Culture Shock - 28th August 2012

28^th August

Culture shock

Quick note: some sad stuff this week, guys, and a few graphic medical details.  Don’t want to catch anyone unawares.  x

Walking home today and, as usual, cries of ‘Aporto aporto wat ees yur nem? Aporto aporto snap me!!’* punctuate the buzz of village life. This is closely followed by a troupe of ecstatic toddlers who proceed to dangle from my every limb, a pantomime which has never failed to make me smile.  Today, however, is an unusually pensive day.

Work was the pits this week.  A new and all consuming crisis every day-total fire-fighting mode.  I can’t say I ever wanted to find myself yelling at people in the middle of the ward,  but when you’re running with a(nother) fitting child that you’ve just found in the far corner, watched by a flotilla of nurses  who move not one muscle to help you….

-Quickly!  We need diazepam, a cannula and a bolus of dextrose for starters, and where are the pickin’s notes?  (pickin=child)

- We haven’t got any dextrose

-Go and get some then!! Please hurry!

- But we haven’t got the key

-Either get the sister (keeper of the key) out of her house (opposite the ward) right this second! or go to the next ward and get some!! It’s really REALLY urgent! Where’s the diazepam??

-We’ve run out of diazepam. And needles.  And syringes.  

-Oh, really? Is there a hole in your ruddy bucket, too, by any chance? (Ok, so I didn’t actually say that.   Just thought it)

Nobody moves, nobody being   1 trained nurse, 3 final year nursing students and several nursing aides. Child continues to fit. All necessary items are within 50 yards of the spot, locked in a cupboard and you know this.  Everybody knows this.  It is common knowledge. 

- %&@@#!!**!*!!!!

 Arrgh!! Then you find out the child has been in hospital for almost a day, convulsing all the while, and has a) received no treatment and b) not been brought to your attention, despite very specific questioning brought on by yesterdays identikit experience.  It’s the strangest thing –you’re there working up a sweat over this kid, really panicking, but it’s like you’re the only one.  Guusje described it as feeling ‘so alone in your emotions,’ which I think is very apt.  Even so, I’m still a bit cross with myself for shouting like that- it’s hardly model professionalism now, is it?  But the worst bit has to be the sense of a chaos so all-consuming that it leaves neither time nor space to address the underlying issues-like I said, just fire-fighting.  The next day brings a man, a young man god love him, completely naked on the filthy stone floor, blood spurting from his guts in a terrible red-black tide of wasted life.  It’s beyond words, all you have to offer is a little comfort and dignity at the last.   And so it continues-a 10 year old boy came today.  Two months ago he fell from a mango tree and broke his back-now he’s paralysed from the waist down and has bed sores through to bone.  These have been freshly packed with herbs and dung by a traditional healer, so first and foremost I ask for the wounds to be cleaned. “No water,” comes the reply.  There is water, I know that, and so I insist.  But returning ten minutes later I find the boy’s father with a bucket of water, daubing at the sores with a filthy rag.  The nursing students (no qualified nurses on the ward) are sat by, texting and chatting.  Well, on one level, who the hell thinks it’s acceptable to staff a hospital with unsupervised students and untrained volunteers? But even so….  It’s as if the hospital exists to drive me mad and my sole job is to stay sane. Unstoppable force Vs immovable object? Ha! I’m definitely moving…

So now it’s Friday. I’m sloping home from work and I’m feeling the strain.  Looking around me it’s quite heartbreaking to see the vestiges of pre-war Sierra Leone.  Before the war Kambia had electricity and running water, a telephone box and working post office. Walk a hundred yards down any street in the old town and there are the ruins of the most beautiful houses, all colonnades and ornate verandas, now slipping inexorably towards a vine strangled and mossy oblivion.  These days the best on offer is tin-roofed concrete, though of course many people don’t even have that.  Our Appeal Base is a rare example of a house left standing-it was captured and used  by the rebels during the war, then subsequently by MSF in the immediate aftermath (it’s still called ‘old msf base’).  The former address is still just visible in faded paint above the door; ‘Kingdom Palace, 1, Sibikie Lane.’

Nobody talks about the war-can’t say I blame them, I don’t think I’d talk about it either if it were me.  It’s impossible to gauge, for example, how much the seemingly disjointed family structures are attributable to human losses.  Pretty much the first thing we all did when we got here was try and figure out a bit more about the war- causes, course, consequences etc.….  Well, I’ve read quite a few books now (A Long Way Gone by Ishmael Beah comes highly recommended) but it’s still a mystery to me how things spiralled into such horror.  I don’t think anyone really understands.

