within my time away - but it has been good to catch up with people.
The school staff and students were very welcoming too - I was quite moved - they really had missed me!
Whilst I was away a newborn baby was found in a bag in a public toilet within the midwifery school compound. One of the nightwatchman had heard a baby cry - this is a very lucky little girl to be alive today - and well done to the diligent nightwatchman.
She is being taken care of by someone at the school - and she attends daily - and is cared for and loved by all of us.
The rainy season is still with us - but it seems to be a little bit less than when I left in July. The rain still dictates when and were we go out to.
Lots of work to be done as there are now 75 more midwifery students who started on 13th September. There are 73 student midwives already who started in January 2010.
There are more tutors than before. There was just me and the Head of School before. We are now joined by 3 Sierra Leonians who have completed their training in Nigeria and one additional VSO midwife teacher.
Things are improving all the time.

Thursday, 16 September 2010

Back in Sierra Leone - Makeni

I am now back in Sierra Leone - Makeni - teaching student Midwives at the Makeni Midwifery School.
I have been back in Europe for the month of August. My students were on clinical placements and it was also the rainy season.
There are a new group of midwifery students - 75 in set 2 (started 13.9.10) and 73 in set 1 (started Jan 2010).
I now have internet connection so I will write an update shortly - a personal account about my return to Makeni.

Monday, 12 July 2010

Thank you to all those who donated - especially those I do not know

I would like to thank everyone who has donated via the justgiving site to VSO. I am quite overwhelmed - especially as I do not know many of you. There have been so many it is not possible to send a personal reply - but I have read each and every comment and good wish. Thank you on behalf of the women in Sierra Leone.

Death of the Antenatal Sister in childbirth - today

Last week I went with Jenny Hardy - a freelance photographer who took photos of the Makeni Maternity Government Hospital that I have previously written about in my blog.
During the visit we met the Antenatal Sister of the Makeni Government Maternity Department. I have worked with her on previous occasions as many of the student midwives where placed there.
The Antenatal Sister, when I met her last week was about 40 weeks pregnant and expecting her third baby.
I asked her if she was still working in her Antenatal clinic as she was near term (40 weeks pregnant) she told me that she had only come to the maternity department to see how the staff all were.
I touched her belly and wished her well with her birth that was only going to be a few days away. She looked healthy and had grown a good sized baby - not too big or too small - just right. She was wearing a beautiful purple Gara cloth dress and looked radiant. She told me that she was looking forward to having her third child and we spoke about things like childcare and returning to work following the birth of her child.
Today the Sister of the Antenatal clinic of Makeni Maternity Hospital died in childbirth at her own Maternity Unit. I do not have any details - the baby - a much wanted little girl survived.
This was a very good midwife - she will be missed by her family, student midwives, colleagues, mothers and babies and all those who came into contact with her.
Sadly she was that 1 in 8 that did not survive childbirth in Sierra Leone.

Sunday, 11 July 2010

A couple of links to follow

Many thanks to Jenny Hardy who I met in Makeni - she is a freelance photographer. Some of her photos were used in the recent BBC on line news article.
More updates soon

