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.