The upshot of all the above is that all week I’ve been oscillating furiously between, “oh my God, what the hell is wrong with these people??!” and, “shit, these people really have nothing…”   I mean, anyone who’s around my age must have lost virtually all of their education to the war for starters… But no, dammit!! They could still be doing such a better job of running that hospital! Sigh.  Factor in the emotional lability and basically I think this might be the culture shock we were warned about. I’m dealing.  We’re dealing together, Suzanne, Tasha and I.

Ok, just made a brew and read back through what I’ve written.  A grim picture indeed.  Had a bit of a think about whether to edit some of it out but decided against.  For better or worse, it is as it is.   I can’t quite leave it on such a negative note though, especially as the process of writing it all down has proved so cathartic.  There are a lot of people in that hospital who really care about the patients.  Whether it’s for want of knowledge or skills, extreme short-staffing or a lack of basic medical supplies, day to day work is not easy.   And it’s not true that there’s no time to try and tackle the issues-we started the Volunteer Nursing Aide training this week, after all.  Turnout was good and although it’s a bit daunting, at least it feels like we’re hacking at the root of the thing.  Quite fun, too, what with Suzanne’s  hand-wash- jive! CHO Barrie is another cause for optimism-the guy’s quite newly qualified and being asked to do a phenomenally difficult job (essentially 24/7) without any senior support.  Nightmare.  But his attitude is spot on, really he’s a joy to teach and to work with.  Barrie, if you’re reading this blog…just remember you’ll be a Clinical Beast by the end of it!!

So you see, it’s not all bad. Perhaps I can even muster a few light hearted anecdotes to end on……hmmmmm….well,  undoubtedly the best thing that’s happened in the last week was the rave that we had in the Toukel as a send off for James and Victoria. There was cake! There was gin! There was Fanta! There was dancing! (black good, white not so much- oh, except Tasha who pulled out some killer moves! ) There was more gin!! There was Aunty strutting to her song (‘Fatima’) and a circle dance to ‘African Queen’!!  Small totally rocked the circle dance!!  Guusje stole someone’s silly hat and headphones and wore them all night!!!  Heh J So that was all very jolly and compensated us somewhat for the pain of losing J&V.  What else? Oh, for weeks now Abbas has been obsessing over the ratta that’s been chop-chopping our food, displaying mangled bread rolls and chewed up plastic bags with a look of dismay so acute it’s almost comical.**  Well, not any more… coffee was interrupted this morning  by a gleeful Abbas swinging the wretched thing round by it’s tail. Dead as a door mouse (ahem).  He’d bludgeoned  it to death with his flip flop…. This Is Hardcore.

Back to the hospital-I managed to completely undermine myself and the very serious point I was making to Sister Agnes (paeds sister) when I caught sight of ‘Snakespeare live in Central Park’ picked out in gems on her T-shirt and promptly got a fit of the giggles. You don’t half see some rum things on clothes out here…..‘Ovarian Klein’ anyone?!  Suggestions on a postcard!  

Ooh, on a geeky note, I found an engorged argasid tick on the porch outside my room t’other day.  Hallo Ornithodorus!  First one I’ve seen ‘in the field’ so to speak, but after all my Dagnall training I’d recognise that bugger anywhere!  Slightly less cool-it’s highly likely that it’s recent blood meal came from me!! ……warned Tash and Suzanne about my impending tick-borne relapsing fever and left an advance directive NOT to be taken to Kambia Government Hospital under any circumstances….   but then remembered I’m on doxcycline anyway for malaria and calmed down a bit-I should be ok, right?

Bloody hell, the sudden influx of giant flying ants is actually beginning to really piss me off now, and one just got inside my pants(?!)  which is clearly gross, so I think I’ll have to leave it there for now and take refuge under my mozzy net.  

Goodnight my dearhearts, missing you all and hoping all goes well with you and yours,

Katie

x

*Oh light skinned one, please introduce yourself then be so kind as to take a photograph of me, preferably on a digital camera so I can view it with minimum delay. Be warned: I may quite simply explode in chubby legged, sticky-fingered excitement.

**There’s a rat in me kitchen, wat am me gonna do?!