Wednesday, 7 July 2010

Looking after a new colleague who got Malaria

A new recruit joined my house recently. Something I had been looking forward to for a while as I had been living on my own since I came to Makeni. So I went to Freetown (a less adventurous journey - see previous blog) to catch up on the rest of my In Country Training and meet my new housemate.
We had a pretty good time in Freetown as I joined with the June group - although I arrived at the end of April - I belong to this cohort.
As a group we toured around Freetown, went to many beaches, ate and drank in several bars and met lots of new people before heading back up north east - or up country as it is described here to Makeni.
My new housemate and I arrived at our house on Tuesday - she had a cough as did some of the other new recruits. She was too unwell to come to work on the Wednesday with me and did not appear to be getting better.
The thoughts of flying, air conditioning, meeting new people and all the bugs that are around it would be reasonable to think that within the first week this was a nasty flu or cold.
We got news that one of the recruits contracted Typhoid and was hospitalised. My new housemate had similar signs and symptoms so we went to a local charitable hospital and got her tested for typhoid and malaria. Both came back negative. But the cocktail of drugs was something I had never experienced before; antibiotics - 1 gram doses, vitamins as the haemoglobin was 11 and would only go down over here due to the lack of red meat. Folic acid!!! all wrapped in little plastic bags with no name or what the drugs contained let alone a sheet to read up on with side effects.
My new housemate spent the night in my bed - just as well as I was beginning to feel concerned. She took the antibiotics as she had a nasty productive cough. Her temperature was high - 38.8C axilla - and not at all well. I returned home at lunch time (I had been doing this sice she arrived) and was not convinced that this was just a touch of flu.
We requested a second opinion at another charitable hospital and the diagnosis of malaria was made. Her haemaglobin remarkably rose to 12.5 overnight!!!! I felt relieved as I felt at least we knew what was going on. The antimalarial treatment was given (it is a 3 day course of tablets) and off we went home.
The antimalarial treatment is sometimes said to be worse than the malaria. My housemate was quite unwell but with some periods when she felt much better. Things were improving. After the last dose of antimalarials and 3 days of very strong antibiotics my housemate was looking better and beginning to eat and drink much more.
My housemate was feeling so much better that she started her volunteering work this Monday.
We since heard that another of the June cohort contracted typhoid too, but was not hospitalised unlike the the first colleague.
It is quite challenging looking after someone you do not know who is clearly very unwell without a diagnosis in a country with generally poor health facilities. We were fortunate that the charitable hospital where the diagnosis was made ran along european lines - so the care and management did not seem quite as alien as it might have been. It is one thing to visit hospitals in a professional capacity but quite another to have to use the services.
My housemate is now fully recovered, fit and well and has started her volunteering placement.

Monday, 21 June 2010

Brlliant Progress Today

The Makeni Midwifery School was connected to the internet today. This is really good news as the students will be able to access information that will help their studies. Most of the students have never touched a computer before - but they are so keen to learn - it is a pleasure to teach them.

Sunday, 20 June 2010

My Teaching Experience - so far!

My teaching has now started as the students have all returned from their clinical placements. I have been left as the only teacher in the midwifery school as the other 2 onsite teachers have left me to it - for my first week.
I have a class of 73 student midwives and I thought I had one class (we had been introduced previously) of SECHN's (doing their midwifery module) - but no - I found out last Tuesday that I had 2 more groups of about 50 in each - making 4 groups in total.
The 2 groups that I had been teaching - I was working flat out without any break - we get 11.30 - 12.00 for lunch - but my lunch break turned into students who had not been taught shouting at me that it wasn't fair that I had not taught them and why had I favoured one group over another. Well I just had to divide my time into 4 groups being mindful that my committment (or so I thought) is to the student midwives.
My voice is hoarse and I have covered so much that sometimes I wonder what have I taught which group - I have a system now of who I have taught what to.
I understand the other teaching staff are returning next week. There was one visiting teacher who came for 2 periods - but I did not see her.
There is intermittent electricity from a generator which does not work effectivly because of a battery failure. The photocopier does not work - and they are awaiting a service engineer. I cannot print off some of the notes I have done for the students as one of the teachers has some part of the computer that liks the computer with the printer. There is only one printer that works - and that is not currently available due to this missing componant.
There is often no lighting for the students to take notes because the generator is not on. I cant do powerpoint presentations due to lack of electricity. Also to do this preparation - I am unable to do it at my home because I too have no electricity.
I feel frustrated as I could do and offer so much more to the students if only their facilities were improved. The students have IT classes - but they dont even have internet. The books are very small in number - and not all suitable for midwifery today.
The classrooms are so small even though the school is a new build - it makes it very difficult to break into small numbers to do group work.
But despite all this the students did some really good role play and I could see that they had learnt what we had been doing - antenatal care. How to give good care and poor care. It was quite a laugh with 150 SECHN's in the hall.
The students like to sing songs - so I do some and so do they. The students are getting the hand of 'The wheels on the bus go round and round' and 'If you are happy and you know it clap your hands'. I could not translate the songs they sing - but my name comes into the songs somewhere.
The students are just so keen to learn - and it is despirate to see the lack of resources. This country has a maternal death rate of 1 in 8 women and an infant mortality rate of 1 in 5 by the age of 5. Sierra Leone needs midwives and well trained at that.

