Somewhere
Beyond the Barricades
22th September
POOOOOST!!!! I got a letter!! Me!! In
Kambia!! Guusje came to find me on my rounds last Tuesday waving a crumpled
green slip, much adorned with fancy stamps and reading, quite clearly, ‘Dr Kate
Wilkinson-please report to The Postmaster, Kambia Post Office, to receive one
letter.’ A small boy had been sent as a
runner to the hospital and had given the paper to the first ‘aporto’ he’d come
across…..hell, it works! Only took 28
days to traverse the seas from far-distant York (even the postmark was a thing
of wonder to this lonely exile….) That’s twenty-eight. Not twenty-nine,
twenty-eight. Ahem.
So that was all very exciting J Back at Kambia government Hospital we’ve had a few memorable cases
recently. One little lad came to us in a
terrible state, fitting uncontrollably.
He’d been comatose for the best part of a day by this point, but his
family, trusting to tradition, had brought him to the native healer rather than
the hospital. Well-I’m no expert on
traditional medicines-that I freely admit-but I do not and never will believe
that they can cure cerebral malaria, this being a very severe form affecting
the brain.
The next day found him deeply
unconscious-if anything his condition was slightly worse. A glance through his medication chart
revealed only ominous gaps where neat signatures should have traced the regular
life-saving injections of quinine and fluid. Crap. Cue stern remonstration with
nurses. Except that, midway through said
hand-wringing a rather strange fact came to light-mum had actually been hiding the drugs from the staff!
Basically, any adult patient (5 and over!) buys their meds at pharmacy and
keeps them in a plastic bag, usually under their pillow. The boy’s father had bought all the stuff the
day before so I knew it was there, but mum had been insisting otherwise to the
nurse doing the drug round. ‘What the
bejeezus?!’ I hear you cry, ‘why would she do that?’ Ah. The same reason she didn’t being him to
hospital in the first place. And the
reason she had neglected to sponge him down with water, keeping his fever from
burning out of control (turns out someone else’s Grandma had been doing
that). In fact, the very same reason she
was just gathering her few belongings together and preparing to take him
home. As far as she was concerned he was
already dead. He had a devil inside him and that was that-she was already
grieving. Well, what are you supposed to
say to that? Maybe a minute passed while
we sought to dissuade her, but the boy’s limp body, glistening with fever, gave
the lie to our hollow reassurances. His
heart was hammering desperately, frantically-you could see beating out it’s
final tattoo through his skinny ribs.
She didn’t believe us, couldn’t.
Looking down at his little body, I barely believed it myself. She picked him up to go. And then I quite clearly heard myself say,
“if you take him home he’ll die. But if
he stays here he’ll survive. Definitely this boy will not die if he
stays in hospital.” Nurse Esther
translated, I barely had time to think ‘oh, shit’, and then she placed her
first born child gently back down on the bed and looked up at us,
hopefully. Shit, shit, shit.
Obviously, as a doctor it’s never great to lie. False hope is one thing, but over and above
the purely humane element, I sensed that this particular lie had also put all
of ‘Western’ medicine, my medicine, on trial.
Would she trust the hospital next time around, would her sisters and the
other women of the village? Where would she take the infant presently swaddled
to her back when he got malaria (as he inevitably would)? ‘well’, I thought ‘at least we have this
window of opportunity. Maybe God (that’s
the God of Western Medicine, of course!) will smile on us.’ We bustled to reconnect the drips, I left
some very explicit instructions (most of which I ended up carrying out myself,
but I like to think of that as the ‘see one’ in the ‘see one, do one, teach
one’ educational model……:s) and moved on to the next patient. Out of the corner of my eye, I saw mum
quietly dip her cloth and bend to the little brow.
The boy lived. Two days later no fewer than
three of his family stopped me on my way to work -‘de pickin done better, doc.
