I have just got home from the hospital and the generator is on so it seems like a good time to write another blog entry – such a luxury to have the fan on! I got a lift back with Peter, who used to live at the base, and now rides an akada around Kambia. (The akada’s are the main way of getting from A to B here – small motorbike’s with cushions on the back for 1 or 2 passengers to sit on. Quite fun as long as you don’t think too much about how dangerous it is!)
It’s hard to believe I've been here nearly a month. We had a lovely weekend at Bureh Beach just over a week ago – camping right on the beach – about 2meters from the water at high tide! Fresh fish for dinner, met some Peace Corp and VSO volunteers working around Sierra Leone, attempted some surfing, learnt some poi, and lots of swimming – the water is so warm!
Back at the base, Lorraine arrived about two weeks ago so it’s been lovely having her here. She is a nurse practitioner from Inverness, it’s really great having her skills and ideas here too – especially since a lot of the teaching we’re doing is to nurses and nursing aides. She also bought some rock rings which we've hung from a mango tree at the base, and we've set up my slack line so getting some exercise! I've also bought a bike so we now have two at the base and have been on some nice leisurely evening rides.
And at the hospital, I've mainly been on the paediatric ward so far. The first week was pretty horrific but it seems to have settled down a bit since then. It’s really amazing seeing the children get better, a 3 year old child with malaria was admitted having a convulsion yesterday, the paediatric ward had no diazepam to treat the seizure, (this seems to be an ongoing issue), so we gave the only anticonvulsant available (IV phenobarbital), and treated for malaria and meningitis. She was unconscious for the rest of the day and I was convinced she wasn't going to wake up, but she was up eating a banana this morning!
Another memorable case was a two year old boy who was bought to the ward in severe respiratory distress, right sided chest signs, breathing really hard and really struggling, peripherally shut down. We gave him everything we could on the ward, but there is no oxygen, or electricity for the oxygen concentrator on the ward. We managed to persuade one of the staff members in the outpatients area (which has power through the day, as do the offices, but not the wards!) to let the mum come and sit with the child outside his office, so we could give the child oxygen for the rest of the day. Thankfully the child did really well, but unfortunately the oxygen concentrator seemed to cause a power surge and break all the phone chargers that were plugged into the same extension lead, so we've not been allowed to plug the oxygen concentrator in there since.
We work quite closely with the CHO’s (community health officers). There are four newly qualified CHO’s who are posted to the hospital, and basically provide the medical cover for the hospital, supported by the medical officer (doctor) and ourselves. They are all reasonably experienced but their training is much more limited than our medical training, so we feel we have plenty to teach them on the ward rounds, mostly really simple things, like feeling for a liver or spleen, or what to write in patient notes. They also teach us a lot too, about local conditions, and logistical aspects of care here.
The teaching is going well. The VNA (volunteer nurses) teaching is relatively straightforward, as they have no medical background and is very practical – it’s also really useful for us – learning how to explain things in simple language, and also some of the practical nursing skills like setting up a drip is something we don’t really do as junior doctors in UK. The nursing and CHO teaching is a bit more demanding, but motivates us to read lots about the topics for fear of looking stupid and not being able to answer their questions!
We are all a little apprehensive about a weekend training course we are running next weekend. It’s for a group called the Network for Rural Development, a local charity who, amongst other things, send volunteers to give health education talks in the local schools. Our course “training the trainers” is for the volunteers, teaching them how to teach/learning theory/develop training etc. A previous volunteer wrote the course, so we just have to present it, and Grace has prepared most of it. It’s all actually (surprisingly) really interesting and we've learnt all sorts of new powerpoint presentation tricks putting the slides together!
Finally, sadly, the puppies are gradually disappearing from the base L We hear some squealing and howling every so often and when we ask the boys what they are doing they say they are put them in a bag and take them away to “deposit them somewhere”!
And now it’s now time to watch Game of Thrones… I hope you are all well and surviving winter, the thought of even wearing a jumper has not entered my head since I arrived, and it’s not due to rain here until May!
Zoe
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