Monday, 14 June 2010

Character Building

I was asked last Monday at short notice to attend the Nursing and Midwifery Council of Sierra Leone in Freetown some 135 km from Makeni where I am based. There was little time to try and arrange transport other than use public transport.
I was put into a taxi in Makeni by one of the midwifery school staff and he said a prayer as I drove off!!
The taxi had 4 in the back and I was made to sit in the front although I was happy to share with 3 others in the back. The journey takes about 3 hours to the outskirts of Freetown. The car was a right hand drive and in Sierra Leone they drive on the right - so it all felt a bit precarious.
I was instructed by the member of staff who put me into the taxi in Makeni to get out at a place just outside Freetown called Shell. This is an old relic - before the war - of a petrol station which still retains the name even thought there is no longer a petrol station.
I was put out of the taxi I soon learnt well before the Shell stop. I was also charged double the price I had negotiated before I got into the taxi - when I questioned this the driver said it was because I had a seat to myself. Well this is how it is.
I dont know why I got put out early either. I got into a poda poda which I hoped was going to Freetown, they are the cheapest form of transport with loads of others all crammed to the gunnels. The door I was squashed into was held shut by a coat hanger. I was terrified to move incase the door popped open and we all fell out under the pressure. Well that did'nt happen. By this time I was in the east end of Freetown which is absolutely packed - the traffic at a standstill and the markets and the people - you just cant move. The poda poda had a puncture and the tyre which looked bald to me was stuck in a pothole in the road.
By this time it was 11.30 and my appointment with the Nursing and Midwifery Council of Sierra Leone was at 1.30pm. so I got out as the traffic was going nowhere and the flat needed attention. I did not know which direction to walk but knew my next stop was a place called PZ. I walked through the people, traffic, muck on the ground, markets, animals, noise and of course the heat - about 38-40 degs. I just kept asking people 'where I go PZ' eventually I got to PZ just a big central point with no signs or street names and I had not got a clue what direction to pick up a taxi to take me to my destination.
I asked a man and he very kindly found me a taxi on the right road that would take me to my destination. He was just such a poor man with odd shoes and very bad teeth. He had a black plastic bag with his things in - I gave him 10,000leones - he thought I was giving him the money to pay the taxi driver - I said no it is for you - his face just lit up - well if I made his day he certainly made mine.
I got to my destination on time but was not seen until several hours later!
I got a lift back to Makeni 2 days later.
The staff at the school were very pleased to see me again - it was like having a reception committee.
Throughout all of this trip I had no mobile phone. The generator at the school of midwifery had not been working on the Friday - and I lost all power on the Sunday before I went on this character building excercise!