Tenki, tenki!’ Still quite a moment
though, coming round the corner to see him sitting
on the bench outside the ward, eating a boiled egg! Children, eh? Remarkable creatures. And so that particular round of hoodoo Vs. quinine went to the quinine. Tash has also been trying to kibosh ‘country
medicine’, extracting promises from her patients to foreswear all ‘erbs in the future……we’ll see! I don’t want to sound like a git but these
bloody native herbs cause us docs nothing but bother-festering wounds, burns from hot poultices, bloated bellies
and-worst of all-crucial delays coming to hospital in the first place. Witness above. Hmmmm.
Victoria and James went to visit the traditional healer when they were
here. Maybe I should educate myself and
do likewise-know your enem……errrrr, I mean, ummm….not being a git and all it
would be, err, interesting to see it
from the other side. Yes, that’s
it. Ahem. Anyway, even Dr. Gitface here has to admit
that the hospital itself is hardly the shining beacon I would like it to be, so
maybe I should focus on getting my own house in order first.
The hospital itself bumbles along,
seemingly in permanent crisis mode.
We’ve had no more hospital staff meetings since week three and there’s
still no sign of a new medical superintendent.
The ward sisters have all been on strike over conditions and were
summoned to Freetown last week. They’re
back now but Matron won’t speak to them or go onto their wards-it’s dagger eyes
all round. KGH has also been in the
national press this week-scandal over the lack of oxygen and electricity for
the patients. It’s perhaps worth
mentioning that the management offices do
usually have electricity (fans!), at least for some of the day, but over on
paeds ward the oxygen concentrator has lain derelict for so long now that there
is RAT living INSIDE it. A rat.
Inside the oxygen concentrator.
Two feet from the children.
Apparently it isn’t really anyone’s job to deal with this so I’m off to
pharmacy tomorrow morning to try and source some warfarin. Not sure how I’ll get the ratta to eat the
warfarin-the only cheese here is Laughing Cow….do rats like Laughing cow? Let’s hope so-Le Rat Qui Mort! Ha!
I digress.
The most basic problem is, of course, money. Spondoolies, casheesh, dolla-whatever you
want to call it-there aint any. Money
done-done. Inquisitive souls that we
are, we’re trying to understand why this should be. And the more questions we ask, so the iceberg
starts to hove into view. It’s election
year-17th November to be precise.
Apparently, it’s quite common practice for foreign donors, the World
Bank etc. to tighten the purse strings around elections, keeping a steady hand
on the political pulse to ensure the next incumbent will continue to honour
agreements. And so the UNICEF feeding
program for malnourished kiddiwinks appears to be disintegrating. I can’t tell you how distressing this is-the
children need very specific fortified milk to recover and it just isn’t
there. They’re starving to death, quite
literally, before our eyes-little wizened old man faces atop ragdoll heaps of
skin and bone. Suzanne, bless her, has
spent literally hours this week organising crisis meetings, scrounging for
funds from local charities, designing a recipe to make substitute milk with
just the right blend of nutrients, teaching the ward staff how to mix it up…..
Despite every kind of red tape, excuse and set-back known to man (easily a
whole blog in itself), I think she has, finally, succeeded. It’s the strangest thing-I mean, these people
that we work with every day, they’re not bad
people-far from it! They don’t want
the kids to starve any more than we do-it’s just so difficult to understand
sometimes. By the way, if any of this
stuff sounds overtly judgemental, that’s not my intention-it’s as much a stream
of consciousness attempt at comprehension as anything.
