Adrienne and Johan Melissen

October 25, 2008

Usually Joe writes the bog entries but I figured after almost two months of reading his entries you might be getting bored or tired of his jokes…

Today is Saturday and I must say that it feels as good here to have the weekend come as it does at home. One thing that is different though is that it is only 7:30 a.m. right now and I am up writing this letter. Those of you who know me can testify that I like to have a nice sleep-in on my days off, but Kabala is not a quiet town to say the least. Most people are up at the crack of dawn starting their daily work or saying Muslim prayers (many times into a megaphone- argggh!), and because daily life happens outside and there are no windows in houses, sound carries.

As Joe mentioned in the last entry we are really beginning to love life here. Almost everything we do is a new experience and this is now something I am really grateful for and trying to learn from. Working as a nurse in Sierra Leone is an experience that I think will impact my life forever. At this point, after only being here for two months, it’s difficult to put into words how exactly I am being impacted.

Right now, you could say my role here is quite varied. My time is mostly split between working at the clinic and the CRC Primary School of Kabala as the school nurse/“Assistant Minister of Health and Sanitation”. I quickly learned that the school doesn’t actually have a health and sanitation program so there is much work to be done. So far we’ve established a small “sick room” where the kids can go to get basic first aid and go when they are feeling unwell (it’s quite common during morning assembly for a couple kids to vomit- some feel better afterward and go back to school and some end up having fever, etc. and have to be taken home). In the near future I’m hoping to train a couple of the teachers in basic first aid so that at least the supplies in the first aid kit don’t look so foreign and get good use.

My first major task at the school has been setting them up with a hand washing system that is sustainable. The staff/student latrines are ready for operation but we want to get the hand washing supplies ready first. This sounds like an easy task, but it has been quite challenging designing an effective hand washing station from scratch with no running water hook-ups and limited available supplies. It’s kind of cool though because you are forced to become more resourceful here, which is something we could all use a lesson in… After the hand washing units are constructed, I’ll start with the germ/hand washing lessons to students, cooks, teachers, etc. JT (head master) tells me that the children will have to be shown how to use the toilets. Haha. Also, something really cool (I think) is that the class 3,4, and 5’s are going to be cleaning the toilets! It makes perfect sense, though, because a) there is no one else to do it, and b) it develops pride and respect for the bathrooms, a place that is often mistreated by the people who are not the one’s cleaning and caring for the facility. Plus, the kids here know how to work! Any time they see a way they can help, they more than love to help out. It’s great!
Working at the school was a job I was not expecting to have, but one that I am grateful for because it’s a nice balance to the clinic. Between the teachers and students there is such a positive, uplifting atmosphere, which I find very refreshing. Another really cool thing has been helping Joe with “Reading Club”. For now, this is a one-hour session two times per week with the five lowest readers in his class. These happen to be the five most adorable kids in Kabala who somehow love learning to read even though they struggle every step of the way…

The rest (and majority) of my time is spent at the clinic and in the community. It is impossible for me to describe everything I have experienced so far. I can say that I have seen how fragile life can be when you have no money and nobody to advocate for you. Before coming to SL, I did some research on health stats put out by the SL government and WHO. I was well aware that this country leads the way in having the highest maternal death rate and infant and child mortality rate, but reading stats on the computer doesn’t really prepare you for seeing it.

During the first couple weeks I was here I spent the day with a first time, young mother who came to the clinic early in the morning when her contractions became strong. We monitored her and her active fetus all day. I am not an expert in maternity nursing, but by mid afternoon I knew that things were not progressing as they should. The contractions were becoming further and further apart, so Theresa (our clinic midwife) and I decided she should be transferred to the government hospital for immediate treatment. If you can, imagine mounting the back of a motorcycle at 9 cm dilated after laboring for 8 hours with no medications. I was absolutely devastated to hear the following day that a stillborn baby was delivered by C-section at around 10:30 pm that night. This women and her husband were not seen or treated because they did not have enough money. By the grace of God, word got to a medical team working with CRS (Catholic Relief Services), but by the time they gathered their equipment, made arrangements with the hospital, and were finally able to do the procedure they were only able to save the mother’s life. As it turns out the cord was wrapped around this baby boy’s neck, which explained the signs of distress. The next week, an almost identical situation occurred again with a breach baby. Most people’s reactions here to this story are “Thanks be to God that the mother survived”. This is so true, yet it is not enough.

The reality of this country is that death is a part of life and it’s the children that are most vulnerable. Although my role is now changing somewhat at the clinic, I spent the last month screening and treating patients. Most of them are children under five years old. Malaria, acute respiratory track infections, worm parasites, and skin infections seem to be the most common problems amongst children, many of these illnesses made much worse due to initial malnutrition. One thing that strikes me over and over again is how much smaller in size generally the kids are compared to kids of the same age at home. I am finding that we treat most cases at the clinic because a) we can usually offer equal or better treatment unless the person needs more advanced treatment (e.g. blood transfusion for severe malaria) or b) parents refuse to take their children to the hospital because of a prior bad experience. It is not my intention to put down the government hospital, I am only stating what I have experienced. The hospital is doing many wonderful things (e.g. infant growth monitoring clinics, village outreach, etc.), however they have just reopened this year and are in the early stages of their development. As well, they are very understaffed only having one doctor and a few trained “sisters” (nurses).