Monday, 31 May 2010

A shift on Delivery Unit Government Hospital

These are just the facts of what I observed on one short shift at the Makeni Government Hospital.
I arrived having seen some of my students providing antenatal care. I asked to go to the delivery unit to see how things worked - there were none of my students working there at the time.
A woman had just given birth vaginally to twins. I was not present at the birth but was there to witness a haemorrhage following the birth of the placenta. The floor was covered in blood - I've not seen so much in all my time as a UK midwife. The woman was tipped head down on the rusty old delivery bed - an infusion of syntocinon was put up and an injection of something that I did not get to read the label of the phial. The newly delivered woman was lying on a blue plastic sheet and I worried that she would slip off the delivery bed. Her legs were propped up on the bed by means of a chair that was wedged ontop of a portable set of steps. The whole thing looked incrediably dangerous. The clots were being expressed manually as she continued to trickle - the bleeding was by now less. Her Hb was done and was around 6.4 having had a booking Hb of 9 - so she had probably lost a significant amount of blood. There is no banked blood transfusion service in Sierra Leone - so relatives had to be traced to see who had the same blood group as this woman - as she had been prescribed 2 units - relatives permitting.
I wondered about the twins - the first a girl had lived and was wrapped in a cloth and left at the side of the delivery room - which was also the office, and place where staff got changed, put their bags and washed their hands in a bucket as there is no running water in the Government Hospital. The second twin a boy - born by breech died during birth - he looked like a fresh stillbirth to me. There were no signs of maceration - only bruising to his legs as I understand he was a footling breech. He was wrapped in a cloth too - and put on a table where everyone who came into the delivery room passed by.
Through a small curtain there is another room about 10x10 foot square with 3 really old rusty birth beds - just metal the rubber mattresses have long gone. Very dirty and one sink without running water. There were 2 other women in this small progress room. One woman had been in labour for 2 days and had transferred from another area. It was her second pregnancy - the first baby was born by cesearian section (classical) and had died at birth. This pregnancy the decision was made that she required a cesearian section too. I went into theatre. A nurse did the epidural (yes epidural) and the doctor proceeded to do another classical cesearian section. I can't recall any written consent or explanation being given to the woman. I also do not recall any form of intravenous fluid being administered. The baby's body was delivered (no fetal heart was listened into prior to the cesearian section)then part of the placenta came out of the abdomen with what I could see - a snapped cord with the head still in the uterus. It seemed like forever before the head was birthed. It came out like a cork from a bottle. The baby was covered in meconium and was flacid. The many staff present in theatre started to clean down the baby but at this stage no attempt was made to do a full resucsitation. Eventually an old dirty bag and mask was taken out of a cupboard. At this stage I instructed the operator of the bag and mask to bring the baby's head backwards and lift up the chin to get a clear airway. (I know what I will be teaching). There were 8 people round the table where the baby was - no one came back to the mother to let her know they were having difficulty with the baby. I felt for a heart beat and told the personnel around the table that it was 40 beats per minute. At this stage I felt the need to leave - I went back to the delivery room. I could see this baby was not going to make it. The staff brought the baby back into the delivery room - where they all thought the baby had recovered. I explained that the baby was taking its last gasps before she died. The oxygen is only obtained by means of a concentrator and the electricity is only put on for operations - then it is switched off.
When I returned to the delivery room I found the twin woman still in the same place awaiting blood from her relatives. In the progress room all 3 beds were full. 2 women birthed in that room - no curtains or privacy - within minutes of each other. The first baby had a urinary catheter pushed down its nose and throat to 'clear the airways' that did not need clearing. I asked the midwife (the only midwife on duty) to stop - the so called resucistation was very rough - the baby being held by its feet and in my opinion being hit rather hard. The second baby only had the urinary catheter pushed down its nose and mouth and was not subjected to rough handling. Both babies were not given to their mothers but put on tables in the delivery room where the twin mother was.
The third mother in the progress room - it was her first birth - witnessed the 2 births and looked terrified - no one reassurred her - I tried but she did not speak english and just looked terrified knowing she would be next. I understood there were 2 more women waiting in the courtyard in labour waiting to come in.
At this point I left.
Now that there is free healthcare for pregnant women, lactating women and under 5's - many women are coming to the Government Hospital when perhaps previously they would have birthed at home with TBA's. This is one way of stopping TBA practice but with only 95 midwives in Sierra Leone, births are being done by nurses, aides and others. There is a new Government Hospital being built - which is great - but without the staff to support all the births and provide a safer outcome - it is all going to take time. 60% of maternal and child health care is now free and the remaining 40% is provided by charities/faith hospitals - but they charge a small fee. I understand that these charity/faith hospitals are not busy now and one I know of is closing for a short period. If the charity/faith hospitals were paid to provide care - centrally - this would alleviate some of the pressure the Government Hospital are currently facing. The staff said they were exhausted - they have been on the go since the free health care was introduced on 27th April.
I will follow up the outcomes of the twin mother and the cesearian section mother when I next go to the Government Hospital.
The midwifery students return to classes 7th June.