It’s not just the aid money that’s dried
up, either-the hospital should receive a quarterly budget of government funds
from the district council-one payment and counting so far for 2012…..Elections
again, we think. The political
rallies-cum-late night raves are becoming more frequent now as candidates vie
for popular support, ‘political party’ seemingly a literal translation! And so we’re stuck on this merry-go-round
where most of the hospital ground staff don’t get paid a penny. It’s generally accepted that the paediatric
volunteer nurses can sell i.v. cannulas to the patients (everything else is
free), as the tiny ones we need are ‘never in stock’. I had thought this a form of permanent stop
gap (!) but a couple of weeks ago our fragile ecosystem was suddenly threatened
by a predatory influx of free cannulas for the children. As news of their arrival spread the ward
started to resemble the Marie Celeste-it did cross my mind that we might be
about to lose about 75% of our workforce-well, I don’t known many people who
would be willing and/or able to work for free, year in year out. Fortunately-I don’t know quite what happened-they
all started turning up for shifts again within just a few days. Turns out I might know one or two of those
people, after all….
And on that front, our teaching program for
the nurses is really starting to gather momentum now. We still have to round them up before each
session but these days all it takes is a cocked head and raised eyebrows before
they condescend to be shepherded, laughing, to the classroom. I was even admonished for being late to
teaching myself last week by Jariatsu (one of our more senior paeds VNAs)! It’s hard to appreciate day to day, but
looking back to when we first arrived, we’re all agreed that standards on the
wards have improved. For me, personally,
I think that this is the only way we’ll be able to make a lasting impact
here-the bureaucracy and higher workings (above ward level) are so impenetrable
that it’s going to have to come from the front line. Well, so be it.
Our Krio (the Salonean lingua franca) is
getting better small small as well. How
de pickin sleep? De body de warm? He de
shake so? He de cough, he de vomit, he get rum belleh? Repeat ad infinitum…. :) And I can now more or less do my paeds ward round in
Temne (the local tribal lingo) if needs be. Ha! Well, I say that, but what
actually tends to happen is that I’ll ask a question and the patient will just
look baffled, prompting the nurse to repeat exactly what I’ve just said with
some added attitude +/- volume. Hey presto! Patient understands perfectly and
trots out a reply which, although perfectly intelligible to me, still gets
‘translated’ back by the nurse. Still, I’m
getting there and everyone (else) generally seems to find it hilarious! Mende, Fulla, Susu, Maringo, Limba, however….
One rather surprising source of tuition has
been the local church-St. Augustine’s, if you please!! (not a particularly
well-known Saint, he was nonetheless also the patron of both my junior school
and childhood church back in Nottingham!)
The two incarnations are very different-drumming, clapping and
unfettered singing lend a wonderful rhythm to the mass here, and certainly the
offertory processions back home do not include dancing or bunches of pink
plastic flowers being waved aloft by the alter-servers! The sermon, delivered here in English by a
Polish priest, is never translated line for line into Krio, either (hence the
language lessons). Oh, and Jesus is
black here, naturally. So-a lot of
differences, but still, of course, essentially and eternally constant. It’s actually surprised me how comforting
I’ve found the church, and how grounding.
Yes, it reminds me of home and family but at the same time also why I’m
here, so far away from them. To see the
congregation colourfully but so carefully attired in their Sunday best, leaving
the struggles of daily life behind to exalt so joyfully, is to be gently
reminded to do likewise. Truly an
unlooked for source of strength.
Religion really is a big part of people’s
lives here. It doesn’t seem to matter
very much which one, exactly-in fact, Sierra Leone represents the closest
integration of Christians and Muslims that I’ve yet come across. ‘God is Allah’ is one popular slogan painted
on cars and buses, and they really do live cheek to cheek-even intermarriage is
common. You can’t even tell from
somebody’s name which book the read-Sister Agnes, for example, is a Muslim,
whereas our carpenter here at the base proudly declared himself to be ‘the only
Christian in the world called Mohammed!’ when we asked if he was off to Mosque
for Eid! This everyday tolerance just doesn’t
bear comparison with all the world news currently filtering through to us on
Aunty Beeb….
Right then, I think that’s quite enough for
now-bit of a bumper instalment this week!
Ovaltine and lesson planning await (!) so I’ll take my leave now if I
may. Loving you all,
Katie
Alleluia is my song, alleluia is my song. Whatsoever
comes tomorrow, alleluia is my song.