When the kids come through the door at the clinic, you can spot the really sick ones instantly. I often think of the attention and treatment these kids would receive if they were brought into the emergency department at home. I also think of how if only I could have a couple of people from work back home help us out for the day we could take more time and care with each individual. Often these kids would benefit from IV’s or even just meticulous oral dehydration and medication administration, but presently we do not have the staff to do such things. Most of the time we just do a lot of teaching with the child’s caregiver and then send them on their way praying that what we have given is the right choice of treatment and that they will be ok. (On a side note… I think I have done more reading and research on diseases and treatment options than I have over the last couple years combined. If you don’t know already, there is an amazing book called “Where There is No Doctor” which, along with a few other handy books I took along, have been my Bible. However, many days I feel completely inadequate, and dream of one day having a doctor at the clinic). I try to always reiterate that if the patient is not responding to the prescribed treatment or their condition worsens over the next couple days, they need to come back! The clinic is hoping to hire some more nurses and possibly a medical officer in the near future, which I think will help out tons.

I guess word travels quickly in the community when a “white nurse” or even “doctor” lives in the area. It’s becoming a weekly occurrence that people will show up on my doorstep with various problems hoping that I can offer some sort of assistance. Most of the time I just tell them to come see me at the clinic because a) I am unable to get the full story because of language barrier and b) I obviously can not properly treat them from our house. One day last week, two of my wonderful neighbor ladies, Nali and Raggiatu, who I have developed a special relationship with, (mostly because their kids are at our house everyday to visit), came by while Joe and I were getting ready for work. I noticed that Nali had a young baby tied on her back that I didn’t recognize. She handed me a note that said, “This child’s mother is dead”. At first I thought she wanted me to adopt the girl, but I soon realized this child was not well. To make a long story short, this baby whose name is “Mariama”, was born to Nali’s older sister four months ago and her mother died shortly after. Nali received word from the village where her sister lived that if she could not come collect the baby she would die. Nali said she was only feeding her around 3 times per day. I think the baby was probably dehydrated and malnourished by the time Nali received her, but she was now running a high fever and not eating much at all. At the clinic we spent a lot of time teaching with them and were able to send them home with medications and formula. I have since been going to the house to check on things and help them with a feeding schedule.(Joe Here. Adrienne is understating the importance of her impact here. She bought them bottles, brought formula, and drew up a picture – feeding graph which told them when to feed Mariama according to where the sun is in they sky – she did really well and had an important impact) I was able to buy a bottle in Kabala and showed them exactly how to use and clean it. I fed Mariama with it for the first time- at first she had no idea how to suck, but literally within 5 minutes she was going to town and loved it! She cried when the bottle was finished. I find it hard to know exactly how much I should offer my input in situations like this because I do not want to interfere, but I find that if I don’t at least try, guilt and worry haunt me…

I don’t know what it was about this past week, but Mariama must have literally been one of ten orphan babies that I met personally. It is so sad because they almost always are underweight and more susceptible to illness because they are not receiving protection via breast milk, as well as often the new caregivers are too busy and poor to properly care for them. Like I said before, children are most vulnerable, but these babies who are not being breast fed are at even more risk… I’m sure you know what is coming next… As you can imagine, seeing these little ones (especially the girls who I know have an exceptionally challenging road ahead) in such a state and at my mercy was especially emotionally draining for me. There were two instances I can think of where if the mothers had have held out their baby and said, “Please take her” (something which has happened in other situations), I don’t think I could have refused. Being a woman, a nurse, and at that stage where having children is more of a reality, makes it difficult to resist. Don’t worry, when I talk about it with Joe he quickly gives me a reality check and offers some perspective… Still, it is something to think about.

Oh, there are many other stories… Also, this past week, JT asked me to go visit a CRC class one girl who had burned herself. Joe and I followed JT on the bike to her family’s house. Joe led the way as we rounded the back of the house, and as he approached I heard him mumble, “Oh-my-goodness”, and I knew it was bad. The burns covered her entire left arm and hand, her chest and abdomen and parts of her legs. She appeared to be somewhat comfortable and when I asked her if she had pain she said “no”. However, her mother said she doesn’t sleep and cries all night long. She had been receiving daily antibiotic injections and dressing changes from the hospital as an outpatient so I was at least pleased to hear that. However, she had removed most of the dressings because she said they were too hot. My main concern as I looked around the dirt yard with ashes falling all around from the fire, was that the burns would become infected. Unfortunately, there wasn’t too much I could do for them other than teaching and encouraging her to keep the dressing the hospital applied on and stay as clean as possible. I was also concerned about electrolyte imbalance and pain control seeing that the burns were so severe, so I gave them some ORS (oral re - hydration solution) and pain killers so she could sleep at night…

Anyway, this has been one of the more trying weeks here. I am learning to be patient with myself and not hold myself personally responsible for each suffering person I meet. There are too many. However, this is one of those constant struggles between what logic tells you and that of what your heart says. I also want to say, though, that for every tragic story, there is also a redemptive one in which God puts His healing hand over a small life and makes them well.

I know this is getting way too long. If my procrastinating personality hadn’t have been at it’s best, I would have written soon. I will try to write more frequent and brief entries in the future. I also want to say hi to everyone at home! It has been hard to be away these last couple weeks as many major life changes have occurred with our friends and family. Our thoughts and prayers are with you all!

Missing you always,

Adrienne