Thursday, 27 May 2010

Antenatal clinic Government Hospital Makeni

I went to the Government Hospital in Makeni as an observer and to see how the student midwives I will be teaching are getting on in their placements. There were about 10 pregnant women all sitting on benches under a corregated roof with poles supporting the roof. The ages of the women were from probably about 11 or 12 to 30's. Some of the women do not know their birth date and so it is difficult to know quite how old some of the women are.
The antenatal clinic started with a short talk by one of the student midwives about looking after their health in pregnancy and caring for their baby afterwards. Looking for signs of infection, premature rupture of membranes, sexually transmitted diseases. The women are advised to plait their hair tightly - so as to prevent wee beasties making their homes.
This talk (no questions asked by the women)was followed by prayers - both christian and muslim - all women partook in both religous activities without any conflict.
The pregnant women had blood pressure taken and this was put on a small piece of paper, then the same happened regarding their weight - so by the time the women got to have their pregnant uterus palpated they had collected various bits of paper. These bits of paper with various recordings on them were then handed to a clerk who recorded the information in a large A4 size record book. Very scant information was held in the maternal records - which are held by the women.
The examination of the mother was I thought brusk - women are not asked permission to touch their bodies or thanked afterwards. No questions seem to be asked by the women - their abdomens are briefly palpated - many women do not know the date of their last period - so dates for when babies are expected - is quess work by using fundal height.
Twins are more prevelant here - but twins are not always seen as a joy as in the developed world. Sometimes a weaker twin does not survive beyond a few weeks if that long - many twins die at birth or one does not survive the birth - more about this in another installment.
Women are seen four times during pregnancy, they are tested for HIV, STI's and have tetanus and malarial treatment as a routine. Rhesus negative women are not given anti D and there is no test on the baby to see if it is rhesus positive.
Women do not appear to have any privacy, several student midwives, State Enrolled Child Health Nurses, nursing aides are all present whilst a women has her teashirt pulled up to check her breasts and her skirt pulled down to check presentation of the baby. Fetal hearts are listened into using a Pinnard's. A scan costs money - so generally women do not have scans. Most women are anaemic but at the moment I'm not sure of the uptake of iron tablets or how they are obtained.
Men do not figure in any of the antenatal care.
Women are however referred to medical care if there are any abnormal findings.
Urine is not tested unless there is a specific reason, blood pressure is taken and attention to hair, eyes, mouth and any lymph nodes around the neck are checked so too are the legs for any swelling. I'm not sure how much women know how to look for early pre-eclampsia signs in themselves.
Next installment - a day in the delivery unit.

Friday, 21 May 2010

I have moved house - again!

I have moved to my permanant address today! Two hours later than planned - but I am in Africa - at least the day was right. I was collected by 3 men in a pick up truck with all my stuff bundled into the back. Enroute we encountered a march through the street of primary school children complete with a brass band! The temperature that registered on some religous icon on the dashboard of the pick up truck said 46c - wow it felt like it too.
We went over some really rough terrain to get to my new accomodation. I don't even know the address of where I am living - I suppose it is over the back of the Midwifery School by the trees, pink house within a compound - that is walled with big metal security gates with coiled barbed wire all the way round.
The house is so much better than the previous temporary house - a distinct lack of cockroaches, no loud music that resonates through the walls, no constant smell of mariujana - which makes me feel sick!
I set to work cleaning the kitchen and bathroom to a standard that I can live with - it took all day - but I feel for the first time I can cook here.
I made a cup of 'instant' coffee - boiled the water in the shiny new kettle after I had put the gas connections together without blowing myself up!
There is limited furniture - I'm still living out of suitcases until a wardrobe arrives! There is a promise of some sort of bench/table in the kitchen to prepare food on and place the 2 burner hob on safely!
There is no electricty here but a need for a generator to pump water from the well into the storage tank - needless to say the water tank is nearly empty and I was looking forward to a day of washing clothes (by hand of course!) - but I will have to save the water for showers - as it is just so hot, damp and sweaty here.
I have bought a couple of small battery operated lanterns and have candles - that is my power supply. I can charge up my laptop, toothbrush and phone at the school - but only on week days - so if I use my computer too much - I am then without the outside world!
Tomorrow I will go to the market and buy some food stuffs now that I can cook on the 2 burner gas hob. I have got an African cookbook - all beans and rice - but it is very tasty stuff.
Who knows what I will eat tomorrow.
I worked in the Government Hospital Antenatal Clinic this week - I will tell you about this in another installment.

