I have now been in Kambia just over a week! Thanks to my new phone and 3g internet connection is better than I was expecting so hopefully I’ll be able to keep up with the blog!
I’ve had a really warm welcome by everyone at the Kambia Appeal Base - a collection of huts and houses, surrounded by a straw fence, which is my home while I’m here. We share the base with Moses, the appeal co-ordinator, a couple of other families who also work for the appeal (+Bionce and her 3 puppies!). I have my own hut, and we use a big central house with a nice veranda to sit on, and a toukel - a round open sided thatched roofed building that is the main outdoor living space.
The hospital is a 10 minute walk from our base, through a maze of houses, banana, mango and palm trees, past some shops (small sheds or tables) selling bananas, oranges and basic supplies, then along a marram road. We are showered with dust each time a vehicle passes and the children (and some of the adults) shout excitedly “apoto, apoto” (white person) at us all the way!
The hospital has around 100 beds, and was re-built in 2003/4 after being destroyed during the civil war. There are 4 wards – male, female, paediatrics and maternity, a surgical theatre, 2-3 outpatient clinic rooms, and an under 5s clinic run by nurses. The wards have no electricity most of the time (the generator is usually on between 7-11pm, and can be switched on in an emergency), and limited running water (as far as I know there is a tap in maternity and the male ward).
This week I mainly shadowed Grace and Mary, who have been here since October and December, and have settled into the Kambia way of life! We have done ward rounds each morning on the male, female and paediatric wards, and help with any new admissions (usually paeds). When we are not around, the admissions are seen either by a CHO, (community health officer) who has 3 years training, and essentially work as doctors in the hospital, or the medical officer (doctor, but there is only one for the whole hospital). Paeds isn’t quite as frightening as I had expected, partly because we can do very little here, so if they’re sick they all basically get the same treatment. So I’m getting good at managing paediatric seizures, malaria, and malnutrition. Seeing these children presenting so unwell really makes me appreciate the importance of preventive medicine and primary care.
The adult wards are less busy, probably because people cannot afford to come to hospital, but it’s tricky trying to work out how best to manage patients without even being able to do an X-ray or basic blood tests.
The hospital has around 100 beds, and was re-built in 2003/4 after being destroyed during the civil war. There are 4 wards – male, female, paediatrics and maternity, a surgical theatre, 2-3 outpatient clinic rooms, and an under 5s clinic run by nurses. The wards have no electricity most of the time (the generator is usually on between 7-11pm, and can be switched on in an emergency), and limited running water (as far as I know there is a tap in maternity and the male ward).
This week I mainly shadowed Grace and Mary, who have been here since October and December, and have settled into the Kambia way of life! We have done ward rounds each morning on the male, female and paediatric wards, and help with any new admissions (usually paeds). When we are not around, the admissions are seen either by a CHO, (community health officer) who has 3 years training, and essentially work as doctors in the hospital, or the medical officer (doctor, but there is only one for the whole hospital). Paeds isn’t quite as frightening as I had expected, partly because we can do very little here, so if they’re sick they all basically get the same treatment. So I’m getting good at managing paediatric seizures, malaria, and malnutrition. Seeing these children presenting so unwell really makes me appreciate the importance of preventive medicine and primary care.
The adult wards are less busy, probably because people cannot afford to come to hospital, but it’s tricky trying to work out how best to manage patients without even being able to do an X-ray or basic blood tests.
Healthcare isn’t free here, which is difficult to get used to coming from the NHS. Although children under 5, and pregnant and lactating mothers are supposed to receive free healthcare, this often isn’t the case in reality- they still have to pay for every cannula (tube into vein for a drip/medications), and when the ‘free health’ cupboard runs out of medications, the family have to buy them from the hospital pharmacy or the local market. Selling medications and cannulas is also a way some of the volunteer nurses (untrained and unpaid) make some money, which you can’t blame them for.
After the morning rounds, we come back to the base for lunch, and this week have been teaching every afternoon. This is usually a team effort, which makes it a bit less daunting and more fun. Previous volunteers have set up regular teaching sessions for the volunteer nursing aides (VNAs) every Tuesday and Thursday afternoons - we started the paediatric module this week - identifying emergency signs and what to do about them. Other staff at the hospital are also eager to have some ongoing training, so we started weekly sessions for the CHOs and for the trained nurses this week, which were very well received. Grace and Mary are excellent teachers so I have a lot to live up to, but hopefully with their help I’ll manage!
Grace and Mary are teaching a first aid course to the local police this morning, they’ve run 3-4 already, and there will be many more so I decided to leave them to it today, I’ve done my washing and enjoying a lazy morning. Lorraine is joining us tomorrow which will be great, and we are planning a long weekend to the beach next weekend which we are all looking forward to! Kambia is a lovely place and with endless footpaths and walks but it will be good to get away and see some more of Sierra Leone!
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