Tuesday, 11 May 2010

My first week in Makeni

I have been 'up country' as it is described in Selonian for a week. The climate is much hotter than Freetown which is on the west coast with atlantic seas. I have been at the Midwifery School since last Wednesday with my first teaching session on the female pelvis with 10 minutes to prepare!
The next day I worked with another midwifery tutor where we did some revision classes for student nurses doing their 'midwifery' module. We did the breast and the male reproductive organ - guess what I had to draw on the board!! Yep you guessed right.
I had a tour of 4 midwifery establishments and the Primary Health Department - which manages health for the Bombali district. Makeni is situated within this district.
Some hospitals are run by religious groups and some by the government. Government hospitals are providing free health care for women who are pregnant or lactating or both and children up to the age of 5. The faith based hospitals at present do not fall into the category of offering free health care - this may have some implications if women prefer to receive free health care in the government hospitals.
My accommodation is temporary and I am going to move to a bigger, cleaner house shortly.
I was woken at 4am by a cockroach hanging off my right wrist. I shone a torch on it and in its fear - it bit me - I have a wound to prove it. I sprayed it with insecticide - but it is not unusual to have 10 dead on the floor in the morning - I spray my room first thing in the morning. But this cockroach must have got into my mozzie net!!
I am learning to barter for goods/food in the markets. They are colourful and sell just about everything if you are prepared to take your time and ignore the crowds. There are really smellie fish markets and I have never seen so many flies!
I also get around using motorbike taxi's and as I have only once - aged 15 - been on the back of a bike - this is a bit of a novelty. I keep telling the drivers to go 'slow slow' but it does'nt make much difference. Still it saves a long hot walk to where I need to get to.
I have met a few other NGO's and VSOers and have been introduced to several other expats - all good fun!

Friday, 30 April 2010

I've been in Freetown for a week

Well it is hot and sticky and coming into the rainy season for the next 2 months. I have my leopard skin print wellies and a pink plastic mack and an umbrella in preparation. I was supposed to go to a concert - Akon - in Freetown but it was rained off - the rain was just amazing the the thunder and lightening electric. This was in Selonian 'small small' apparently the rain gets even heavier. But the fence were we live was washed down by the rains - how can it get even heavier?
I'm going to Makeni - my placement on Tuesday - this week is full of visitors - other VSOers/NGO's. I think the beach is where we will spend most time. They are just fantastic - like on the adverts - for those who watch adverts!!
I am learning how to hail a cab and negotiate a price - nothing has a price on it - it is all about bartering. I had a ride with 5 others in the cab - 3 in the front and three in the back - it was such a tight squash - but it got me to the government building where I was going to meet one of my housemates for lunch in the canteen. We ate a bean stew with unidentifyable meat, fish, beans and rice - it was really OK. But I eat most things and not fussy. This must be difficult for vegetarians.
I'm also getting used to sleeping under a mossie net, intermittent electricity, difficulties in accessing the internet and unable to download pictures as it is just too slow. Apologies everyone!! Having showers as I have never used showers before - I just prefer a soak in the bath. Washing my clothes by hand, having a strict 'kitchen hygiene regime'. I've never seen termites before - but now I have - they are in the flat I'm sharing!! Oh well.
I have been made so welcome by my flatmates, Carole, Fiona and Henning - this has contributed enormously to my adaptation within this new culture.

Monday, 26 April 2010

I have arrive in Sierra Leone

Well I have arrived in Sierra Leone. My flight took off as booked 23rd April. I am in Freetown until next week when I will be going 'up country' to Makeni.
What an exciting time to be in Sierra Leone - it is Independance Day tomorrow 27th April and already the party has started - I can hear all sorts of music, shouts and cars from the balcony where I am staying for the first week.
What is even better is that from tomorrow - all pregnant and lactating women and children up to the age of 5 will receive free healthcare. How amazing to be part of such a momentus change in history - I will just be a small part of these changes.
It is hot and humid as we await the rainy season which is just about to start. I have swum in the altantic sea at number 2 beach - I understand that the bounty or was it flake advert was filmed there - because it is so beautiful.
Life is hard here but the people are happy, friendly and cheerful. Freetown is a very colourful town.
Internet is slow and prone to problems - dont expect too many pictures!!

Thursday, 22 April 2010

Going to Sierra Leone

Hi, the dust has settled and I'm off tomorrow to Sierra Leone. More updates when I arrive.

Tuesday, 20 April 2010

Waiting to go - Icelandic volcanic dust permitting!

Well I'm getting finally organised - just back from France - and at this moment I do not know if the flight to Freetown, Sierra Leone is on or off this Friday 23rd April. I have got my flight ticket and am awaiting final instructions.
Hopefully my next blog will be from Sierra Leone to say I have arrived.

Friday, 26 March 2010

Monday, 15 March 2010

About to go to Sierra Leone

I am about to go to Sierra Leone as a Midwife teacher at Makeni University. I am going with VSO (Voluntary Services Overseas) initially for a year.
My flight is booked for 23rd April and I will update my blog whenever possible.
My fundraising website is open for anyone wishing to donate.